Urinary incontinence in nulliparous women aged 25‐64 years: a national survey The Effect of Behavioral Therapy on Urinary Incontinence: A Randomized Controlled Trial Efficacy of bladder training in older women with urinary incontinence. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Effectiveness of a new standardised Urinary Continence Physiotherapy Programme for community-dwelling older women in Hong Kong. An overactive bladder online self-management program with embedded avatars: a randomized controlled trial of efficacy. Effectiveness of continence promotion for older women via community organisations: a cluster randomised trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians. Understanding randomised controlled trials Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial. Minimal clinically important differences in Incontinence Quality-of-Life scores in stress urinary incontinence. The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial. Beyond incontinence: the stigma of other urinary symptoms. Ten-Year Prevalence and Incidence of Urinary Incontinence in Older Women: A Longitudinal Analysis of the Health and Retirement Study. Behavioural interventions for urinary incontinence in community-dwelling seniors: an evidence-based analysis. Help-seeking behaviour and associated factors among women with urinary incontinence in France, Germany, Spain and the United Kingdom. Outcomes of a Small Group Educational Intervention for Urinary Incontinence Surgery versus physiotherapy for stress urinary incontinence. A randomized trial of behavioral management for continence with older rural women. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial Effect of Group-Administered Behavioral Treatment on Urinary Incontinence in Older Women: A Randomized Clinical Trial Long-term effect of community-based continence promotion on urinary symptoms, falls and healthy active life expectancy among older women: cluster randomised trial Bladder Training and Kegel Exercises for Women with Urinary Complaints Living in a Rest Home
BACKGROUND : A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously . OBJECTIVE : The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant , nulliparous women , and thereby construct a reference group for comparisons with parous women . STUDY DESIGN : This postal and World Wide Web – based question naire survey was conducted in 2014 . The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25‐64 years . Four independent age‐stratified , r and om sample s comprising 20,000 women were obtained from the total number of eligible nullipara ( n = 625,810 ) . A 40‐item question naire about pelvic floor symptoms , its severity , and its consequences were used . Age‐dependent differences for various aspects of urinary incontinence were analyzed with the youngest group ( 25‐34 years ) serving as reference . Crude and body mass index – adjusted prevalence and its 95 % confidence limits were calculated for each 10‐year category . RESULTS : The response rate was 52 % and the number of study participants was 9197 . Urinary incontinence increased > 5‐fold from 9.7 % in the youngest women with a body mass index < 25 kg/m2 to 48.4 % among the oldest women with a body mass index ≥35 kg/m2 . The prevalence of bothersome urinary incontinence almost tripled from 2.8‐7.9 % among all nulliparas . The proportion with bothersome urinary incontinence among incontinent women increased from 24.4 % in the youngest age group to 32.3 % in the age group 55‐64 years . Nocturia ≥2/night increased 4‐fold to 17.0 % and leakage ≥1/wk increased 3‐fold to 12.8 % among the oldest women . Mixed urinary incontinence increased from 22.9‐40.9 % among the oldest 0‐para with incontinence , whereas stress urinary incontinence decreased inversely from 43.6‐33.0 % . In the total cohort surgical treatment for urinary incontinence occurred in 3 per thous and . CONCLUSION : Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25‐64 years . This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth OBJECTIVE To evaluate the effect of a low‐intensity behavioral therapy program on urinary incontinence in older women . METHODS A r and omized clinical trial for community‐dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted . Women were r and omly assigned to a behavioral therapy group ( n = 77 ) or a control group ( n = 75 ) . The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules . The control group received no instruction but kept urinary diaries for 6 weeks . After this period , the control group underwent the behavioral therapy protocol . Using per‐ protocol analyses , t and χ2 tests were used to compare the treatment and control groups , and paired t tests were used to evaluate the efficacy of behavioral therapy for all women ( treatment and control groups before and after behavioral therapy ) . RESULTS Women in the treatment group experienced a 50 % reduction in mean number of incontinent episodes recorded on a 7‐day urinary diary compared with a 15 % reduction for controls ( P = .001 ) . After behavioral therapy , all women had a 40 % decrease in mean weekly incontinent episodes ( P = .001 ) , which was maintained over 6 months ( P < .004 ) . Thirty ( 31 % ) women were 100 % improved ( dry ) , 40 ( 41 % ) were at least 75 % improved , and 50 ( 52 % ) at least 50 % improved . There were no differences in treatment efficacy by type of incontinence ( stress , urge , mixed ) or group assignment ( treatment , control ) . CONCLUSION A low‐intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first‐line treatment for urinary incontinence in older women The efficacy of bladder training was evaluated in a r and omized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence . Subjects were urodynamically categorized as those with urethral sphincteric incompetence ( N = 88 ) and those with detrusor instability with or without concomitant sphincteric incompetence ( N = 35 ) . Bladder training reduced the number of incontinent episodes by 57 % ; the effect was similar for both urodynamic diagnostic groups . The quantity of fluid loss was reduced by 54 % . This was greater for patients with detrusor instability than for those without it . Diurnal and nocturnal voluntary micturitions were also reduced . The effect on nocturnal micturition , however , was not observed in subjects with unstable detrusor