Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial

JAMA. 2003 Jul 16;290(3):345-52. doi: 10.1001/jama.290.3.345.


Context: Pelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent behavioral training program has not been defined.

Objective: To determine if PFES increases efficacy of behavioral training for community-dwelling women with stress incontinence.

Design and setting: Prospective randomized controlled trial conducted from October 1, 1995, through May 1, 2001, at a university-based outpatient continence clinic in the United States.

Patients: Volunteer sample of 200 ambulatory, nondemented, community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern; stratified by race, type of incontinence (stress only vs mixed), and severity (frequency of episodes).

Interventions: Patients were randomly assigned to 8 weeks (4 visits) of behavioral training, 8 weeks (4 visits) of the behavioral training plus home PFES, or 8 weeks of self-administered behavioral treatment using a self-help booklet (control condition).

Main outcome measures: Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life.

Results: Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with behavioral training, 71.9% with behavioral training plus PFES, and 52.5% with the self-help booklet (P =.005). In comparison with the self-help booklet, behavioral training (P =.02) and behavioral training plus PFES (P =.002) were significantly more effective, but they were not significantly different from each other (P =.60). The PFES group had significantly better patient self-perception of outcome (P<.001) and satisfaction with progress (P =.02). Significant improvements were seen across all 3 groups on the Incontinence Impact Questionnaire but with no between-group differences.

Conclusions: Treatment with PFES did not increase effectiveness of a comprehensive behavioral program for women with stress incontinence. A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Behavior Therapy* / methods
  • Biofeedback, Psychology
  • Combined Modality Therapy
  • Electric Stimulation Therapy* / instrumentation
  • Exercise Therapy
  • Female
  • Humans
  • Middle Aged
  • Patient Satisfaction
  • Pelvic Floor
  • Prospective Studies
  • Quality of Life
  • Treatment Outcome
  • Urinary Incontinence, Stress / therapy*
  • Urodynamics