Strategies for Managing Stress Incontinence Are Not Additive or Long-Lasting

Behavioral therapy for urinary stress incontinence (i.e., instruction in pelvic floor muscle training) is effective, but this approach has not been evaluated in comparison to or in combination with vaginal continence pessaries. Investigators randomized 446 U.S. women to pessaries, behavioral therapy, or a combination of the two methods and assessed treatment efficacy for 1 year at 3-month intervals.

At 3 months, half of the women in the behavioral group and one third of those in the pessary group had no bothersome stress-incontinence symptoms (P=0.006) as indicated by responses in the Pelvic Floor Distress Inventory. However, intent-to-treat analysis showed no statistical differences among groups: 40% of the pessary group, 49% of the behavio…