function . It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence . Provided prior comprehensive clinical evaluation is done , it can be prescribed without the need for urodynamic characterization Importance Electroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence ( SUI ) , but evidence is limited . Objective To assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI . Design , Setting , and Participants Multicenter , r and omized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015 , with data collection completed in December 2015 . Interventions Participants were r and omly assigned ( 1:1 ) to receive 18 sessions ( over 6 weeks ) of electroacupuncture involving the lumbosacral region ( n = 252 ) or sham electroacupuncture ( n = 252 ) with no skin penetration on sham acupoints . Main Outcomes and Measures The primary outcome was change from baseline to week 6 in the amount of urine leakage , measured by the 1-hour pad test . Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary ( 72-hour incontinence episodes ) . Results Among the 504 r and omized participants ( mean [ SD ] age , 55.3 [ 8.4 ] years ) , 482 completed the study . Mean urine leakage at baseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group . Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group . At week 6 , the electroacupuncture group had greater decrease in mean urine leakage ( −9.9 g ) than the sham electroacupuncture group ( −2.6 g ) with a mean difference of 7.4 g ( 95 % CI , 4.8 to 10.0 ; P < .001 ) . During some time periods , the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 ( 95 % CI , 0.2 - 1.7 ; P = .01 ) , 2.0 episodes in weeks 15 to 18 ( 95 % CI , 1.3 - 2.7 ; P < .001 ) , and 2.1 episodes in weeks 27 to 30 ( 95 % CI , 1.3 - 2.8 ; P < .001 ) . The incidence of treatment-related adverse events was 1.6 % in the electroacupuncture group and 2.0 % in the sham electroacupuncture group , and all events were classified as mild . Conclusions and Relevance Among women with stress urinary incontinence , treatment with electroacupuncture involving the lumbosacral region , compared with sham electroacupuncture , result ed in less urine leakage after 6 weeks . Further research is needed to underst and long-term efficacy and the mechanism of action of this intervention . Trial Registration clinical trials.gov Identifier : NCT01784172 OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE To examine the effectiveness of a st and ardised Urinary Continence Physiotherapy Programme for older Chinese women with stress , urge , or mixed urinary incontinence . DESIGN A controlled trial . SETTING Six elderly community health centres in Hong Kong . PARTICIPANTS A total of 55 women aged over 65 years with mild-to-moderate urinary incontinence . INTERVENTIONS Participants were r and omly assigned to the intervention group ( n=27 ) where they received eight sessions of Urinary Continence Physiotherapy Programme for 12 weeks . This group received education about urinary incontinence , pelvic floor muscle training with manual palpation and verbal feedback , and behavioural therapy . The control group ( n=28 ) was given advice and an educational pamphlet on urinary incontinence . RESULTS There was significant improvement in urinary symptoms in the intervention group , especially in the first 5 weeks . Compared with the control group , participants receiving the intervention showed significant reduction in urinary incontinence episodes per week with a mean difference of -6.4 ( 95 % confidence interval , -8.9 to -3.9 ; t= -5.3 ; P<0.001 ) and significant improvement of quality of life with a mean difference of -3.93 ( 95 % confidence interval , -5.08 to -2.78 ; t= -6.9 ; P<0.001 ) measured by Incontinence Impact Question naire Short Form modified Chinese ( Taiwan ) version . The subjective perception of improvement , measured by an 11-point visual analogue scale , was markedly better in the intervention group ( mean , 8.7 ; st and ard deviation , 1.0 ; 95 % confidence interval , 8.4 - 9.1 ) than in the control group ( mean , 1.4 ; st and ard deviation , 0.7 ; 95 % confidence interval , 1.2 - 1.7 ; t=33.9 ; P<0.001 ) . The mean treatment satisfaction in the intervention group was 9.5 ( st and ard deviation , 0.8 ) as measured by an 11-point visual analogue scale . CONCLUSIONS This study demonstrated that the Urinary Continence Physiotherapy Programme was effective in alleviating urinary symptoms among older Chinese women with mild-to-moderate heterogeneous urinary incontinence OBJECTIVE To determine whether an avatar-based , online , self-management program is an effective therapeutic approach for women with overactive bladder ( OAB ) . OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life ( HRQOL ) . Behavioral interventions can produce substantial improvement in symptoms and HRQOL . Online education programs offer patients with OAB an alternative to face-to-face self-management instruction . Evidence suggests that avatars ( digital humans ) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors . METHODS In a 12-week , r and omized , controlled trial , women ( aged > 55 years ) with symptoms of OAB for at least 3 months were r and omized to 2 versions of a 3-part , online , self-management program . After collecting the baseline metrics , the intervention group viewed a generic avatar coach with a self-avatar peer mentor design ed to resemble the participant , and the control group viewed the identical online program with voice only . Participants viewed part 1 at week 1 and parts 2 and 3 at week 6 . Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1 , 6 , and 12 . RESULTS Forty-one women completed the study ( mean age = 61 years , st and ard deviation = 6 ) . The analysis of covariance of week-12 outcome measures with the baseline as covariates demonstrated significant improvements in the intervention group in OAB question naire HRQOL ( P = .02 ; large effect ) , 24-hour frequency ( P < .001 ; large effect ) , night-time urination ( P < .001 ; large effect ) , urgency ( P < .001 ; large effect ) , and urge incontinence ( P < .001 ; large effect ) . CONCLUSION An avatar-based intervention embedded into an online self-management program improved OAB HRQOL and symptoms in women Objectives The primary objective of this cluster r and omised controlled trial was to compare the effectiveness of the three experimental continence promotion interventions against a control intervention on urinary symptom improvement in older women with untreated incontinence recruited from community organisations . A second objective was to determine whether changes in incontinence-related knowledge and new uptake of risk-modifying behaviours explain these improvements . Setting 71 community organisations across the UK . Participants 259 women aged 60 years and older with untreated incontinence entered the trial ; 88 % completed the 3-month follow-up . Interventions The three active interventions consisted of a single 60 min group workshop on ( 1 ) continence education ( 20 clusters , 64 women ) ; ( 2 ) evidence -based self-management ( 17 clusters , 70 women ) ; or ( 3 ) combined continence education and self-management ( 17 clusters , 61 women ) . The control intervention was a single 60 min educational group workshop on memory loss , polypharmacy and osteoporosis ( 17 clusters , 64 women ) . Primary and secondary outcome measures The primary outcome was self-reported improvement in incontinence 3 months postintervention at the level of the individual . The secondary outcome was change in the International Consultation on Incontinence Question naire ( ICIQ ) from baseline to 3-month follow-up . Changes in incontinence-related knowledge and behaviours were also assessed . Results The highest rate of urinary symptom improvement occurred in the combined intervention group ( 66 % vs 11 % of the control group , prevalence difference 55 % , 95 % CI 43 % to 67 % , intracluster correlation 0 ) . 30 % versus 6 % of participants reported significant improvement respectively ( prevalence difference 23 % , 95 % CI 10 % to 36 % , intracluster correlation 0 ) . The number-needed-to-treat was 2 to achieve any improvement in incontinence symptoms , and 5 to attain significant improvement . Compared to controls , participants in the combined intervention reported an adjusted mean 2.05 point ( 95 % CI 0.87 to 3.24 ) greater improvement on the ICIQ from baseline to 3-month follow-up . Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of improvement in all intervention arms . Conclusions Continence education combined with evidence -based self-management improves symptoms of incontinence among untreated older women . Community organisations represent an untapped vector for delivering effective continence promotion interventions . Trial registration Clinical Trials.gov ID number NCT01239836 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES This study explored reasons why older adults with urinary incontinence ( UI ) do not initiate discussion s with or seek treatment for UI from their primary care provider . DESIGN A r and omized , prospect i ve controlled trial involving 41 primary care sites . SETTING Primary care practice sites . PARTICIPANTS 49 older adults age 60 and older not previously screened for UI by their primary care doctor . MEASUREMENTS Demographic data , self-reported bladder-control information using question naires , and health status . RESULTS Adults who did not discuss UI were older , had less-frequent leaking accidents and fewer nighttime voids and were less bothered by UI than those who did . The two main reasons why patients did not seek help were the perceptions that UI was not a big problem ( 45 % ) and was a normal part of aging ( 19 % ) . CONCLUSIONS Embarrassment or lack of awareness of treatment options were not significant barriers to discussing UI . Adults with a fairly high frequency of UI ( average of 1.7 episodes per day ) did not view UI as abnormal or a serious medical condition The hierarchy of evidence in assessing the effectiveness of interventions or treatments is explained , and the gold st and ard for evaluating the effectiveness of interventions , the r and omised controlled trial , is discussed . Issues that need to be considered during the critical appraisal of r and omised controlled trials , such as assessing the validity of trial methodology and the magnitude and precision of the treatment effect , and deciding on the applicability of research results , are discussed . Important terminologies such as r and omisation , allocation concealment , blinding , intention to treat , p values , and confidence intervals are explained CONTEXT Previous research on urge urinary incontinence has demonstrated that multicomponent behavioral training with biofeedback is safe and effective , yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy . OBJECTIVE To examine the role of biofeedback in a multicomponent behavioral training program for urge incontinence in community-dwelling older women . DESIGN Prospect i ve , r and omized controlled trial conducted from April 1 , 1995 , to March 30 , 2001 . SETTING University-based outpatient continence clinic in the United States . PATIENTS A volunteer sample of 222 ambulatory , nondemented , community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern . Patients were stratified by race , type of incontinence ( urge only vs mixed ) , and severity ( frequency of accidents ) . INTERVENTIONS Patients were r and omly assigned to receive 8 weeks ( 4 visits ) of biofeedback-assisted behavioral training ( n = 73 ) , 8 weeks ( 4 visits ) of behavioral training without biofeedback ( verbal feedback based on vaginal palpation ; n = 74 ) , or 8 weeks of self-administered behavioral treatment using a self-help booklet ( control condition ; n = 75 ) . MAIN OUTCOME MEASURES Reduction in the number of incontinence episodes as documented in bladder diaries , patients ' perceptions and satisfaction , and changes in quality of life . RESULTS Intention-to-treat analysis showed that behavioral training with biofeedback yielded a mean 63.1 % reduction ( SD , 42.7 % ) in incontinence , verbal feedback a mean 69.4 % reduction ( SD , 32.7 % ) , and the self-help booklet a mean 58.6 % reduction ( SD , 38.8 % ) . The 3 groups were not significantly different from each other ( P = .23 ) . The groups differed significantly regarding patient satisfaction : 75.0 % of the biofeedback group , 85.5 % of the verbal feedback group , and 55.7 % of the self-help booklet group reported being completely satisfied with treatment ( P = .001 ) . Significant improvements were seen across all 3 groups on 3 quality -of-life instruments , with no significant