Physical Therapy Cuts Urine Leaks in Women With Osteoporosis

Marcia Frellick

February 23, 2016

Physical therapy (PT) with pelvic floor muscle training resulted in a 75% reduction in urinary-leakage episodes among postmenopausal women with osteoporosis and urinary incontinence (UI), according to results of a new study published online February 17 in Menopause.

The small study is the first randomized, controlled trial that has tested physical therapy's ability to reduce urinary incontinence among this group.

Meena Sran, PhD, from the BC Women's Hospital & Health Centre in Vancouver, British Columbia, and colleagues recruited 48 women ages 55 and older who had osteoporosis or low bone density and UI.

Half were randomly assigned to the 12-week, once-per-week, PT intervention group and half to the control group, which received intensive osteoporosis education.

The primary outcome measure was weekly median number of leakage episodes recorded by participants in 7-day diaries at baseline, after treatment and at 1 year.

Three months into the study, the women in the PT group saw a reduction of 75% in the physical-therapy group (eight to two leakage episodes per week) vs the control group, which saw no reduction (5.5 to 5.5 episodes), for a significant difference (P = .04). At 1 year, physical-therapy participants maintained the gains, whereas the control participants' incontinence worsened (P = .01). The effect size was 0.34 at 1 year, and no harms were reported.

Study Makes Important Link

The stakes for finding an effective treatment for urinary incontinence are high. Dr Sran and colleagues note that up to 28% of older women experience weekly UI, and the rate is even higher in women with osteoporosis.

"Not only is it a top health priority for this demographic of the population, it is also related to reduced physical activity and increased risk of falls and is the second leading cause of admissions to long-term care," they write.

JoAnn Pinkerton, MD, NCMP, executive director of the North American Menopause Society and professor of obstetrics and gynecology at the University of Virginia Health Center in Charlottesville, told Medscape Medical News that's a link she hadn't made before this study and one that should spark conversation between women and their providers.

"Since incontinence is associated with a high risk of falls and also associated with osteoporosis, women who have bone loss should be assessed for incontinence as a potential risk for falls and fractures," she advised. Incontinence is often associated with urgency in older women and rushing to the bathroom is an independent risk factor for falls.

Finding out that a nondrug alternative for UI works may help women with osteoporosis get back to the exercise that is essential to helping them get stronger, she noted. Women who are embarrassed about leakage might have stopped exercising, but now they may be more likely to do the physical therapy to treat the UI and then resume exercising to help the osteoporosis, Dr Pinkerton said.

And while endocrinologists are asking the questions to determine fracture risk and gynecologists and primary-care physicians are asking questions related to women aging, the questions may not be asked in the same setting, missing the big picture, she added.

Intervention vs Control

In addition to pelvic floor muscle exercises, the PT intervention added biofeedback and other training on urge control and dietary changes. The women in the control group had a 3-hour education session on how to change physical activity, diet, and medications to prevent or treat osteoporosis, 60-minute one-on-one sessions with a dietitian and physical therapist, and extensive follow-up with healthcare providers.

The study does have limitations. In addition to the small study size, the average age of the women in both groups was 66, and as a result they may be more likely than older women to adhere to an exercise regimen, Dr Sran and colleagues say.

At the 3-month follow-up, 33% of participants in the PT group had completed 100% of the home exercises and 33% completed 70% to 99%. At 1 year, 78% continued to do the pelvic floor exercises and 67% did so regularly (daily to three times a week).

" Whether a significantly older population would adhere to or have the same results remains unknown, but a previous study of women aged 70 and above who did not have osteoporosis or low bone density also found positive results for exercise adherence," they conclude.

The study was funded by the BC Women's Health Research Institute. The authors report no relevant financial relationships. Dr Pinkerton reports receiving consultant work for Pfizer and grant/research support from TherapeuticsMD.

Menopause. Published online February 17, 2016. Abstract

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