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Behavior modification program can improve incontinence

(Reuters Health) – Women with urinary or bowel incontinence who participate in behavior modification programs may experience less severe symptoms and a better quality of life than their counterparts who don’t, a small study suggests.

Researchers tested the effectiveness of the “Mind Over Matter: Healthy Bowels, Healthy Bladder” program, which is designed to reduce incontinence with small-group classes focused on diet changes, fluid intake, pelvic floor exercises and bladder training.

The study team randomly assigned 121 women aged 50 and older with incontinence either to participate immediately in the program or to join a waiting list.

After four months, 71% of women in the program reported improvements in urinary incontinence, compared with 23% of women in the waitlist group. And 55% of women in the program reported improvements in bowel incontinence, compared with 27% in the waitlist group.

“The most powerful behavior change taught in Mind Over Matter is learning how to relax, strengthen and coordinate the muscles that support the openings of the bladder and bowels, called the pelvic floor muscles,” said Dr. Heidi Wendell Brown, lead author of the study and a researcher at the University of Wisconsin School of Medicine and Public Health in Madison.

“Many women have heard of ‘Kegels,’ but many of us do not actually do a correct contraction when we think we are doing a Kegel squeeze,” Brown said by email. “Mind Over Matter teaches women how to do a pelvic floor muscle contraction, or Kegel squeeze, correctly, and also teaches them how to relax those muscles – an equally important component that is not often talked about.”

More than 60% of older U.S. women suffer from urinary incontinence, bowel incontinence, or both, researchers note in Obstetrics & Gynecology. In addition to reducing women’s quality of life and increasing the risk of depression, these conditions can also increase the risk for institutionalization when women are unable to care for themselves at home.

Treatment groups in the study were run by community volunteers who went through two-day training programs. Groups of 8 to 12 women met for a series of three workshops, each of them two weeks apart.

All of the participants lived independently and didn’t need help with daily tasks like dressing or bathing, and they all had experienced urinary incontinence at least weekly or bowel incontinence at least monthly in the previous four weeks.

More than half of the women had both urinary and bowel incontinence. They were predominantly white, retired and 75 years old, on average.

Women in the program and the waitlist group were assessed at the end of four months.

At that point, 39% of the women in the program said their urinary incontinence was much improved, compared to 5% of women in the waitlist group. And 35% of women in the program with bowel incontinence were much improved, compared with 11% in the waitlist group.

One limitation of the study is that the participants were a homogenous group of older white women, and it’s possible that the classes might get different results with a more diverse patient population, the study team notes.

Even so, the results highlight the importance of women getting help to set goals and plan behavior changes that may help ease incontinence, said Dr. Cindy Amundsen, a researcher at Duke University in Durham, North Carolina, who wasn’t involved in the study.

“Older women with mild to moderate bowel and urinary incontinence should set personalized goals and action plans when beginning pelvic floor muscle exercises, dietary changes that include fiber supplementation, fluid adjustments to avoid bladder irritants as well as a scheduled bladder and bowel regimen,” Amundsen, who wasn’t involved in the study, said by email.

“Empowering themselves to change and sustain these changes in their lives will help improve their bladder and bowel symptoms,” Amundsen added.

The Mind Over Matter: Healthy Bowels, Healthy Bladder program is available to the public (here:

SOURCE: Obstetrics & Gynecology, online August 23, 2019.

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