between-group differences . CONCLUSIONS Biofeedback to teach pelvic floor muscle control , verbal feedback based on vaginal palpation , and a self-help booklet in a first-line behavioral training program all achieved comparable improvements in urge incontinence in community-dwelling older women . Patients ' perceptions of treatment were significantly better for the 2 behavioral training interventions The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting OBJECTIVES To evaluate the effectiveness of pelvic floor muscle ( PFM ) and fitness exercises in reducing urine leakage in elderly women with stress urinary incontinence ( UI ) . DESIGN R and omized , crossover , follow-up trial . SETTING Urban community in Japan . PARTICIPANTS Seventy women aged 70 and older who reported urine leakage one or more times per month ; 35 were r and omly assigned to intervention and the other 35 to control . INTERVENTION The intervention group attended an exercise class aim ed at enhancing PFMs and fitness . Duration of the exercise was 60 minutes per session twice a week for 3 months . After 3 months of exercise , the intervention group was followed for 1 year . MEASUREMENTS Body mass index ( BMI ) , urine leakage , walking speed , and muscle strength were measured at baseline , after the intervention , and at follow-up . RESULTS In the intervention group , maximum walking speed and adductor muscle strength increased significantly after the intervention ; there were no significant changes in the control group . After 3 months of exercise , 54.5 % of the intervention group and 9.4 % of the control group reported being continent . Within the cured group of UI , a significantly higher proportion had decreased their BMI at 3 months ( P=.03 ) and increased walking speed at 3 ( P=.04 ) and 12 ( P=.047 ) months . CONCLUSION Decrease in BMI and increase in walking speed may contribute to the treatment of UI , although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI , which needs more research OBJECTIVES To determine the clinical ly relevant reference points for the Incontinence Quality of Life ( I-QOL ) question naire scores in women with stress urinary incontinence and compare them with the treatment effects observed with duloxetine and placebo . METHODS Using data from 1133 women with predominant stress urinary incontinence in two r and omized ,  placebo-controlled duloxetine  studies , the within-treatment and between-treatment minimal clinical ly important differences ( MCIDs ) were obtained by anchoring the I-QOL scores to the vali date d Patient Global Impression of Improvement scale ( PGI-I ) . The within-treatment MCID ( mean I-QOL for women rating their condition " a little better " with treatment ) and between-treatment MCID ( difference in scores between the group ratings of " no change " and " a little better " ) were derived . The treatment effects were compared with these MCIDs . Real-time urinary diaries were completed , along with the I-QOL and PGI-I. RESULTS The within-treatment and between-treatment MCID for the I-QOL total score was 6.3 and 2.5 , respectively . The total and subscale scores had almost identical MCIDs . Duloxetine 80 mg significantly improved the I-QOL total and subscale scores . Treatment differences in the I-QOL scores exceeded the between-treatment MCID and the duloxetine  I-QOL treatment effect exceeded the within-treatment MCID . The number of patients needed to treat to gain an additional I-QOL responder was 6.8 . CONCLUSIONS Improvements in I-QOL scores should be greater than the within-treatment MCID , and differences between two treatments should be greater than the between-treatment MCIDs , for statistically significant differences to be considered clinical ly meaningful . We propose 2.5 points as a reasonable guide for the I-QOL between-treatment MCID and 6.3 points for the within-treatment MCID BACKGROUND Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly . Pelvic floor exercise is effective in reducing stress urinary incontinence , but few studies have investigated the effect of behavioral management on urge and mixed incontinence . OBJECTIVES To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress , urge , and mixed urinary incontinence . DESIGN R and omized controlled , follow-up trial . SETTING S Urban community-based study . PARTICIPANTS 127 community-dwelling women aged 70 and older with stress , urge , and mixed urinary incontinence were r and omly assigned to the intervention ( n=63 ) or the control group ( n=64 ) . METHODS Urine leakage and fitness data were collected at baseline , and after the intervention and follow-up . The intervention group received a multidimensional exercise treatment twice a week for 3-month . After treatment , the participants were followed for 7-month . RESULTS There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups . The intervention group showed urine leakage cure rates of 44.1 % after treatment and 39.3 % after follow-up ( χ(2)=21.96 , p<0.001 ) ; whereas , the control group showed no significant improvement . The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence . However , the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence . At the 7-month follow-up , while cure rates of all three types of urinary incontinence were significantly maintained , a slight reversal was seen only in the urge and mixed urinary incontinence ( χ(2)=10.28 , p=0.008 ) . According to the logistic regression model , urine leakage volume ( adjusted odds ratio OR=0.69 , 95 % confidence interval CI=0.39 - 0.98 ) , compliance ( OR=1.03 , 95%CI=1.01 - 1.16 ) , and BMI reduction ( OR=0.67 , 95%CI=0.48 - 0.89 ) were significantly associated with the cure of urine leakage after intervention . The cure rate of urine leakage after the follow-up was significantly associated with compliance ( OR=1.13 , 95%CI=1.02 - 1.29 ) and BMI reduction ( OR=0.78 , 95%CI=0.60 - 0.96 ) . CONCLUSIONS The intervention group showed higher urine leakage cure rates than control group . This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence . BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment AIM This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals . BACKGROUND Lower urinary tract symptoms , including frequency , urgency and incontinence , are susceptible to stigma , but previous stigma research has focused almost exclusively on incontinence . METHOD The Boston Area Community Health Survey is a population -based , r and om sample epidemiological survey of urologic symptoms ( N = 5503 ) . Qualitative data for this study came from in-depth interviews conducted between 2007 and 2008 with a r and om sub sample of 151 black , white and Hispanic men and women with urinary symptoms . FINDINGS Respondents reported stigma associated with frequency and urgency - not just incontinence . The stigma of frequency/urgency is rooted in social interruption , loss of control of the body , and speculation as to the nature of a non-specific ' problem ' . Overall , the stigma of urinary symptoms hinged upon whether or not the problem was ' perceptible ' . Men felt stigmatized for making frequent trips to the bathroom and feared being seen as impotent . Women feared having an unclean body or compromised social identity .  