News Release: Research

May 10,  2011

Behavioral Therapy Effective in Treating Urinary Incontinence in Parkinson's Disease

Exercise-based behavioral therapy for older adults with Parkinson’s disease leads to a reduction in frequency of urinary incontinence and improvement in quality of life, according to a recent study led by Emory University and the Department of Veterans Affairs. The study appears in the May 10 issue of the journal Neurology (http://neurology.org/).

“This study demonstrates feasibility and efficacy of pelvic floor muscle exercise-based behavioral therapy to treat urinary incontinence in older adults with Parkinson’s. These results are promising and should be evaluated in randomized controlled trials,” says lead investigator Camille P. Vaughan, MD, MS, assistant professor in the Emory School of Medicine’s Division of Geriatric Medicine & Gerontology and investigator with the Birmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center (GRECC).

There are several compelling reasons to treat urinary incontinence in Parkinson’s disease patients, particularly without additional medications, says Vaughan.

“In one recent study,” Vaughan adds, “quality of life scores in patients with moderate Parkinson’s were more closely associated with a measure of lower urinary tract symptom severity than with a measure of their physical disability, and older patients with Parkinson’s disease suffering from urinary incontinence are at greater risk for falls and their caregivers report more stress than those without urinary incontinence.”

Participants in the study were 50 years of age or older and were recruited from Oct. 2008 to Oct. 2009 at Veterans Affairs and Emory University movement disorder clinics in Atlanta. All were diagnosed with Parkinson’s by a movement disorder specialist. Potential participants were evaluated for eligibility with the following: history and physical examination, mental status assessment, simple laboratory tests, urinalysis and culture.

The behavioral intervention was administered for a total of five visits over eight weeks. At the first visit, computer-assisted dual-channel EMG biofeedback was used to help participants identify pelvic floor muscles and teach them to contract and relax these muscles in isolation while keeping abdominal muscles relaxed. Participants were given guidance regarding fluid management and education regarding constipation.

Participants were instructed to perform daily pelvic floor muscle contractions and relaxations. They were taught an urge-suppression strategy and a strategy to reduce stress-related urine loss.

Participants were offered a session of biofeedback, and subsequent visits were used to promote exercise adherence and reinforce bladder control strategies. 

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