This study tests two behavioral interventions to relieve stress or mixed incontinence in symptomatic elderly females. Urinary incontinence caused by either relaxed pelvic musculature or detrusor instability is one of the most frequently reported health problems among elderly females. It causes untold embarrassment, discomfort, and for the bedridden patient, it exacerbates decubiti, thus requiring extensive and expensive nursing care. The study is divided into three components: 1) a randomized prospective trial of the efficacy of two behavioral interventions for reducing symptoms of urinary incontinence in elderly females; (2) an assessment of factors influencing all study participants post-intervention, three and six-month compliance; and 3) determination of the range of muscle activity of the pubococcygeus muscle in 60 elderly women asymptomatic for urinary incontinence. The experimental component will be comprised of 120 women who meet physical, previous health history and urodynamic criteria for assignment into the study. The subjects will be randomly assigned to Group I (muscle education established exercise schedules); Group II (muscle education, established exercise schedule, resistive exercise reinforced with biofeedback training); or Group III (control). It is hypothesized that biofeedback plus muscle education will be most effective in educating study participants and maintaining compliance with the intervention since biofeedback provides repetitive, focused information necessary for learning new behaviors. Group II participants are therefore expected to show the greatest improvements on the dependent measures post-intervention, i.e. urethral closings pressure and self reports of alleviation of symptoms of incontinence as compared to Group I and Group III. The data analytic plan includes correlational analysis of the 60 baseline study participants, Multivariate Analysis of Covariance and Multivariate Repeated Measures Analysis of the post-intervention dependent measures, and discriminant analysis of the characteristics of compliant and noncompliant study participants. Establishment of the efficacy of these behavioral interventions for alleviation of urinary incontinence would offer a low cost, low risk alternative treatment option for a population with diminished tolerance for surgical or pharmacological treatment of incontinence.
| Nochajski, T H; Burns, P A; Pranikoff, K et al. (1993) Dimensions of urine loss among older women with genuine stress incontinence. Neurourol Urodyn 12:223-33 |
| Burns, P A; Pranikoff, K; Nochajski, T H et al. (1993) A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. J Gerontol 48:M167-74 |
| Burns, P A; Nochajski, T H; Pranikoff, K (1992) Factors discriminating between genuine stress and mixed incontinence. J Am Acad Nurse Pract 4:15-21 |
| Burns, P A; Pranikoff, K; Nochajski, T et al. (1990) Treatment of stress incontinence with pelvic floor exercises and biofeedback. J Am Geriatr Soc 38:341-4 |
