CLINICAL ARTICLE Behavioral therapy for urinary incontinence in India Santosh Kumari, Vanita Jain, Arup Kumar Mandal, Amarjeet Singh ⁎ Post Graduate Institute of Medical Education and Research, Chandigarh, India Received 6 May 2008; received in revised form 10 June 2008; accepted 12 June 2008 Abstract Objective: To ascertain the prevalence of urinary incontinence in a sample of women from northern India, and the impact of behavioral therapy to treat its occurrence and severity. Methods: A randomized controlled trial conducted from 2005–2006 to test the null hypothesis that behavioral therapy would not have an effect on urinary incontinence. Following a prevalence study, a total of 198 women with urinary incontinence were randomized into 2 groups: an intervention group (behavioral therapy) and a control group (no therapy). Results: The prevalence of urinary incontinence was 11.6%. After an 8-month follow-up period, 41 women (52.5%) in the intervention group had become continent, and severity had shifted from severe to mild in 19 women (24.4%). In contrast, 11 women (12.8%) in the control group had become continent. In the intervention group, mean daytime voiding frequency decreased from 9.56 to 7.64, mean nighttime voiding frequency decreased from 1.45 to 0.69, and mean episodes of urine leakage decreased from 1.97 to 0.23. Conclusion: Behavioral therapy was effective in treating urinary incontinence, particularly in women with mild and moderate incontinence. © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. KEYWORDS Behavioral therapy; India; Randomized controlled trial; Urinary incontinence 1. Introduction Urinary incontinence affects women of all ages, but is par- ticularly common among older age groups. Approximately 15%–30% of women suffer from urinary incontinence world- wide [1]. Women with urinary incontinence can have a severely compromised quality of life, with disrupted daily routines, restricted social and leisure activities, and fear of unpleasant odors adding an additional burden. Many women do not report their symptoms for a considerable time [2,3], and those who do seek help may not receive adequate support or attention to treat the condition. Although several treatment options are available, incontinence is an often neglected problem. Urinary incontinence in women can result from pelvic floor muscle weakness associated with age and/or childbirth, and various conditions that increase intra-abdominal pressure also aggravate the situation. Medicinal treatments consist of bladder relaxants, anticholinergics, or smooth muscle relaxants; and although a success rate of 50%–60% has been reported, side effects are also common. Electric stimulation, vaginal cones, urethral plugs, and the injection of bulking agents have also been used. Surgical treatments include colposuspension, pubovaginal sling placement, and vaginal tape procedures. The success rate of surgical treatments is ⁎ Corresponding author. School of Public Health, PGIMER, Chandigarh, 160012, India. Tel.: +91 172 2755217; fax: +91 172 2744401. E-mail addresses: amarminhas56@rediffmail.com, dramar56@sifymail.com (A. Singh). 0020-7292/$ - see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2008.06.019 available at www.sciencedirect.com www.elsevier.com/locate/ijgo International Journal of Gynecology and Obstetrics (2008) 103, 125–130