Physical Therapy Improves Continence for Older Women with Osteoporosis

Canadian researchers suggest physical therapy that includes pelvic floor muscle training can produce dramatic improvements in urinary incontinence in women with osteoporosis. The study was published online ahead of print in Menopause (2016;23(3):286-293).

Researchers recruited 48 women age 55 years and older from an osteoporosis clinic and the waitlist for a continence clinic. The women were post-menopausal and had incontinence and osteoporosis or low bone density. Incontinence included stress incontinence (leaking when activity puts pressure on the bladder, such as coughing or running), urge incontinence (leaking before reaching the bathroom with a strong urge to urinate), or a mixture of the two types. 

At the beginning of the study, after 3 months, and after 1 year, all of the women completed bladder diaries, incontinence and self-efficacy questionnaires, and pad tests, which measure how much urine leaks over 24 hours.

Half of the participants went through 12 weekly sessions of physical therapy with a trained physical therapist. The therapy involved pelvic floor muscle exercise and retraining with biofeedback as well as other interventions such as urge control techniques and dietary changes. The other half of participants had a 3-hour education session on physical activity, diet, and medications used to prevent or treat osteoporosis; one-on-one sessions with a dietitian and physical therapist; and extensive follow-up discussions with health care providers.

Three months after the study began, participants who underwent physical therapy had a dramatic 75% reduction in urine leaks, whereas the other group of participants had no change. The physical therapy group also had significantly better results on the incontinence questionnaires. One year later, participants who underwent physical therapy still had a 75% reduction in leak episodes, whereas the other group of participants had more leak episodes. The physical therapy group also had better pad test results and better scores on one of the incontinence questionnaires.

The study is the first-ever randomized, controlled trial to evaluate physical therapy for incontinence in postmenopausal women with osteoporosis or low bone mass. Although the association between osteoporosis and worse problems with incontinence is currently unclear, it is crucial for this population to receive effective management for their incontinence.—Amanda Del Signore