Hypothesis / aims of study
ICS recommends pelvic floor muscle training to be first choice of treatment for stress and mixed urinary incontinence in women [1 ]. Based on the report presented by the 4th ICI, there is Level 1 evidence that pelvic floor muscle training programs effectively treat stress and mixed urinary incontinence[2 ].
This study is a prospective one, looking into the value of structured BT/PFMT in treating UI in elderly women who are refraining from surgery
Study design, materials and methods
The study comprised women referred to voiding dysfunction unit during a period of six months. They were aged ≥ 60 years, having stress, urge or mixed UI for at least 1 year with free neuro-urological examination, unwilling to undergo surgery for their UI. They should be able to cooperate in the program able to provide an informed consent.
Data collected included socio-demographic and UI risk factors. The type and onset of UI, number of pads, stress test and 1-hour pad test were also recorded
Those in the study group received 6 sessions: Two educational and 4 instructed PFMT and BT, including biofeedback. Women were evaluated at baseline, 2 and 4 months after the program ended. History, examination, voiding diary, pad test and Standard Arabic UDI-6 and IIQ-7 were collected.
Results
Fifty women were included; 25 in each group. No significant differences were observed between the study and control group as regards age, marital status, education and living arrangements. Table (1) shows socio- demographic characteristics of both groups. Diabetes mellitus was more common among the study group while hypertension and musculo-skeletal diseases were similarly affecting both groups. Figure (1) shows co-morbid conditions.
Gravidity and parity were similar in both groups. Median pregnancy was 6 and 7 in the study and control group respectively (p= 0.15). Likewise, median normal delivery was 5 in the two groups (p =0.47).
Two thirds (68%) of the study and 72% of the control group had UI for 1-5 years, 24% of each group had UI for 5 -10 years while the remaining had incontinence for over 10 years. Over half of the study and control groups (56.0%, 52.0% respectively) had mixed incontinence, 32.0% of study group and 40.0% of control group had urge. The rest (12.0% of study, 8.0% of control) had SUI. Difference between the groups remained insignificant (p=0.795). Table (2) shows type and duration of UI.
Interpretation of results
Forty four percent of both groups were using pads, while 32.0% of study and 16.0% of control group decreased their fluid intake, 12% decreased caffeine intake. Nevertheless, difference between the two groups were insignificant (p = 0.158 and 0.074 respectively). The number of incontinence episodes among study group significantly decreased at 2 and 4 month follow- ups. (p = 0.001). Table (3) shows the Voiding diary in study and control groups before and after behavioral intervention program.
At baseline, 9 and 12 patients in the study and control group had insignificant (≤ 1 gm) pad weight increase respectively whereas 16 and 13 in the study and control groups had pad weight increase >1 gm. After 2 months, 14 and 15 had pad weight gain > 1gm in the study and control group. At 4 months, the numbers of women with pad weight gain of > 1 gm decreased to 12 in the study group and remained at 15 in the control.
UDI-6 did not show any statistically significant differences between the groups at baseline (p = 0.062). However, difference between groups became statistically significant at 2-month and the improvement continued till 4 months (p= 0.005). This was the same regarding IIQ-7, where no significant differences between groups were noted at baseline. However, differences turned to be statistically significant at both 2 and 4 months (p=0.000). Table 4 reflects changes in UDI-6 and IIQ-7 scores