The broad objective of this study is to determine the efficacy of behavioral therapy in the management of urinary incontinence in women. This clinical trial will use a randomized experimental design to investigate the comparative effectiveness of three treatments (bladder training; pelvic muscle exercise; bladder training and pelvic muscle exercise) in the management of urinary incontinent community-dwelling women ages 45 years and over. Subjects will be stratified by urodynamic subgroup 1) SI alone, and 2) DI +/- SI, and severity of incontinence 1) mild, 2) moderate, and 3) severe, and randomly assigned to a treatment group. All treatments will be conducted over six weeks involving weekly clinic visits. Bladder training will consist of scheduled voidings with progressive increases in the intervals between voidings. Pelvic muscle exercises will consist of biofeedback clinic sessions and home practice. A combination therapy will include both bladder training and pelvic muscle exercise protocols simultaneously. Follow-up will be conducted at 6, 12 and 30 (6 months) weeks post-randomization. Treatment outcome will be primarily assessed by weekly incontinent episodes. Secondary endpoints will be 1) diurnal micturition frequency, 2) nocturnal micturition frequency, 3) grams of fluid lost during a laboratory test, 4) maximal urethral closing pressure, 5) functional urethral length, 6) pressure transmission ratios, 7) maximal intravaginal pressure, and 8) intravaginal pressure over time. This study will help determine the comparative benefits of three behavioral interventions in management of different types of urinary incontinence, and will help identify the characteristics of women most likely to receive maximal benefit from each intervention.
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