A Self-directed home biofeedback system for women with symptoms of stress, urge, and mixed incontinence

Abstract

Purpose: To evaluate a self-directed home biofeedback treatment system in a group of community dwelling, otherwise healthy women with symptoms of stress, urge, and mixed urinary incontinence (UI). Setting and subjects: Fifty-five women, aged 25 to 81 years, participated in the study. Methods: Initial evaluation included a self-reported continence assessment, a 24-hour bladder and fluid habits diary, severity indices for stress and urge UI, and assessment of pelvic floor strength using a pneumatic biofeedback device. Subjects completed a 16-week self-directed program. Assessment and severity index data were self-reported using a continence assessment form, a 24-hour bladder habit and fluid form, and stress and urge incontinence severity indices. Strength level of the trainer, number of digital bands lit on the screen during contraction, number of sessions, and program (starter, intermediate, advanced, or maintenance) were recorded on data sheets. Instruments: The treatment system includes an 8-minute educational and motivational video; a journal for education, instructions, and daily documentation forms; and a home biofeedback trainer with pneumatic vaginal sensors that displays the strength of pelvic muscle contraction. Results: Forty-four women completed the 16-week program. At the end of treatment, 19 (43%) were dry and 16 (36%) reported 50% or more improvement in number of leaks per day, number of voids per day, or both. Women with stress leakage experienced a significant reduction in the number of incontinent episodes per day and the mean severity index of incontinence (P < .001). Participants with urge UI experienced a significant reduction in the mean number of voids per day and mean severity index for UI (P < .001). Younger subjects were more likely to improve when compared with older participants, but no significant differences were found when comparing women who take estrogen with those who do not take estrogen or when comparing those with a history of bladder surgery with those who had no previous surgery. Conclusions: These data suggest that self-selected healthy women with symptoms of urge, stress, and mixed incontinence can improve their symptoms and lower their severity index with a minimal intervention, comprehensive, self-directed home biofeedback continence system. (J WOCN 2000;27:240–6)