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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01AG005170-05S1
Application #
3546204
Study Section
(SSS)
Project Start
1984-09-28
Project End
1990-06-30
Budget Start
1989-09-01
Budget End
1990-06-30
Support Year
5
Fiscal Year
1989
Total Cost
Indirect Cost
Name
Virginia Commonwealth University
Department
Type
Schools of Medicine
DUNS #
City
Richmond
State
VA
Country
United States
Zip Code
23298
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Bump, R C; Hurt, W G; Addison, W A et al. (1998) Reliability and correlation of measurements during and after bladder neck surgery. The Continence Program for Women Research Group. Br J Urol 82:628-33
Theofrastous, J P; Wyman, J F; Bump, R C et al. (1997) Relationship between urethral and vaginal pressures during pelvic muscle contraction. The Continence Program for Women Research Group. Neurourol Urodyn 16:553-8
Fantl, J A; Bump, R C; Robinson, D et al. (1996) Efficacy of estrogen supplementation in the treatment of urinary incontinence. The Continence Program for Women Research Group. Obstet Gynecol 88:745-9
Bump, R C; Hurt, W G; Theofrastous, J P et al. (1996) Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for W Am J Obstet Gynecol 175:326-33;discussion 333-5

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