Comparing Conservative Methods

of Continence Management

Home-bound women over the age of 65 years::A review of the literature

Sonja Karon, Gerontology / Continence Nurse Specialist. Home and older people’s health. Auckland, New Zealand

Defined as the application of environmental, behavioural, and motivational principles to the management of lifestyle rated health problems.

Defined as an alteration to patient’s actions or their environment in order to improve bladder control. Can be either caregiver dependent techniques for patients with cognitive or motor deficits or techniques for those requiring active rehabilitation.

Defined as graded muscle training with or without feedback or intravaginal resistance in order to improve function of the pelvic floor muscles.

Lifestyle / Risk Factor Modification

Summary of Evidence Summary of Evidence Summary of Evidence

Behavioural Therapies Physical Therapies

Conclusions

1. All conservative management used in the younger women may be used in the selected older, frailer and motivated women.

2. Predictors of response to conservative therapy in the older women are few.

3. Successful training is dependent on the woman’s ability to contract her pelvic floor muscles and on the severity of the incontinence.

4. The greater the symptoms the greater the likely hood of achieving a statistically significant response.

5 Not enough research around the older woman aged over 65 years.

Low risk interventions

✔ Smoking cessation

✔ Relief of constipation

✔ Reduction in caffeinated drinks

✔ Decreased fluid intake

✔ Weight loss

Low risk interventions

✔ Bladder training

✔ Behavioural techniques

✔ Scheduled voiding regimens

✔ Timed voiding

✔ Prompted voiding

✔ Habit training

Low risk interventions

✔ Mechanical devices

✔ Vaginal cones

✔ Electrical stimulation

✔ Magnetic stimulation

✔ Biofeedback

✔ Pelvic floor muscle training

What is Conservative Management?

Any therapy that does not involve

pharmacological or surgical

intervention:

•lowriskinterventions

•simplelowcostremedies

•lowriskofadverseeffects

•doesnotprejudiceothertherapies

After completing a clinical assessment including looking at the reversible causes of incontinence (DIAPPERS).

• Cliniciansshouldchoose a treatment that considers patients comorbidities.

•GradeBrecommendation;Thatcaffeinateddrinksare associated with UI.

•GradeArecommendation;Thatdecreasingcaffeine improves continence. and reduces incidence of overactive bladder.

•GradeBrecommendation;thatmoderateweightloss significantly decreases UI in the morbidly obese.

•Notrialshaveshownthatresolvingconstipationhas an impact on UI.

•Anecdotalevidenceonlythatreducingartificialsweeteners affects UI.

•NoassociationbetweenUIandconsumption of alcohol.

•Currentdatasuggestssmokingincreasestheriskof more severe incontinence – no data whether cessation improves or resolves UI.

•Overallstudieshaveonlyreportedassociationsandonly a small number of RCTs have been carried out to assess the specific effects.

•GradeBrecommendation;Acombinationofpelvicfloor muscle training and bladder training is better than bladder training alone in the treatment of urge and mixed UI.

•GradeBrecommendation;PFMTtrainingandbladdertrainingmaybemoreeffectivethanPFMTalone in the short term but any benefit will not be maintained after more than 6 months.

•GradeArecommendation;Pelvicfloormuscletraining exercises should be offered as first line therapy to all women with stress, urge or mixed UI.

•Theuseofpelvicfloormuscletrainingisbetterthan placebo or no treatment or inactive control treatment for women with stress/urge or mixed UI.

•Womenwithjuststressincontinencebenefitthemostin terms of reports of cure or improvement and fewer episodes of leakage/day.

•Appearsthatwomenwhohadregularandrepeated contact with the trainer were more likely to report improvement after treatment

•Mechanicaldevices.Researchshowedthatthereisnot enough evidence to recommend any specific device to allow for a blanket recommendation.

Reference: The Cochrane Collaboration http://www.cochrane.org/cochrane-reviews