Drug Therapy Appears To Work Better Than Rehabilitation for Urinary Incontinence
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.
Dr. Ling reports no relationship to this field of study.
Synopsis: Pelvic floor muscle training and behavior modification had better long-term effects than oxybutynin on women with symptoms of urge incontinence.
Source: Kafri R, et al. Int Urogynecol J. 2008;19:47.
These Israeli researchers assigned 44 women with overactive bladder alternately into 2 groups: one group receiving 3 months of pelvic floor rehabilitation, and the other receiving oxybutynin. They measured frequency of urination, quality of life and side effects at the time of entry, completion of the 3 months intervention, 3 months later, and 21 months later. The long-term outcome resulted in the pelvic rehab group maintaining and even improving what had been accomplished during the intervention period while the group treated with medical intervention deteriorated to baseline values in urinary frequency.
Commentary
This makes sense, doesn't it? It certainly seems logical that patients who are given a solution that potentially has long-lasting effects should do better than those who are simply provided with a medication that works only as long as its pharmacology would allow. Having said that, is this something that is viable in clinical practice with patients who would rather have a pill solve their problems than be obligated to put in significant effort? We deal with patients who want to lose weight, but would rather take phentermine than exercise or change lifestyle. They would rather take an antidepressant than undergo counseling.
Other than a magic pill, the other "quick fix" that patients look for is surgery. Since we know that urge incontinence associated with overactive bladder is not correctable to surgery, and because pharmacologic agents don't have much better than a 50% cure rate, there isn't anything "easy" for these patients. This pelvic floor rehabilitation included strategies for preventing incontinence as well as daily exercises. It is unknown why the pelvic floor rehabilitation works, but potential explanations include strengthening and tolerance of the pelvic floor muscles or possible psychological effects of having a support system.
This study provides further evidence that a multi-disciplinary approach to many patients with urinary incontinence may prove optimal. Knowledgeable physical therapists can motivate and teach patients to change behavior and, thus, reduce symptoms. Although not all physical therapists are trained in this treatment approach, there is a growing interest in women's health among physical therapists. Since both my son and his wife are physical therapists, I can identify with any reader who is wondering why the physical therapists that they use aren't skilled in this treatment modality.
First of all, women's health is relatively new to the field of physical therapy. Second, not all schools are well-versed or well-staffed with this in the curriculum. Third, because there are many different areas that therapists can evolve into, such as sports medicine, rehabilitation medicine, pediatrics, etc. (much like the various fields that physicians can specialize in), not all therapists will have the interest.
Any physician who is dealing with patients with incontinence would do well to have both medical and non-medical options available to them. Obviously, surgery is always viable for stress incontinence and even some patients with mixed incontinence, but patients with overactive bladder with its associated urge incontinence can be served well with both medication and physical therapy intervention. If you don't believe me, try it! I think you'll be pleasantly surprised. Your patients will thank you, too. Given the side effects of the medications for urge incontinence, one less pill for some patients is a real blessing.
These Israeli researchers assigned 44 women with overactive bladder alternately into 2 groups: one group receiving 3 months of pelvic floor rehabilitation, and the other receiving oxybutynin.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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