Bladder training for urinary incontinence in adults

Urinary incontinence is the inability to control the leakage of urine and is a common and distressing problem. Urge incontinence is leakage of urine when a person is unable to control the strong desire to pass urine (void). Stress incontinence is the leakage of urine when a person coughs or undertakes physical exertion. Bladder training encourages people to extend the time between voiding so that continence might be regained. This can take months to achieve but may help people who are physically and mentally able to use this method. The review of trials did not find enough rigorous evidence and concluded that more research is needed. The limited evidence available suggests that bladder training may be helpful in treating urinary incontinence but this is not definite.

Authors' conclusions: 

The limited evidence available suggests that bladder training may be helpful for the treatment of urinary incontinence, but this conclusion can only be tentative as the trials were of variable quality and of small size with wide confidence intervals around the point estimates of effect. There was also not enough evidence to determine whether bladder training was useful as a supplement to another therapy. Definitive research has yet to be conducted.

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Background: 

Urinary incontinence is a common and distressing problem. Bladder training aims to increase the interval between voids and is widely used for the treatment of urinary incontinence.

Objectives: 

To assess the effects of bladder training for the treatment of urinary incontinence.

Search strategy: 

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 March 2006). The reference lists of relevant articles were searched, and trialists contacted for details of other trials.

Selection criteria: 

Randomised or quasi-randomised trials of bladder training for the treatment of any type of urinary incontinence.

Data collection and analysis: 

Two reviewers assessed trial quality and independently extracted data. Five primary outcomes were prespecified: participant's perception of cure of urinary incontinence; participant's perception of improvement of urinary incontinence; number of incontinent episodes; number of micturitions; and quality of life. Adverse events were also noted. Three comparisons were made: bladder training compared to no bladder training; bladder training compared to other treatments; and combining bladder training with another treatment compared to that other treatment alone.

Main results: 

We assessed 109 reports of 60 potentially relevant trials; 31 reports of 12 trials were eligible for inclusion with a total of 1473, predominantly female, participants. In four trials not all participants with overactive bladder, in four trials had urinary incontinence. Data from eight trials with 858 participants with urinary incontinence at baseline, mostly female, are therefore included in the review. The quality of trials was variable. Few data describing long term follow up are available.

Bladder training compared to no bladder training: Data were available for 172 women from three trials comparing bladder training with no bladder training. These described only a limited number of prespecified outcomes, which varied across the three trials. Point estimates of effect favoured bladder training; however, confidence intervals were wide and no statistically significant differences were found for primary outcome variables.

Bladder training compared to other treatments: Three trials including 159 women compared bladder training with drugs: two with oxybutynin and one with imipramine plus flavoxate. In the former trials the only outcomes demonstrating a statistically significant difference were participant's perception of cure at six months (RR 1.69; 95% CI 1.21 to 2.34), quality of life (general physical measure) (WMD 9.00; 95% CI 1.64 to 16.36) and adverse events, all favouring bladder training, and number of daytime micturitions per week (WMD 2.80; 95% CI 0.91 to 4.69) favouring drug treatment. In the latter trial participant's perception of cure immediately after treatment just achieved statistical significance (RR 1.50; 95% CI 1.02 to 2.21) favouring bladder training, and this difference was maintained at approximately two months post treatment. Two comparisons of bladder training with pelvic floor muscle training plus biofeedback included 164 women: none of the differences in the primary outcomes achieved statistical significance.

Combining bladder training with another treatment compared to that other treatment alone: Two trials including 331 participants compared the combination of bladder training plus an anticholinergic drug with the drug alone. For the largest trial, data for only one prespecified outcome were available: the median number of incontinent episodes was the same for both treatment groups. One trial compared pelvic floor muscle training plus biofeedback supplemented with bladder training versus pelvic floor muscle training plus biofeedback alone and included 125 women. Of the primary outcomes, both participants' perception of improvement and quality of life, both immediately after treatment, achieved statistical significance, favouring the bladder training combined with pelvic floor muscle training and biofeedback group (perception of improvement: RR 1.18; 95% CI 1.01 to 1.39; quality of life: MD -47.20; 95% CI -87.03 to -7.37), this was not sustained at three months.

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