Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group

Am J Obstet Gynecol. 1998 Oct;179(4):999-1007. doi: 10.1016/s0002-9378(98)70206-6.


Objective: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes.

Study design: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed with genuine stress incontinence (n = 145) and/or detrusor instability (n = 59) received a 12-week intervention program (6 weekly office visits and 6 weeks of mail/telephone contact) with immediate and 3-month follow-up. Outcome variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of analysis of covariance using baseline values as covariates and chi2 tests.

Results: The combination therapy group had significantly fewer incontinent episodes, better quality of life, and greater treatment satisfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had greater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no differences were noted by diagnosis, incontinence severity, or treatment site.

Conclusions: Combination therapy had the greatest immediate efficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling, and frequent patient contact.

Publication types

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

MeSH terms

  • Aged
  • Behavior Therapy*
  • Biofeedback, Psychology
  • Combined Modality Therapy
  • Educational Status
  • Estrogen Replacement Therapy
  • Exercise
  • Female
  • Humans
  • Middle Aged
  • Muscles / physiopathology
  • Quality of Life
  • Treatment Outcome
  • Urinary Bladder / physiopathology
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence / therapy*
  • Urinary Incontinence, Stress / physiopathology
  • Urinary Incontinence, Stress / therapy