Hispanic people in particular voiced a desire to keep their urinary symptoms a secret . CONCLUSION The stigma of urinary symptoms goes beyond incontinence to include behaviours associated with frequency and urgency . Healthcare practitioners should assess for stigma sequelae ( e.g. anxiety , depression ) in individuals with frequency and urgency , and stress treatment options to circumvent stigmatization OBJECTIVES To measure the incidence of urinary incontinence ( UI ) over 10 years in older women who did not report UI at baseline in 1998 , to estimate the prevalence of female UI according to severity and type , and to explore potential risk factors for development of UI . DESIGN Secondary analysis of a prospect i ve cohort . SETTING Health and Retirement Study . PARTICIPANTS Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline ( 1998 ) . MEASUREMENTS UI was defined as an answer of " yes " to the question , " During the last 12 months , have you lost any amount of urine beyond your control ? " UI was characterized according to severity ( according to the S and vik Severity Index ) and type ( according to International Continence Society definitions ) at each biennial follow-up between 1998 and 2008 . RESULTS In 1998 , 5,552 women aged 51 to 74 reported no UI . The cumulative incidence of UI in older women was 37.2 % ( 95 % confidence interval (CI)=36.0 - 38.5 % ) . The most common incontinence type at the first report of leakage was mixed UI ( 49.1 % , 95 % CI=46.5 - 51.7 % ) , and women commonly reported their symptoms at first leakage as moderate to severe ( 46.4 % , 95 % CI=43.8 - 49.0 % ) . CONCLUSION Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms UNLABELLED In early August 2007 , the Medical Advisory Secretariat began work on the Aging in the Community project , an evidence -based review of the literature surrounding healthy aging in the community . The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry 's newly released Aging at Home Strategy .After a broad literature review and consultation with experts , the secretariat identified 4 key areas that strongly predict an elderly person 's transition from independent community living to a long-term care home . Evidence -based analyses have been prepared for each of these 4 areas : falls and fall-related injuries , urinary incontinence , dementia , and social isolation . For the first area , falls and fall-related injuries , an economic model is described in a separate report . Please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html , to review these titles within the Aging in the Community series . AGING IN THE COMMUNITY : Summary of Evidence -Based AnalysesPrevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors : An Evidence -Based Analysis Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors : An Evidence -Based Analysis Caregiver- and Patient-Directed Interventions for Dementia : An Evidence -Based Analysis Social Isolation in Community-Dwelling Seniors : An Evidence -Based Analysis The Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over ( FEMOR ) OBJECTIVE : To assess the effectiveness of behavioural interventions for the treatment and management of urinary incontinence ( UI ) in community-dwelling seniors . CLINICAL NEED TARGET POPULATION AND CONDITION Urinary incontinence defined as " the complaint of any involuntary leakage of urine " was identified as 1 of the key predictors in a senior 's transition from independent community living to admission to a long-term care ( LTC ) home . Urinary incontinence is a health problem that affects a substantial proportion of Ontario 's community-dwelling seniors ( and indirectly affects caregivers ) , impacting their health , functioning , well-being and quality of life . Based on Canadian studies , prevalence estimates range from 9 % to 30 % for senior men and nearly double from 19 % to 55 % for senior women . The direct and indirect costs associated with UI are substantial . It is estimated that the total annual costs in Canada are $ 1.5 billion ( Cdn ) , and that each year a senior living at home will spend $ 1,000 to $ 1,500 on incontinence supplies . Interventions to treat and manage UI can be classified into broad categories which include lifestyle modification , behavioural techniques , medications , devices ( e.g. , continence pessaries ) , surgical interventions and adjunctive measures ( e.g. , absorbent products ) . The focus of this review is behavioural interventions , since they are commonly the first line of treatment considered in seniors given that they are the least invasive options with no reported side effects , do not limit future treatment options , and can be applied in combination with other therapies . In addition , many seniors would not be ideal c and i date s for other types of interventions involving more risk , such as surgical measures . NOTE It is recognized that the terms " senior " and " elderly " carry a range of meanings for different audiences ; this report generally uses the former , but the terms are treated here as essentially interchangeable . DESCRIPTION OF TECHNOLOGY/THERAPY Behavioural interventions can be divided into 2 categories according to the target population :  caregiver-dependent techniques and patient-directed techniques . Caregiver-dependent techniques ( also known as toileting assistance ) are targeted at medically complex , frail individuals living at home with the assistance of a caregiver , who tends