Evaluation and Biofeedback Treatment
At least 13 million U.S. adults living in the community, and more than 50% of all residents in nursing facilities, suffer from urinary incontinence (UI) (Agency for Health Care Policy and Research, 1996). The direct medical costs of caring for incontinent people in the community are more than $15 billion annually, plus $35.2 billion for nursing home residents. Indirect costs (which include costs for protective garments, loss of income, and/or costs for caring for an incontinent person in the home are difficult to estimate. Moreover, the embarrassment, depression and social isolation associated with UI probably, contribute to hidden costs related to the abandonment of exercise and other activities that maintain health and well-being (Nygaard, DeLancy, Amsdorf, & Murphy, 1990).
Despite its prevalence and implications, UI is underreported, and often health care providers do not treat it comprehensively (Agency for Health Care Policy and Research, 1996). This is unfortunate, given estimates that available treatments can cure or significantly improve most forms of UI. There is a consensus that in most cases, behavioral treatments, including biofeedback, should be used before invasive treatments such as surgery. This chapter reviews essential issues and procedures related to using biofeedback for UI. (As in other chapters, italics on first use of a term indicate that the term is included in the glossary at the end of the chapter.)
Behavioral treatments for UI aim to alter complex bladder control mechanisms that coordinate smooth and striated muscle activity. This section contains a condensed summary and not a comprehensive review of the anatomical and physiological concepts that need to be understood by therapists who use behavioral treatments for UI. We refer readers to the references and texts for further study of bladder anatomy and physiology before application of biofeedback techniques for UI (Mundy, Stephenson, & Wein, 1984; Hald & Bradley, 1982; Grey, 2000; Krane & Siroky, 1991; Torrens & Morrison, 1987; Ostergard & Bent, 1991; Wein & Barrett, 1988).