Please select the eligibility criteria that correspond to the clinical trial below.
Title: Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms
Brief Summary: This three-site randomized controlled trial compares the effectiveness and cost-effectiveness of a group-administered behavioral treatment program to no treatment. Women with stress, urgency, or mixed urinary incontinence will be recruited and screened centrally, evaluated clinically at each of three study sites, and random assigned to one of two treatment arms: 1. Group behavioral treatment or 2. No treatment. Group treatment modalities have the potential to reach a larger population of older women with urinary incontinence, not only in the traditional medical settings, but also in community settings. The investigators hypothesize that group behavioral treatment will be more effective than no treatment. The investigators hypothesize that the group treatment will be cost-effective compared to no treatment.


Options:
A: Inclusion Criteria:

* Urgency urinary incontinence or mixed urinary incontinence, established via telephone interview
* Urinary leakage twice a week or more often
* Duration of urinary leakage with urgency for at least 12 months
* Ability to read and write Swedish
* Asset to a smartphone (minimum iOS\* 8.0 for Apple, 4.0.3 for Androids
* Possibility to send and receive email and asset to printer
* Motivation and time to perform a 15 weeks long treatment programme with focus on self-care and behavioural training (mainly pelvic floor muscle training and bladder training).
* Accept to be randomized to one of two groups; a treatment app group or an information app Group

  * iOS=mobile operating system including iPhone, iPad and iPod touch

Exclusion Criteria:

* Participation in our previous internet or smartphone study
* Ongoing pregnancy
* Former incontinence surgery
* Known malignancy in lower abdomen
* Unassessed difficulties in emptying bladder
* Visual blood in urine
* Three or more urinary tract infections during the last 12 months
* One or more pyelonephritis during the last three years
* Painful micturition
* Painful urgency
* Intermenstrual bleeding
* Neurological disease such as multiple sclerosis or Parkinsons disease
* Previous stroke
* Diabetes mellitus
* Maximum voided volume of less than 150 ml (micturition chart)
* Regular use of any mobile app for pelvic floor muscle training during the last month
* Usage of antimuscarinic drugs or mirabegron during the last month
B: Inclusion Criteria:

1. Female
2. Aged 55 years or older
3. Ability to understand, read and write English
4. Stress, urgency, or mixed urgency and stress urinary incontinence (UI) (by self report)
5. On the International Consultation on Incontinence Modular Questionnaire - Short Form (ICIQ UI-SF), frequency of leakage at least a 1 ("about once a week or less often") on item #1 and volume of urine loss at least a 2 ("a small amount") on item #2.
6. Symptoms of three months duration or longer (on history)
7. Passing score (i.e., categorized as "probably not demented") on the MiniCog Test
8. Timed "Up and Go" Test (TUG) score of 20 seconds or less
9. Willing to undergo vaginal/pelvic examination
10. Signed informed consent form

Exclusion Criteria:

1. History of renal, bladder, uterine, ovarian, urethral, anal or rectal cancer, radiation therapy to the pelvis for any cancer/malignancy, or any active cancer/malignancy (except skin cancer)
2. Non-ambulatory (participant confined to bed or wheelchair)
3. Persistent pelvic pain (defined as daily pelvic pain \> 3 months)
4. History of neurologic or end-stage diseases (e.g. cerebral vascular accident (CVA), Parkinson's disease, multiple sclerosis, epilepsy, spinal cord tumor or trauma, spina bifida, symptomatic herniated disc)
5. Previous treatment or current participation in a research study for UI, including surgery or formal behavioral treatment (pelvic floor muscle training, biofeedback, pelvic floor electrical stimulation, percutaneous tibial nerve stimulation, sacral neuromodulation, botox or other periurethral injection)
6. Currently taking urinary incontinence or overactive bladder medications
7. History of other urinary conditions or procedures that may affect continence status (e.g. urethral diverticula, previous augmentation cystoplasty or artificial urinary sphincter; implanted nerve stimulators for urinary symptoms)
8. Participation in any drug/device research study.
9. Pelvic organ prolapse protruding past the introitus (at rest or persisting after strain)
10. Evidence of urinary tract infection (UTI) by urine dipstick (leukocytes +1 or greater, nitrites +1 or greater, leukocytes alone (w/o nitrites) +2 or greater, or presence of hematuria \> +1). Participants may be re-screened after treatment with antibiotics or if hematuria work-up is negative.
11. History of 2 or more recurrent UTI's within the past year; more than one UTI within past 6 months
12. Post void residual urine volume 150 cc or more.
13. Unstable medical condition (as determined by site PI)

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C: Inclusion Criteria:

* Women with IUU and / or IUM with a predominance of urinary urgency, capable of contracting MAPs adequately, and who agree to participate in the study, signing the Informed Consent Form.

Exclusion Criteria:

* Women with a diagnosis of glaucoma, myasthenia gravis, urinary tract obstruction, neurological and chronic-degenerative diseases, decompensated diabetic patients and patients with complete denervation of the pelvic floor, pregnancy, abnormal genital bleeding, impairment of cognition, inability to fill in the diary voiding, genital dystopias beyond the vaginal introitus and urethral sphincter defect. Patients may not be in use or have used anticholinergics, tricyclic antidepressants or local hormone therapy within the six months prior to the study.
D: Inclusion Criteria:

* Symptoms of overactive bladder (including urinary frequency, urgency with/without urge incontinence) for\> 3 months

Exclusion Criteria:

* Clinically significant outflow obstruction
* Significant post void residual volume
* Significant stress incontinence or mixed stress/urge incontinence where stress is the predominant factor as determined by the investigator.
* Patient with a neurological cause for abnormal detrusor activity.
* Evidence of a symptomatic urinary tract infection, chronic inflammation such as interstitial cystitis, bladder stones, previous pelvic radiation therapy or previous or current malignant disease of the pelvic organs

Answer: B