to be a family member . These seniors may also have cognitive deficits and /or motor deficits . A health care professional trains the senior 's caregiver to deliver an intervention such as prompted voiding , habit retraining , or timed  voiding . The health care professional who trains the caregiver is commonly a nurse or a nurse with advanced training in the management of UI , such as a nurse continence advisor ( NCA ) or a clinical nurse specialist ( CNS ) . The second category of behavioural interventions consists of patient-directed techniques targeted towards mobile , motivated seniors . Seniors in this population are cognitively able , free from any major physical deficits , and motivated to regain and /or improve their continence . A nurse or a nurse with advanced training in UI management , such as an NCA or CNS , delivers the patient-directed techniques . These are often provided as multicomponent interventions including a combination of bladder training techniques , pelvic floor muscle training ( PFMT ) , education on bladder control strategies , and self-monitoring . Pelvic floor muscle training , defined as a program of repeated pelvic floor muscle contractions taught and supervised by a health care professional , may be employed as part of a multicomponent intervention or in isolation . Education is a large component of both caregiver-dependent and patient-directed behavioural interventions , and patient and /or caregiver involvement as well as continued practice strongly affect the success of treatment . Incontinence products , which include a large variety of pads and devices for effective containment of urine , may be used in conjunction with behavioural techniques at any point in the patient 's management . EVIDENCE -BASED ANALYSIS METHODS A comprehensive search strategy was used to identify systematic review s and r and omized controlled trials that examined the effectiveness , safety , and cost-effectiveness of  caregiver-dependent and patient-directed behavioural interventions for the treatment of UI in community-dwelling seniors ( see Appendix 1 ) . RESEARCH QUESTIONS Are caregiver-dependent behavioural interventions effective in improving UI in medically complex , frail community-dwelling seniors with/without cognitive deficits and /or motor deficits?Are  patient-directed behavioural interventions effective in improving UI in mobile , motivated community-dwelling seniors?Are behavioural interventions delivered by NCAs or CNSs in a clinic setting effective in improving incontinence outcomes in community-dwelling seniors ? ASSESSMENT OF QUALITY OF EVIDENCE The quality of the evidence was assessed as high , moderate , low , or very low according to the GRADE methodology and GRADE Working Group . As per GRADE the following definitions apply : HighFurther research is very unlikely to change confidence in the estimate of effect . ModerateFurther research is likely to have an important impact on confidence in the estimate of effect and may change the estimate . LowFurther research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate . Very LowAny estimate of effect is very uncertain SUMMARY OF FINDINGS Executive Summary Table 1 summarizes the results of the analysis . The available evidence was limited by considerable variation in study population s and in the type and severity of UI for studies examining both caregiver-directed and patient-directed interventions . The UI literature frequently is limited to reporting subjective outcome measures such as patient observations and symptoms . The primary outcome of interest , admission to a LTC home , was not reported in the UI literature . The number of eligible studies was low , and there were limited data on long-term follow-up . Executive Summary Table 1 : Summary of Evidence on Behavioural Interventions for the Treatment of Urinary Incontinence in Community-Dwelling SeniorsInterventionTarget Population Interventions Conclusions GRADE quality of the evidence 1 . Caregiver-dependent techniques ( toileting assistance)Medically complex , frail individuals at home with/without cognitive deficits and /or motor deficitsDelivered by informal caregivers who are trained by a nurse or a nurse with specialized UI training (NCA/CNS)Prompted voidingHabit retrainingTimed voidingThere is no evidence of effectiveness for habit retraining ( n=1 study ) and timed voiding ( n=1 study ) .Prompted voiding may be effective , but effectiveness is difficult to substantiate because of an inadequately powered study ( n=1 study ) .Re source implication s and caregiver burden ( usually on an informal caregiver ) should be considered . Low2 . Patient-directed techniquesMobile , motivated seniorsDelivered by a nurse or a nurse with specialized UI training (NCA/CNS)Multicomponent  behavioural interventions Include a combination ofBladder trainingPFMT ( with or without biofeedback)Bladder control strategiesEducationSelf-monitoringSignificant  reduction in the mean number of incontinent episodes per week ( n=5 studies , WMD 3.63 , 95 % CI , 2.07 - 5.19)Significant improvement in patient 's perception of UI ( n=3 studies , OR 4.15 , 95 % CI , 2.70 - 6.37)Suggestive beneficial impact on patient 's health-related quality of lifeModerate PFMT aloneSignificant reduction in the mean number of incontinent episodes per week ( n=1 study , WMD 10.50 , 95 % CI , 4.30 - 16.70)Moderate3 . Behavioural interventions led by an NCA/CNS in a clinic setting Community-dwelling seniorsBehavioural interventions led by NCA/CNSOverall , effective in improving incontinence outcomes ( n=3 RCTs + 1 Ontario-based before/after study ) Moderate*CI refers to confidence interval ; CNS , clinical nurse specialist ; NCA , nurse continence advisor ; PFMT , pelvic floor muscle training ; RCT , r and omized controlled trial ; WMD , weighted mean difference ; UI , urinary incontinence . ECONOMIC ANALYSIS A budget impact analysis was conducted to forecast costs for caregiver-dependent and patient-directed multicomponent behavioural techniques delivered by NCAs , and PFMT alone delivered by physiotherapists . ( ABSTRACT TRUNCATED OBJECTIVES To assess the proportion of women who consult their doctor about urinary incontinence ( UI ) , and explore factors associated with help-seeking in France , Germany , Spain and the UK . METHODS A representative sample of 29,500 women received a 13 