Behavioral therapy to treat urinary incontinence in Parkinson disease
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Abstract
Objective:To assess the feasibility and efficacy of exercise-based behavioral therapy to treat urinary incontinence (UI) in older adults with Parkinson disease (PD).
Methods:Participants with PD ≥50 years with ≥4 UI episodes on a 7-day bladder diary were recruited from movement disorders clinics. In 5 visits over 8 weeks, participants learned pelvic floor muscle exercises using computer-assisted EMG biofeedback, and bladder control strategies including urge suppression. Bladder diaries were used to reinforce techniques and monitor the primary outcome of UI frequency. Secondary outcomes included additional reporting of lower urinary tract symptoms, symptom bother, and quality of life (QOL) using the International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB).
Results:Twenty participants were enrolled (90% male, age 66.5 ± 6.2 [mean ± SD], with PD for 6.9 ± 5.4 years) and 17 completed the study. The median (interquartile range) weekly frequency of baseline UI episodes was 9 (4–11) and following intervention was 1 (0–3), representing an 83.3% reduction (45.5–100.0, p = 0.0001). QOL scores on the ICIQ-OAB improved from 71.1 ± 23.9 to 54.7 ± 15.4 (p = 0.002).
Conclusions:In this uncontrolled pilot study of an exercise-based, biofeedback-assisted behavioral intervention, older participants with PD demonstrated statistically significant and clinically meaningful reductions in frequency of UI and improvement in QOL. Randomized controlled trials to assess behavioral therapies for UI in patients with PD are warranted.
Classification of evidence:This study provides Class IV evidence that exercise-based, biofeedback-assisted behavioral intervention can reduce UI frequency in patients >50 years old with PD.
Footnotes
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Study funding: Supported by the John A. Hartford Foundation (Southeast Center of Excellence in Geriatric Medicine) and the U.S. Department of Veterans Affairs. The funding agencies had no role in the study design, data collection and analysis, or interpretation and presentation of study results.
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C.P.V., K.L.B., P.S.G., R.A.W., T.M.J. prepared this article as part of official duties as an officer or employee of the U.S. Government and cannot assign copyright to AAN Enterprises, Inc.
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- ICIQ-OAB
- International Consultation on Incontinence Questionnaire for overactive bladder
- PD
- Parkinson disease
- QOL
- quality of life
- UI
- urinary incontinence
- UPDRS
- Unified Parkinson's Disease Rating Scale
- Received August 9, 2010.
- Accepted February 1, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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