International Urogynecology Journal

, Volume 21, Issue 6, pp 711–719 | Cite as

The effects of drug and behavior therapy on urgency and voiding frequency

  • Kathryn L. Burgio
  • Stephen R. Kraus
  • Diane Borello-France
  • Toby C. Chai
  • Kimberly Kenton
  • Patricia S. Goode
  • Yan Xu
  • John W. Kusek
  • for the Urinary Incontinence Treatment Network
Original Article

Abstract

Introduction and hypothesis

The objective of this study was to examine the effects of drug therapy alone and combined with behavioral therapy on urgency and 24-voiding frequency in women with urge-predominant incontinence and to identify predictors of change.

Methods

A planned analysis of data from a multi-site, randomized, controlled trial (N = 307). Bladder diaries were used to document voids, incontinence, and urgency severity.

Results

Urgency scores decreased significantly within both treatment groups, but changes did not differ between groups (p = 0.30). Improvement in urgency was associated with greater baseline urgency (p < 0.0001) and black ethnicity (p = 0.03). Voiding frequency increased with drug alone and decreased slightly with combined therapy (p = 0.009), and improvement was associated with combined treatment (p < 0.0001), higher baseline frequency (p < 0.0001), and lower baseline incontinence episode frequency (p = 0.001).

Conclusions

Although combined drug and behavioral therapy does not appear to improve urgency more than drug alone, it resulted in better outcomes on voiding frequency.

Keywords

Behavioral treatment Drug therapy Overactive bladder Urge incontinence Urinary frequency Urinary urgency 

Notes

Funding

This study was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK 58225, U01 DK58234, U01 DK58229, U01 DK58231, U01 DK60397, U01 DK60401, U01 DK60395, U01 DK60393, U01 DK60380, U01 DK60379). Pfizer, Inc. provided additional support, including donation of study drugs and funding.

Conflicts of interest

Four of the authors have a financial relationship with Pfizer. Kathryn L. Burgio: Pfizer (consultant, research grant), Astellas (advisory board); Stephen R. Kraus: Lilly (consultant, research grant), Pfizer (consultant, speaker), Novartis (speaker); Diane Borello-France: none; Toby C. Chai: Pfizer (consultant), Allergan (consultant); Kimberly Kenton: none; Patricia S. Goode: Pfizer (research grant); Yan Xu: none; John W. Kusek: none.

