Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women.

BACKGROUND

Although urinary incontinence affects up to 35% of community-dwelling elderly women, the long-term efficacy of conservative treatment in this population is unknown.

METHODS

Between April 1991 and January 1994, 81 community-dwelling women over age 60 underwent nonsurgical incontinence treatment that included pelvic muscle exercises, bladder retraining, estrogen replacement, biofeedback, functional electrical stimulation, and pharmacologic therapy. Information about intercurrent medical problems, urogynecologic diagnoses, treatment recommendations, and provider-documented outcome were collected from medical records. We mailed structured questionnaires evaluating persistent incontinence, treatment efficacy, interval therapy, and quality of life to women who had last attended clinic at least one year previously.

RESULTS

Fifty-three of 81 (65%) women, mean age (+/- SD) 76 +/- 8 years, returned the questionnaire. The mean follow-up interval was 21 +/- 8 months. At follow-up, 43% of women reported incontinence was not a problem or mild, 33% reported moderate incontinence, and 21% reported severe incontinence. When patients compared their initial with current incontinence severity, improvement was significant (p < .01). Genuine stress incontinence was diagnosed in 18 women, detrusor overactivity in 14, and mixed incontinence in 13. Improvement did not vary consistently by incontinence diagnosis. Older patients had more severe incontinence at presentation (r = .94, p = .02) and reported less improvement (r = .97, p < .01) than younger ones. However, the overall likelihood of improvement was greatest among patients with the most severe incontinence at presentation (r = .534, p < .001). Subjects considered pelvic muscle exercises, delayed voiding, and caffeine restriction most effective in reducing incontinence severity.

CONCLUSIONS

Elderly women derive long-term clinical benefit from nonsurgical incontinence therapy. Younger patients and those with more severe incontinence are most likely to respond to treatment.