Urinary incontinence occurs in about 11 to 12% of community-dwelling female individuals. This condition may lead to physical, psychological and financial damage. Bladder training is a non-invasive, inexpensive behavioral therapy found useful in the management of incontinence due to detrusor instability. Forty to 70% of incontinent elderly females have evidence of such detrusor instability, most showing concomitant evidence of sphincter incompetence. Few clinical trials of bladder training have specifically incorporated elderly subjects. Urodynamic diagnostic criteria have been mostly based on data derived from protocols incorporating younger individuals. In order substantiate the applicability of such criteria to older patients, further data is needed. Bladder training protocols have seldom been controlled for concomitant interventions such as the clinical evaluation itself. In the elderly, conditions such as mental, functional, social and environmental status need to be assessed and monitored throughout the protocol for they may significantly influence both the pathogenesis of the incontinence as well as the treatment outcome. The proposed study represents a prospective, randomized protocol on the effect of bladder training on elderly community-dwelling incontinent females. Patients with evidence of detrusor instability and/or sphincteric incompetence will be incorporated and stratified. Clinical, urodynamic, mental, functional, social and environmental status will be evaluated at entry. Bladder training will consist of a 6-week outpatient protocol of scheduled voidings with progressive increase of the intervals between voidings. Control for the intervention of the clinical evaluation will be done by randomly assigning patients to an immediate or delayed entry into the training protocol. Outcome will be assessed on self-reported episodes of incontinence, diurnal urinary frequency and nocturia, as well as quantification of urinary loss. Follow-up will be at 6 and 24 weeks. At 24 weeks, mental, functional, social and environmental status will be reassessed. It is expected to determine the effectiveness of bladder training in the entire study group. The data obtained is expected to help determine etiologic mechanisms of incontinence in elderly females. In addition, it should be possible to recognize the characteristics of those individuals who benefited most from the therapeutic program. Such data would permit the future identification of subjects suitable for bladder training as therapy for their urinary incontinence.
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