Behavioral and drug therapy for urinary incontinence.

In a randomized, controlled trial comparing biofeedback-assisted behavioral therapy and drug therapy with oxybutynin, both types of therapy were superior to placebo in older, community-dwelling women with urge or mixed incontinence. Behavioral therapy significantly reduced incontinence compared with oxybutynin therapy (80.7% vs 68.5%, P = 0.04). Patients expressed high levels of satisfaction with behavioral therapy, and 97% were willing to continue this therapy indefinitely, compared with 55% receiving drug therapy. Results of recent studies suggest that behavioral therapy without biofeedback or pelvic floor electrical stimulation also results in significant clinical benefits, which should make behavioral therapy a more practical approach in the general practice setting. Statistical analysis showed no significant relationship between posttreatment urodynamic changes and clinical outcomes, and thus, the mechanisms by which behavioral and drug therapies work remain unidentified. In a small trial of combination therapy, patients who received both drug and behavioral therapy experienced significant clinical improvements compared with the effects of monotherapy with either treatment.