Both behavioral treatment and drug therapy have been shown to be effective treatments for urge incontinence in older women, but neither has proven to be completely satisfactory for all patients. In this study, women who had completed treatment with either behavior training or drug therapy were treated with the alternative regimen to investigate the benefits of combination therapy.
One hundred ninety-seven mentally and physically competent women with at least two documented urge accidents per week and urodynamic evidence of bladder dysfunction served as study subjects. They were randomly assigned into one of three groups for treatment with behavioral training, drug therapy, or placebo (control subjects). All women were seen in the clinic every 2 weeks for 8 weeks and kept a daily bladder diary.
Behavioral training consisted of four sessions of biofeedback-assisted behavioral training for 8 weeks. Drug treatment was initiated with 2.5 mg TID of oxybutynin chloride, and this dosage was increased until satisfactory control was achieved. After completion of the first 8 weeks of treatment, women who had not obtained complete continence or who were not satisfied with the results of their treatment were offered the alternative regimen. The daily diaries indicated an 81 percent reduction in incontinence in the behavioral treatment group, a 69 percent reduction in the drug group, and a 39 percent reduction in the control group. Eight women (13 percent) who underwent behavior training added drug therapy to their regimen for an additional 8 weeks. In these patients, the reduction in incontinence improved from 58 percent to 89 percent (P = .034). Twenty-seven women (42 percent) in the drug therapy group added behavioral training to their treatment, and the reduction in incontinence improved from 73 percent to 84 percent (P = .001). Nineteen patients with a 59 percent incontinence reduction with drug treatment alone stopped drug treatment and underwent behavioral training alone. Reduction improved to 77 percent. More than half of the women in the placebo group (55 percent) underwent behavioral training after the first 8 weeks. The reduction in incontinence improved from 23 percent to 64 percent (P = .002) in this group. The 10 women who chose drug therapy achieved a 77 percent reduction of incontinence (P = .012).
J Am Geriatr Soc 2000;48:370–374