Article

First-line conservative treatment for stress urinary incontinence
(SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM)
exercise and bladder control strategies.
The purposes of this study
were: (1) to describe adherence and barriers to exercise and bladder control
strategy adherence and (2) to identify predictors of exercise adherence. DESIGN:
This study was a planned secondary analysis of data from a multisite, randomized
trial comparing intravaginal continence pessary, multicomponent behavioral
therapy, and combined therapy in women with stress-predominant urinary
incontinence (UI). METHODS: Data were analyzed from the groups who received
behavioral intervention alone (n=146) or combined with continence pessary therapy
(n=150). Adherence was measured during supervised treatment and at 3, 6, and 12
months post-randomization. Barriers to adherence were surveyed during treatment
and at the 3-month time point. Regression analyses were performed to identify
predictors of exercise adherence during supervised treatment and at the 3- and
12-month time points. RESULTS: During supervised treatment, >/=86% of the women
exercised >/=5 days a week, and >/=80% performed at least 30 contractions on days
they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of
women, respectively, indicated they were still performing PFM exercises. During
supervised treatment and at 3 months post-randomization, >/=87% of the women
reported using learned bladder control strategies to prevent SUI. In addition,
the majority endorsed at least one barrier to PFM exercise, most commonly
"trouble remembering to do exercises." Predictors of exercise adherence changed
over time. During supervised intervention, less frequent baseline UI and higher
baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted
exercise adherence. At 3 months post-randomization, women who dropped out of the
study had weaker PFMs at baseline. At 12 months post-randomization, only "trouble
remembering" was associated with exercise adherence. LIMITATIONS: Adherence and
barrier questionnaires were not validated. CONCLUSIONS: Adherence to PFM
exercises and bladder control strategies for SUI can be high and sustained over
time. However, behavioral interventions to help women link exercise to
environmental and behavioral cues may only be beneficial over the short term.

Langue : ANGLAIS