Urinary Incontinence

Follow-Up Results We recently completed a two year follow-up on our first group of clients. This indicated that of the total group of 17 which we located for follow-up, 76% had completed treatment, (11/17). 91% were improved compared to their condition at the beginning of treatment and none were worse than at the beginning of treatment. Of the group of 17, only one went on to have surgery, which was not helpful to her. The mean duration of treatment was five treatment sessions.

As we have developed more experience with this treatment modality, we feel our treatment results are probably better now than they were with this initial group; however, obviously only time will verify that. Overall, this is a very promising treatment approach for people who are willing to take part in their own treatment. It does require significant investment of time in daily practice. However, so far, this has not been a major obstacle as people with this problem are usually highly motivated by their difficulty in controlling their bladder and bowels. Based on our experience, we believe this treatment will continue to be validated by further clinical follow-ups.

Protocol: Self-Regulation Of Urinary Incontinence

The treatment protocol that we use is as follows:

1. Physician or Self-Referral.

   a. Obtain signed release for medical records.

   b. Obtain medical records for evaluation.

   c. If no recent physical examination (including pelvic exam) refer back to primary care physician.

   d. Obtain urine analysis. If results are abnormal refer back to primary care physician.

   e. Patients must be under the care of a physician for their incontinence in order to enter treatment.

2. Complete baseline home record of incontinence episodes and fluid intake. Complete baseline psychological assessment.

3. Treatment.

   a. First session to include brief history, psychosocial and psychophysiological evaluation, pelvic floor computerized EMG evaluation, initial EMG biofeedback-assisted Kegel exercises, and instructions for home practice with EMG trainers.

   b. Subsequent office sessions to include regular EMG assessment, training, and behavioral management (including habit training, product awareness, and supportive therapy).

   c. Patients expected to maintain regular daily home practice of 20 to 40 minutes and to keep weekly record sheets documenting amount of practice, incontinence episodes, and fluid intake.

   d. Initial 2 to 3 office sessions at weekly intervals. As training progresses, sessions are less frequent.

4. Completion of treatment.

   a. When no incontinence episodes occur over a thirty day period.

   b. Patient and/or therapist feel maximum benefit has been obtained.

   c. Estimated duration of treatment: 4-7 sessions.

5. Complete post-treatment psychological assessment and EMG evaluation.