Urinary incontinence (UI) is a significant problem in older women. The NIH Consensus Development Conference suggested that treatment sequences should progress from the least to the most invasive. This proposal seeks to evaluate a non-surgical treatment Algorithm. The sample will be 600 community living women 60 years or older, who have self-reported uncontrolled urine loss at least weekly or no incontinence but dysfunctional voiding (DV) as more than a day time or 3 nighttime voids with a concern of wetting. The study is in 3 phases: a non-invasive diagnostic evaluation, a controlled clinical trial, and a one year follow up. The clinical trial will evaluate a 4 week basic behavioral program compared to delay, an additive 8 week pelvic muscle exercise program compared to delay, and an additive 12 week program to estrogen and oxybutynin chloride combined drug program in a factorial design. UI will be classified as stress type, urge type, mixed or other with appropriate referral for exclusion criteria. Dependent measures include patient subjective assessment, patient bladder behavior diary, and a non-invasive provocative pad test, analysis will include descriptive findings for research questions and hypothesis testing adjusting for co-variance and other factors using modeling techniques.
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