item postal question naire to identify those with UI . A r and omly selected sub- sample of 2953 women with UI received a more detailed follow-up question naire . RESULTS There was a response rate of 58 % in the initial survey and 53 % in the second . Thirty-one percent of all women had consulted a doctor about their UI symptoms with more women consulting in France and Germany than in the UK and Spain . A number of factors relating to general health care , UI and women 's attitudes were found to be associated with help-seeking after adjusting for women 's age , UI duration and frequency , and ' bothersomeness ' of UI ; factors traditionally associated with help-seeking . After adjusting for these factors , willingness to take long-term medication and having spoken to others about UI were found to be strong predictors of help-seeking in all four countries Objectives : This community-based intervention to reduce urinary incontinence ( UI ) in elderly women used a small group educational approach . This article reports on change in episodes of incontinence and other urinary symptoms . Methods : Participants were r and omly assigned to intervention orwait control condition .  This article is restricted to 49 intervention and 59 control participants with acceptable diaries . Results : There was a significant treatment effect for a number of incontinent episodes . In the intervention group , 61 % had a 50 % or greater reduction in episodes , with more than one third having 100 % reduction ; 38 % of the control group had a reduction of 50 % or greater . One year postprogram , 75 % of treated women reported subjective improvement . Therewas a reduction in frequency of daily , but not nocturnal , micturition . Discussion : This community-based intervention is an encouraging option for behavioral treatment of UI . Public health models may be particularly appropriate with moderate levels of urinary incontinence BACKGROUND Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence ;  midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful . Data are lacking from r and omized trials comparing these two options as initial therapy . METHODS We performed a multicenter , r and omized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence . Crossover between groups was allowed . The primary outcome was subjective improvement , measured by means of the Patient Global Impression of Improvement at 12 months . RESULTS We r and omly assigned 230 women to the surgery group and 230 women to the physiotherapy group . A total of 49.0 % of women in the physiotherapy group and 11.2 % of women in the surgery group crossed over to the alternative treatment . In an intention-to-treat analysis , subjective improvement was reported by 90.8 % of women in the surgery group and 64.4 % of women in the physiotherapy group ( absolute difference , 26.4 percentage points ; 95 % confidence interval [ CI ] , 18.1 to 34.5 ) . The rates of subjective cure were 85.2 % in the surgery group and 53.4 % in the physiotherapy group ( absolute difference , 31.8 percentage points ; 95 % CI , 22.6 to 40.3 ) ; rates of objective cure were 76.5 % and 58.8 % , respectively ( absolute difference , 17.8 percentage points ; 95 % CI , 7.9 to 27.3 ) . A post hoc per- protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery . CONCLUSIONS For women with stress urinary incontinence , initial midurethral-sling surgery , as compared with initial physiotherapy , results in higher rates of subjective improvement and subjective and objective cure at 1 year . ( Funded by ZonMw , the Netherl and s Organization for Health Research and Development ; Dutch Trial Register number , NTR1248 . ) Urinary incontinence ( UI ) is a commonly underreported and underdiagnosed condition . The purpose of this trial was to implement and evaluate behavioral management for continence ( BMC ) , an intervention to manage symptoms of UI with older rural women in their homes . Participants were r and omized into BMC or a control group , and 178 were followed for between 6 and 24 months . The intervention involved self-monitoring , bladder training , and pelvic muscle exercise with biofeedback . The primary outcome variable-severity of urine loss-was evaluated by pad test . Secondary variables were episodes of urine loss , micturition frequency , voiding interval , quality of life , and subjective report of severity . Urine loss severity at baseline evaluation was not significantly different in the two groups . But using the generalized linear mixed model analysis , at the four follow-ups , severity of urine loss , episodes of urine loss , quality of life , and subjective report of severity were significantly different . At 2 years the BMC group UI severity decreased by 61 % ; the control group severity increased by 184 % . Self-monitoring and bladder training accounted for most of the improvement . The results support the use of simple strategies based on bladder diaries before implementing more complex treatments We compared telemedicine with a conventional outpatient continence service ( CS ) in community-dwelling older women with urge or stress incontinence . After an initial biofeedback-assisted pelvic floor muscle training session , subjects were r and omized to behavioural training for eight weeks via the CS ( n = 27 ) or a telemedicine continence programme ( TCP ) ( n = 31 ) . Participants in both treatment groups experienced significant improvement in their symptoms , namely , a reduction in the number of daily incontinence episodes ( P<0.001 ) and voiding frequency ( P<0.001 ) , while the volume of urine at each micturition increased ( P<0.005 ) . Pelvic floor muscle strength as measured by the Oxford Score also improved ( P<0.005 ) . There were no significant differences in outcomes between the two groups . Thus our findings suggest that videoconferencing is as effective as conventional methods in the management of urinary incontinence Importance Urinary incontinence ( UI ) guidelines recommend behavioral interventions as first-line treatment using individualized approaches . A one-time , group-administered behavioral treatment ( GBT ) could enhance access to behavioral treatment . Objective To compare the effectiveness , cost , and cost-effectiveness of GBT with no treatment for UI in older women . Design , Setting , and Participants Multisite r and omized