References

  1. 1.
    Abrams P, Cardozo L, Fall M et al (2003) The standardization of terminology in lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Urology 61:37–49CrossRefPubMedGoogle Scholar
  2. 2.
    Irwin DE, Milsom I, Hunskaar S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1315CrossRefPubMedGoogle Scholar
  3. 3.
    Andersson KE (2004) Antimuscarinics for treatment of overactive bladder. Lancet Neurol 3:46–53CrossRefPubMedGoogle Scholar
  4. 4.
    Burgio KL, Borello-France DF (2007) Pelvic floor muscle exercises and behavioral therapy. In: Kreder K, Dmochowski R (eds) The overactive bladder: evaluation and management. Informa, UK, pp 86–94Google Scholar
  5. 5.
    Milne JL (2008) Behavioral therapies for overactive bladder: making sense of the evidence. JWOCN 35:93–101Google Scholar
  6. 6.
    Wyman JF (2003) Treatment of urinary incontinence in men and older women. AJN Suppl 26-35Google Scholar
  7. 7.
    Fantl JA, Wyman JF, McClish DK et al (1991) Efficacy of bladder training in older women with urinary incontinence. JAMA 265:609–613CrossRefPubMedGoogle Scholar
  8. 8.
    Wyman JF, Fantl JA, McClish DK et al (1998) Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Am J Obstet Gynecol 179:999–1107CrossRefPubMedGoogle Scholar
  9. 9.
    Nygaard I, Kreder K, Lepic M et al (1995) Efficacy of pelvic floor muscle exercises in women with stress, urge and mixed urinary incontinence. Am J Obstet Gynecol 174:120–125CrossRefGoogle Scholar
  10. 10.
    Burgio KL, Locher JL, Goode PS et al (1998) Behavioral versus drug treatment for urge incontinence in older women: a randomized clinical trial. JAMA 23:1995–2000CrossRefGoogle Scholar
  11. 11.
    Subak LL, Wing R, West DS et al (2009) Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 360:481–490CrossRefPubMedGoogle Scholar
  12. 12.
    Goode PS, Burgio KL, Locher JL et al (2002) Urodynamic changes associated with behavioral and drug treatment of urge incontinence in older women. J Am Geriatr Soc 50:808–816CrossRefPubMedGoogle Scholar
  13. 13.
    Johnson TM, Burgio KL, Redden DT et al (2005) Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc 53:846–850CrossRefPubMedGoogle Scholar
  14. 14.
    Burgio KL, Locher JL, Goode PS (2000) Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc 48:370–374PubMedGoogle Scholar
  15. 15.
    Mattiasson A, Blaakaer J, Hoye K et al (2003) Simplified bladder training augments the effectiveness of tolterodine in patients with overactive bladder syndrome. BJU Int 92:415–417CrossRefGoogle Scholar
  16. 16.
    Burgio KL, Kraus SR, Menefee S, for the Urinary Incontinence Treatment Network et al (2008) Behavioral therapy to enable women with urge incontinence to discontinue drug treatment. Ann Intern Med 149:161–169PubMedGoogle Scholar
  17. 17.
    Urinary Incontinence Treatment Network (2007) Design of the behavior enhances drug reduction of incontinence (BE-DRI) study. Contemp Clin Trials 28:48–58CrossRefGoogle Scholar
  18. 18.
    Herzog AR, Diokno AC, Brown MB et al (1990) Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults. J Gerontol Med Sci 45:M67–M74Google Scholar
  19. 19.
    Brink CA, Wells TJ, Sampselle CM et al (1994) A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res 43:352–356CrossRefPubMedGoogle Scholar
  20. 20.
    Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMedGoogle Scholar
  21. 21.
    Nixon A, Colman S, Sabounjian L et al (2005) A validated patient reported measure of urinary urgency severity in overactive bladder for use in clinical trials. J Urol 174:604–607CrossRefPubMedGoogle Scholar
  22. 22.
    Shumaker SA, Wyman JF, Uebersax JS et al (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Q Life Res 3:291–306CrossRefGoogle Scholar
  23. 23.
    Coyne KS, Matza LS, Thompson C et al (2007) The responsiveness of the OAB-q among OAB patient subgroups. Neurourol Urodyn 26:196–203CrossRefPubMedGoogle Scholar
  24. 24.
    Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefPubMedGoogle Scholar
  25. 25.
    Furlong W, Feeny D, Torrance GW et al (1998) Multiplicative multi-attribute utility function for the health utilities index mark 3 (HUI3) system: a technical report: McMaster University Centre for Health Economics and Policy AnalysisGoogle Scholar
  26. 26.
    Yu YF, Nichol MB, Yu AP et al (2005) Persistence and adherence of medications for chronic overactive bladder/urinary incontinence in the California Medicaid program. Value Health 8:495–505CrossRefPubMedGoogle Scholar
  27. 27.
    Pfisterer MHD, Griffiths DJ, Schaefer W et al (2006) The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc 54:405–412CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2010

Authors and Affiliations

  • Kathryn L. Burgio
    • 1
    • 2
  • Stephen R. Kraus
    • 3
  • Diane Borello-France
    • 4
  • Toby C. Chai
    • 5
  • Kimberly Kenton
    • 6
  • Patricia S. Goode
    • 1
    • 2
  • Yan Xu
    • 7
  • John W. Kusek
    • 8
  • for the Urinary Incontinence Treatment Network
  1. 1.Department of Veterans AffairsGeriatric Research, Education, and Clinical CenterBirminghamUSA
  2. 2.University of Alabama at BirminghamBirminghamUSA
  3. 3.University of Texas Health Sciences CenterSan AntonioUSA
  4. 4.Duquesne UniversityPittsburghUSA
  5. 5.University of MarylandBaltimoreUSA
  6. 6.Loyola University Medical CenterMaywoodUSA
  7. 7.New England Research InstitutesWatertownUSA
  8. 8.National Institute of Diabetes and Digestive and Kidney Diseases, NIHBethesdaUSA

Personalised recommendations