MIND OVER MATTER: TREATINGINCONTINENCE WITH COMMUNITY-BASED INTERVENTION
E. W. MELLER 1, H. BARNES 1,M. E. WISE 1, J. E. MAHONEY 1, R. G. ROGERS 2,H. W. BROWN1;
1Univ. of Wisconsin -Madison, Madison, WI, 2Dell Med. Sch., Austin, TX.
Introduction: More than 60% ofolder women (> 65 years) in the United States (US)experience bladder and/or bowel incontinence (Gorina, 2014).Community-based continence promotion targeting improved knowledge andself-efficacy to manage urinary incontinence (UI) effectivelyimproves UI symptoms and increases care-seeking in older women in theUnited Kingdom (UK) (Tannenbaum, 2013). We adapted thisevidence-based continence promotion program to target both bladderand bowel symptoms for US women.
Objective: To determinethe impact of a group-based behavioral modification program on (a)urinary incontinence; (b) bowel incontinence; and (c) self-efficacyto manage urinary incontinence in community-dwelling older USwomen.
Methods: Between 8 and 15 women aged 50 and olderwith urinary and/or bowel incontinence were recruited from each offive Midwest communities. Participants were eligible if they hadexperienced urinary or bowel incontinence in the previous threemonths and had not initiated new treatment for these symptoms in thattime-frame. The intervention, titled “Mind Over Matter; HealthyBowels, Healthy Bladder” is a group-based workshop, led by atrained facilitator, that builds skills through individualizedgoal-setting and self-monitoring in three sessions over a month-longperiod. Participants completed written questionnaires at baseline andthree months following completion of the workshop, including thePelvic Floor Distress Inventory Short Form (PFDI-20), the PatientGlobal Impression of Improvement (PGI-I), and the GeriatricSelf-Efficacy for Urinary Incontinence (GSE-UI). Descriptive analyseswere used to characterize the sample; paired t-tests were used tocompare scores between baseline and 3 month follow-up on validatedinstruments describing symptoms and self-efficacy.
Results:A total of 55 women with mean age 73 years (SD 8.6, range 57, >89)with bladder and/or bowel incontinence were enrolled and 54/55attended all three workshop sessions; 49/55 (89%) provided 3 monthfollow-up data. The sample was predominantly white (54/55, 98%),well-educated (64% had attended college or technical school), andretired (80%). More than half (56%) lived alone and 87% perceivedthemselves to be in good health. Baseline and three month follow-updata are detailed in table 1. Three months following the workshop,83% of women with bladder incontinence and 63% of women with bowelincontinence reported symptom improvement via the PGI-I. The PFDI-20score improved by 30 points (95% CI 18.6, 41.6, p<.001) and theGSE-UI score improved by 27 points (95% CI , 18.6, 35.7, p<.001).
n/ N (%)
n/ N (%)
Urinaryincontinence (UI) prevalence
53/ 55 (96)
38/ 49 (78)
UIGlobal Impression of Improvement
40/ 48 (83)
3/ 48 (6)
5/ 48 (10)
BowelIncontinence (BI) prevalence
24/ 55 (44)
20/ 49 (41)
BIGlobal Impression of Improvement
24/ 38 (63)
10/ 38 (26)
4/ 38 (7)
PelvicFloor Symptoms (PFDI-20)
Self-efficacyfor UI (GSE-UI)
Conclusions: More than 80%of women with bladder incontinence and more than 60% of women withbowel incontinence had sustained symptom improvement three monthsfollowing completion of this adapted continence promotion workshop,with clinically important and statistically significant improvementsin incontinence symptoms and self-efficacy to manage urinaryincontinence. Based on these preliminary data, more rigorous testingof this workshop’s effectiveness using a comparator group isindicated to confirm these results and further evaluate its impact oncare-seeking.
References: 1. Gorina, Y., S. Schapert, A.Bercovitz, N. Elgaddal and E. Kramarow (2014). “Prevalence ofincontinence among older americans.” Vital Health Stat3(36): 1-33. 2. Tannenbaum, C., R. Agnew, A. Benedetti, D. Thomas andE. van den Heuvel (2013). "Effectiveness of continence promotionfor older women via community organisations: a cluster randomisedtrial." BMJ Open 3(12): e004135.