clinical trial ( the Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms [ GLADIOLUS ] study ) , conducted from July 7 , 2014 , to December 31 , 2016 . The setting was outpatient practice s at 3 academic medical centers . Community-dwelling women 55 years or older with UI were recruited by mail and screened for eligibility , including a score of 3 or higher on the International Consultation on Incontinence Question naire – Short Form ( ICIQ-SF ) , symptoms of at least 3 months ’ duration , and absence of medical conditions or treatments that could affect continence status . Of 2171 mail respondents , 1125 were invited for clinical screening ; 463 were eligible and r and omized ; 398 completed the 12-month study . Interventions The GBT group received a one-time 2-hour bladder health class , supported by written material s and an audio CD . Main Outcomes and Measures Outcomes were measured at in-person visits ( at 3 and 12 months ) and by mail or telephone ( at 6 and 9 months ) . The primary outcome was the change in the ICIQ-SF score . Secondary outcome measures assessed UI severity , quality of life , perceptions of improvement , pelvic floor muscle strength , and costs . Evaluators were masked to group assignment . Results Participants ( 232 in the GBT group and 231 in the control group ) were aged 55 to 91 years ( mean [ SD ] age , 64 [ 7 ] years ) , and 46.2 % ( 214 of 463 ) were African American . In intent-to-treat analyses , the ICIQ-SF scores for GBT were consistently lower than control across all time points but did not achieve the projected 3-point difference . At 3 months , the difference in differences was 0.96 points ( 95 % CI , −1.51 to −0.41 points ) , which was statistically significant but clinical ly modest . The mean ( SE ) treatment effects at 6 , 9 , and 12 months were 1.36 ( 0.32 ) , 2.13 ( 0.33 ) , and 1.77 ( 0.31 ) , respectively . Significant group differences were found at all time points in favor of GBT on all secondary outcomes except pelvic floor muscle strength . The incremental cost to achieve a treatment success was $ 723 at 3 months ; GBT dominated at 12 months . Conclusions and Relevance The GLADIOLUS study shows that a novel one-time GBT program is modestly effective and cost-effective for reducing UI frequency , severity , and bother and improving quality of life .  Group-administered behavioral treatment is a promising first-line approach to enhancing access to noninvasive behavioral treatment for older women with UI . Trial Registration Clinical Trials.gov identifier : Abstract Background The long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence , falls and healthy life expectancy remains unknown . Methods A pragmatic cluster r and omised trial was conducted among 909 women aged 65–98 years with urinary incontinence , recruited from 377 community organisations in the UK , Canada and France . A total of 184 organisations were r and omised to an in-person 60-min incontinence self-management workshop ( 461 participants ) , and 193 to a control healthy ageing workshop ( 448 participants ) . The primary outcome was self-reported incontinence improvement at 1-year . Falls and gains in health utility were secondary outcomes . Results A total 751 women , mean age 78.0 , age range 65–98 completed the trial ( 83 % ) . At 1-year , 15 % of the intervention group versus 6.9 % of controls reported significant improvements in urinary symptoms , ( difference 8.1 % , 95 % confidence intervals ( CI ) 4.0–12.1 % , intracluster correlation 0.04 , number-needed-to-treat 13 ) and 35 % versus 19 % reported any improvement ( risk difference 16.0 % , 95 % CI 10.4–21.5 , number-needed-to-treat 6 ) . The proportion of fallers decreased from 42 % to 36 % in the intervention group ( −8.0 % , 95 % CI −14.8 – −1.0 ) and from 44 % to 34 % in the control group ( −10.3 % , 95 % CI −17.4 – −3.6 ) , no difference between groups . Both intervention and control groups experienced a gain in health utility ( 0.022 points ( 95 % CI 0.005–0.04 ) versus 0.035 ( 95 % CI 0.017–0.052 ) , respectively ) , with no significant difference between groups . Conclusion Community-based group continence promotion achieves long-term benefits on older women ’s urinary symptoms , without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop Background : Urinary incontinence is an annoying , uncomfortable and unpleasant condition affecting the elderly . The problem of bedwetting and other urinary complaints are common in rest homes . Objective : Our study aim ed to determine the efficiency of bladder training and Kegel exercises for older women living in a rest home . Methods : This is an experimental prospect i ve research study . Through a r and omization process , 25 women were included in the treatment group , and another 25 were included in the control group . Participants were living in a rest home for women aged older than 65 years with urinary complaints . The pretreatment interview form , Quality of Life Scale , Mini-Mental Test , Rankin Scale , daily urinary forms and pad tests were administered to the treatment and control groups . Bladder training and Kegel exercises were given to the treatment group for 6–8 weeks . The second evaluation was performed 8 weeks after treatment , and the last evaluation was carried out 6 months after treatment . Results : The average age of the treatment group was 78.88 ± 4.80 years , and the average age of the control group 79.44 ± 5.32 years . Urgency , frequency and nocturia were common complaints . Pretreatment , 8-week and 6-month evaluations revealed that the amount of urinary incontinence with urgency , frequency and nocturia complaints statistically and significantly decreased in the treatment group compared to the control group . In the pad test results , a statistically significant decrease was observed in the treatment group compared to the control group . A significant increase in pelvic floor strength was observed in the treatment group compared to the control group upon all evaluations . Conclusion : Behavioral therapy can be used easily as an effective treatment for urinary incontinence in elderly women living at a rest home
Objective To synthesis e the evidence for the multifaceted self-management interventions for older women with urinary incontinence ( UI ) and to underst and the outcomes associated with these interventions .