SPECIFIC EDUCATION, EXERCISE, AND STRESS INCONTINENCE

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Urinary incontinence affects approximately 27% of women over the age of 65 years. Over 75% of incontinent elderly women have stress urinary incontinence (SI) either alone or as a significant component of mixed incontinence. In this research we seek insights for improving the conservative treatment of moderate SI. Kegel exercises (KE) are commonly prescribed to strengthen the pelvic floor muscles, with particular emphasis on the levator ani (LA). However, how much any benefits derived from this treatment can be ascribed to actual strengthening of the LA, and how much can be ascribed to the educational component which patients, knowingly and unknowingly also receive, is unclear. The educational component includes general bladder training and, more specifically, learning where the LA are, when and why they can be of use to prevent SI and, at a very basic level, the "knack" of how to contract them volitionally. In Phase I we will use a randomized, three group (60+60+60), controlled trial to quantify, for the first time, the effect of education on treating SI. We will recruit at least 180 elderly 65-84 years) parous community-dwelling women with moderate SI (1-3 wetting episodes/day) for this study. A specific education group (ED group, n=60) will be followed over three months in order to determine whether outcome measures, including the number of daily wetting episodes and leak point pressures, show significant changes relative to a wait-listed no-treatment (NT, n=60) control group. We will also determine whether a three month KE intervention (KE group, n=60), which includes exercise to strengthen the LA in addition to the ED program, results in a significantly better outcome at three and six months follow-up than ED alone. ED & KE group LA strength changes will be quantified using an instrumented speculum. All three groups will be stratified by general education and physical activity levels in order to evaluate their effects on outcome. In Phase II we will conduct development studies to enhance Phase I intervention effectiveness by determining the use-acceptance of weighted vaginal cones for (a) learning to contract the LA and (b) strengthening the LA muscles.