Bladder training for urinary incontinence in adults
Editorial Group: Cochrane Incontinence Group
Published Online: 26 JAN 2004
Assessed as up-to-date: 14 MAR 2006
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Wallace SA, Roe B, Williams K, Palmer M. Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001308. DOI: 10.1002/14651858.CD001308.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 26 JAN 2004
Urinary incontinence is a common and distressing problem. Bladder training aims to increase the interval between voids and is widely used for the treatment of urinary incontinence.
To assess the effects of bladder training for the treatment of urinary incontinence.
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 March 2006). The reference lists of relevant articles were searched, and trialists contacted for details of other trials.
Randomised or quasi-randomised trials of bladder training for the treatment of any type of urinary incontinence.
Data collection and analysis
Two reviewers assessed trial quality and independently extracted data. Five primary outcomes were prespecified: participant's perception of cure of urinary incontinence; participant's perception of improvement of urinary incontinence; number of incontinent episodes; number of micturitions; and quality of life. Adverse events were also noted. Three comparisons were made: bladder training compared to no bladder training; bladder training compared to other treatments; and combining bladder training with another treatment compared to that other treatment alone.
We assessed 109 reports of 60 potentially relevant trials; 31 reports of 12 trials were eligible for inclusion with a total of 1473, predominantly female, participants. In four trials not all participants with overactive bladder, in four trials had urinary incontinence. Data from eight trials with 858 participants with urinary incontinence at baseline, mostly female, are therefore included in the review. The quality of trials was variable. Few data describing long term follow up are available.
Bladder training compared to no bladder training: Data were available for 172 women from three trials comparing bladder training with no bladder training. These described only a limited number of prespecified outcomes, which varied across the three trials. Point estimates of effect favoured bladder training; however, confidence intervals were wide and no statistically significant differences were found for primary outcome variables.
Bladder training compared to other treatments: Three trials including 159 women compared bladder training with drugs: two with oxybutynin and one with imipramine plus flavoxate. In the former trials the only outcomes demonstrating a statistically significant difference were participant's perception of cure at six months (RR 1.69; 95% CI 1.21 to 2.34), quality of life (general physical measure) (WMD 9.00; 95% CI 1.64 to 16.36) and adverse events, all favouring bladder training, and number of daytime micturitions per week (WMD 2.80; 95% CI 0.91 to 4.69) favouring drug treatment. In the latter trial participant's perception of cure immediately after treatment just achieved statistical significance (RR 1.50; 95% CI 1.02 to 2.21) favouring bladder training, and this difference was maintained at approximately two months post treatment. Two comparisons of bladder training with pelvic floor muscle training plus biofeedback included 164 women: none of the differences in the primary outcomes achieved statistical significance.
Combining bladder training with another treatment compared to that other treatment alone: Two trials including 331 participants compared the combination of bladder training plus an anticholinergic drug with the drug alone. For the largest trial, data for only one prespecified outcome were available: the median number of incontinent episodes was the same for both treatment groups. One trial compared pelvic floor muscle training plus biofeedback supplemented with bladder training versus pelvic floor muscle training plus biofeedback alone and included 125 women. Of the primary outcomes, both participants' perception of improvement and quality of life, both immediately after treatment, achieved statistical significance, favouring the bladder training combined with pelvic floor muscle training and biofeedback group (perception of improvement: RR 1.18; 95% CI 1.01 to 1.39; quality of life: MD -47.20; 95% CI -87.03 to -7.37), this was not sustained at three months.
The limited evidence available suggests that bladder training may be helpful for the treatment of urinary incontinence, but this conclusion can only be tentative as the trials were of variable quality and of small size with wide confidence intervals around the point estimates of effect. There was also not enough evidence to determine whether bladder training was useful as a supplement to another therapy. Definitive research has yet to be conducted.
Plain language summary
Bladder training for urinary incontinence in adults
Urinary incontinence is the inability to control the leakage of urine and is a common and distressing problem. Urge incontinence is leakage of urine when a person is unable to control the strong desire to pass urine (void). Stress incontinence is the leakage of urine when a person coughs or undertakes physical exertion. Bladder training encourages people to extend the time between voiding so that continence might be regained. This can take months to achieve but may help people who are physically and mentally able to use this method. The review of trials did not find enough rigorous evidence and concluded that more research is needed. The limited evidence available suggests that bladder training may be helpful in treating urinary incontinence but this is not definite.
我們搜尋Cochrane Incontinence Group Specialised Trials Register(搜尋日期為2006年3月15日)。搜尋相關論文的參考文獻列表，並與其他試驗之研究者聯絡以探知詳情
我們評估了60個可能相關的試驗中的109份報告，其中符合納入標準的是12個試驗中的31份報告，共包括了1473名參與者，其中大多為女性。有四個試驗並非所有參與者均有活性過度的膀胱，而是僅有尿失禁。八個被納入分析的試驗其參與者在基準期都有尿失禁的狀況，參與者共有858名，大多數為女性。這些試驗的品質並不一致，僅有少數數據描述長期追蹤。膀胱訓練與沒有膀胱訓練作比較：數據來自三個試驗的172名婦女，對先行指定的結果之陳述有限，且三個試驗所述各自不同。效用上的點估計(point estimates)傾向支持膀胱訓練，然而，因信度區間太寬，各主要結果均不具有意義的統計值。膀胱訓練與其他治療比較：三個試驗共包含159名婦女，比較膀胱訓練與兩種藥物的效果，其中兩個試驗是與oxybutynin比較而另一個則與imipramine加上flavoxate比較。在前兩個試驗呈現統計差異的結果僅有下列幾項：參與者在六個月時自覺痊癒(RR 1.69；95% CI 1.21∼2.34)、生活品質(一般身體狀況衡量)(WMD 9.00；95% CI 1.64∼16.36)及不良事件，以上各項均傾向支持膀胱訓練；而一週中日間排尿次數(WMD 2.80；95% CI 0.91∼4.69)則傾向支持藥物治療。第三個試驗的參與者在治療結束時自覺痊癒剛好達列統計意義(RR 1.50；95% CI 1.02∼2.21)，傾向支持膀胱訓練，而此項差異持續至治療後兩個月。兩項比較膀胱訓練及骨盆底肌肉訓練加上生物回饋的試驗共包含164名婦女，無任何一項主要結果的差異達統計上的意義。合併膀胱訓練及其他治療與單獨其他治療比較：有兩項共計331名參與者的試驗比較膀胱訓練加上抗副交感神經藥物與單獨使用該藥。在參與者最多的一項試驗中只呈現一項先行指定的結果：兩組參與者失禁次數的中值數相同。一項包括125名婦女的試驗比較膀胱訓練配合骨盆底肌肉訓練加上生物回饋與單獨骨盆底肌肉訓練加上生物回饋之效果。兩組參與者在治療當下及之後在自覺改善及生活品質方面均達到統計上的意義，傾向支持膀胱訓練配合骨盆底肌肉訓練加上生物回饋(自覺改善：RR 1.18；95% CI 1.01∼1.39；生活品質：MD −47.20；95% CI −87.03∼−7.73)，這些並沒有維持到三個月
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