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Combined Medical and Behavioral Therapy for Urge Urinary Incontinence in Women

Adding behavioral modification to tolterodine treatment did not augment women’s long-term likelihood of discontinuing drug treatment.

Urge incontinence (involuntary urine loss associated with a strong urge to void) in women is a common and vexing condition. Antimuscarinic agents such as tolterodine commonly are used to treat patients with this condition. In a multicenter, partially manufacturer-sponsored, U.S. trial, community-dwelling women (mean age, 57; two thirds postmenopausal) with urge-predominant urinary incontinence were randomized to 10 weeks of extended-release tolterodine (4 mg daily) plus behavioral training or to tolterodine alone. Behavioral training — provided by a nurse practitioner, nurse specialist, or physical therapist — included exercises for pelvic-floor muscle control and behavioral strategies to reduce urgency, bladder contractions, and stress. Outcomes were assessed at the completion of therapy (week 10) and 6 months later (month 8). The primary outcome was treatment success at month 8, defined as not receiving drugs or other therapy for urge incontinence, and 70% reduction from baseline in frequency of incontinence episodes (previously shown to represent a critical threshold for patient satisfaction). Evaluable data were available for 237 of the 307 women who were originally randomized.

Treatment success rates at month 8 were 41% in each group, and the adjusted mean number of weekly incontinence episodes decreased similarly in both groups (from 23 to about 4). However, significantly more women in the combination arm reported complete satisfaction with treatment at month 8 (33% vs. 20%).

Comment: These results show that, although adding behavior therapy to antimuscarinic medication does not increase the proportion of women who are able to discontinue medication therapy for urge incontinence, the combination seems to promote patient satisfaction. As the authors note, both medication and behavior therapy are established treatments for urge incontinence. Nonetheless, routinely combining these treatments does not seem to be medically warranted.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health September 11, 2008

Citation(s):

Burgio KL et al. Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: A randomized trial. Ann Intern Med 2008 Aug 5; 149:161.

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