Biofeedback and other Therapies for the Treatment of Urinary ...

ReviewUrinary IncontinenceStress IncontinenceConventional Treatments for StressSI is the second-most frequent form of incontinencein women. 1 SI results when laxity in theConventional treatments for SI include pel-Incontinencemuscles of the pelvic floor, loss of urinary sphincterfunction, or urethral closure fails to prevent urine two studies, the combination of exercise and educavicfloor muscle exercises and reparative surgery. Infrom leaking from the bladder. 1 Childbirth-related tion about the function and anatomy of the urinarytrauma is a common cause of pelvic muscle injury tract decreased incontinence by 88 6 and 94 7 percent,that ultimately predisposes to SI. 2 SI can also occur respectively. However, two other studies found no additionalbenefit from the combination after surgery. 8,9in men who have had prostate surgery. 4 The incidenceof SI following prostate surgery varies widely fromSuccess rates of surgical treatments for incontinencefollowing prostatectomy vary widely. In0.3-65.6 percent, possibly due to differences in surgicaltechnique. 5a series of small studies – less than 50 patients perstudy – continence was restored in 36-95 percent ofOverflow Incontinencesubjects. 10-15OI is the second-most common form of incontinencein men. 1 It usually results when the outflowfrom the bladder is blocked by structures distalConventional Treatments for OverflowIncontinenceto the bladder (in men usually an enlarged prostate). 1OI is typically treated with medication or surgery.Urinary pressure builds in the bladder until it exceedsthe ability of the musculature surrounding the bladder1 In published trials of the treatments for symptomaticrelief of benign prostatic hypertrophy, theto maintain continence, causing leakage. 1incidence of OI has been rather low – less than oneevent per patient per year – making evaluation of suchConventional Treatmenttreatments difficult. In these trials, neither surgery norConventional treatments consist of behavioraltherapy, exercises to strengthen the pelvic floormedication decreased the incidence of OI. 16,17muscles, medications, or surgery. 1Alternative TreatmentsSince no conventional therapy is completelyConventional Treatments for Urgeefficacious and older individuals may be unwillingIncontinenceor unable to undergo surgical treatment, alternativeUR is treated either by behavioral therapy treatments may potentially be used as primary or adjunctivetherapy to reduce the number of episodes ofor medication. Behavioral therapies, although nota cure, can decrease the incidence of incontinence. UI. While conventional non-surgical treatments canTherapies may include habit training consisting of eitherscheduled voiding based on a person’s usual toi-Assessment and comparison of the efficaciesbe efficacious, the cure rate is less than 50 percent. 18leting schedule (which can result in at least a 25-percentdecrease in episodes of incontinence) or specific hindered by lack of a standardized definition of UIof alternative therapies in different studies have beeninterval toileting schedules every 2-3 hours (which in the subject populations, lack of standardization ofcan reduce episodes by as much as 80 percent). 1treatments and treatment protocols, inadequate samplesizes, and lack of blinding and appropriate con-The most effective medications, includingoxybutinin and tolterodine, inhibit bladder muscle trols.contractions, reduce episodes of incontinence by approximately70 percent, and have a cure rate of about20 percent. 1Alternative Medicine Review u Volume 11, Number 3 u 2006 Page 225Copyright © 2005 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission. Alternative Medicine Review Volume 10, Number 4 December 2005