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Re: A Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women: A Pilot Randomized Trial
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Re: A Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women: A Pilot Randomized Trial A. J. Huang, H. E. Jenny, M. A. Chesney, M. Schembri and L. L. Subak Departments of Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Urology, University of California San Francisco, San Francisco, California, and Icahn School of Medicine at Mount Sinai, New York, New York Female Pelvic Med Reconstr Surg 2014; 20: 147e154.
Permission to Publish Abstract Not Granted
Re: Comparison of Mindfulness-Based Stress Reduction versus Yoga on Urinary Urge Incontinence: A Randomized Pilot Study with 6-Month and 1-Year Follow-up Visits J. Baker, D. Costa, J. M. Guarino and I. Nygaard Departments of Obstetrics and Gynecology, and Occupational Therapy, University of Utah School of Medicine, Salt Lake City, Utah Female Pelvic Med Reconstr Surg 2014; 20: 141e146.
Permission to Publish Abstract Not Granted Editorial Comment: These 2 studies, each with a minimum number of patients, both using unconventional therapy for lower urinary tract symptoms, could be easily dismissed but stranger things have been proved true. The article by Huang et al was a randomized study of ambulatory women aged 40 or older with stress urinary incontinence, urgency urinary incontinence or mixed incontinence. Randomization was to a 6-week yoga therapy program (twice weekly group classes and once weekly home practice) or a waiting list control group. All participants also received written pamphlets regarding standard behavioral self-management strategies. Mean baseline frequency of incontinence was 2.5 episodes daily. After 6 weeks this decreased by 70% (1.8 fewer episodes) in the yoga therapy group vs 13% (0.3) in the control group (p ¼ 0.049). Those in the yoga therapy group reported an average 71% decrease in stress urinary incontinence frequency (0.7), compared to a 25% increase in controls. No significant differences in the reduction of urgency incontinence were detected. Baker et al looked at women 18 years or older with 5 or more episodes per day of urge predominant incontinence in a 3-day voiding diary. They were randomized to “mindfulness based stress reduction (MBSR) vs yoga.” MBSR is described as a group based psychoeducational intervention that teaches participants mindfulness techniques and has been used to treat or reduce symptoms in a wide variety of conditions, including irritable bowel syndrome. This is delivered in a class based format of 2-hour sessions every 8 weeks. Yoga classes met weekly for 8 weeks. Neither group received any form of usual behavioral treatment of urgency urinary incontinence. The primary outcome measure was mean percent change from baseline of urgency incontinence episodes in a 3-day diary 8 weeks after initiated MBSR. Baseline median values were 2.67 (range 1.67 to 6.33) for the yoga group and 3.00 (1.67 to 9.33) for the MBSR group. Those in the MBSR group employed multiple structured and unstructured practice sessions per week during the 8-week period. At 8 weeks, 6 months and 12 months the median percent change in urgency incontinence episodes on an intention-to-treat analysis was greater for the MBSR group (minus 54.6%, minus 71.4%, minus 66.7%) compared to that for the yoga group (minus 33.3%, minus 11.8%, minus 16.7), with p values ranging from 0.01 to 0.08. In the protocol analysis at 8 weeks 6 of 13 women enrolled in the MBSR program and 0 of 11 in the yoga program reported that they were much better (p ¼ 0.02), as did 6 of 12 and 1 of 9, respectively, at 1 year (p ¼ 0.16). There were no differences in the groups in daytime voids, nighttime voids or pad usage for the 3 evaluation periods. There are obviously many possible factors that could contribute to the improvement seen in the various therapy groups in these 2 studies. However, whatever the mechanism and extenuating factors, a positive result seems to have been achieved, which hopefully will prompt others to dissect the exact causes of the improvement observed. Alan J. Wein, MD, PhD (hon)
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Re: A Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women: A Pilot Randomized Trial A. J. Huang, H. E. Jenny, M. A. Chesney, M. Schembri and L. L. Subak Departments of Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Urology, University of California San Francisco, San Francisco, California, and Icahn School of Medicine at Mount Sinai, New York, New York Female Pelvic Med Reconstr Surg 2014; 20: 147e154.
Permission to Publish Abstract Not Granted
Re: Comparison of Mindfulness-Based Stress Reduction versus Yoga on Urinary Urge Incontinence: A Randomized Pilot Study with 6-Month and 1-Year Follow-up Visits J. Baker, D. Costa, J. M. Guarino and I. Nygaard Departments of Obstetrics and Gynecology, and Occupational Therapy, University of Utah School of Medicine, Salt Lake City, Utah Female Pelvic Med Reconstr Surg 2014; 20: 141e146.
Permission to Publish Abstract Not Granted Editorial Comment: These 2 studies, each with a minimum number of patients, both using unconventional therapy for lower urinary tract symptoms, could be easily dismissed but stranger things have been proved true. The article by Huang et al was a randomized study of ambulatory women aged 40 or older with stress urinary incontinence, urgency urinary incontinence or mixed incontinence. Randomization was to a 6-week yoga therapy program (twice weekly group classes and once weekly home practice) or a waiting list control group. All participants also received written pamphlets regarding standard behavioral self-management strategies. Mean baseline frequency of incontinence was 2.5 episodes daily. After 6 weeks this decreased by 70% (1.8 fewer episodes) in the yoga therapy group vs 13% (0.3) in the control group (p ¼ 0.049). Those in the yoga therapy group reported an average 71% decrease in stress urinary incontinence frequency (0.7), compared to a 25% increase in controls. No significant differences in the reduction of urgency incontinence were detected. Baker et al looked at women 18 years or older with 5 or more episodes per day of urge predominant incontinence in a 3-day voiding diary. They were randomized to “mindfulness based stress reduction (MBSR) vs yoga.” MBSR is described as a group based psychoeducational intervention that teaches participants mindfulness techniques and has been used to treat or reduce symptoms in a wide variety of conditions, including irritable bowel syndrome. This is delivered in a class based format of 2-hour sessions every 8 weeks. Yoga classes met weekly for 8 weeks. Neither group received any form of usual behavioral treatment of urgency urinary incontinence. The primary outcome measure was mean percent change from baseline of urgency incontinence episodes in a 3-day diary 8 weeks after initiated MBSR. Baseline median values were 2.67 (range 1.67 to 6.33) for the yoga group and 3.00 (1.67 to 9.33) for the MBSR group. Those in the MBSR group employed multiple structured and unstructured practice sessions per week during the 8-week period. At 8 weeks, 6 months and 12 months the median percent change in urgency incontinence episodes on an intention-to-treat analysis was greater for the MBSR group (minus 54.6%, minus 71.4%, minus 66.7%) compared to that for the yoga group (minus 33.3%, minus 11.8%, minus 16.7), with p values ranging from 0.01 to 0.08. In the protocol analysis at 8 weeks 6 of 13 women enrolled in the MBSR program and 0 of 11 in the yoga program reported that they were much better (p ¼ 0.02), as did 6 of 12 and 1 of 9, respectively, at 1 year (p ¼ 0.16). There were no differences in the groups in daytime voids, nighttime voids or pad usage for the 3 evaluation periods. There are obviously many possible factors that could contribute to the improvement seen in the various therapy groups in these 2 studies. However, whatever the mechanism and extenuating factors, a positive result seems to have been achieved, which hopefully will prompt others to dissect the exact causes of the improvement observed. Alan J. Wein, MD, PhD (hon)
1313