Internet‐based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training
Authors: Sjöström Malin , Umefjord Göran , Stenlund Hans , Carlbring Per , Andersson Gerhard , Samuelsson Eva 
Published: January 2013

What's known on the subject? and What does the study add?
Stress urinary incontinence (SUI) affects 10‒35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment.
Management of SUI without face‐to‐face contact is possible, and Internet‐based treatment is a new, promising treatment alternative.
Objective
To compare two treatment programmes for stress urinary incontinence (SUI) without face‐to‐face contact: one Internet‐based and one sent by post.
Patients and Methods
Randomised, controlled trial conducted in Sweden 2009–2011. Computer‐generated block‐randomisation, allocation by independent administrator. No ‘blinding’.
The study included 250 community‐dwelling women aged 18–70 years, with SUI ≥1 time/week. Consecutive online recruitment.
The women had 3 months of either; (i) An Internet‐based treatment programme (124 women), including e‐mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training.
Primary outcomes: symptom‐score (International Consultation on Incontinence Questionnaire Short Form, ICIQ‐UI SF) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptoms Quality of Life, ICIQ‐LUTSQoL). Secondary outcomes: (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health‐specific QoL (EQ5D‐Visual Analogue Scale), and (v) Incontinence episode frequency. Follow‐up after 4 months via self‐assessed postal questionnaires.
Results
In all, 12% (30 women) were lost to follow‐up. Intention‐to‐treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean (sd) changes in symptom‐score were: Internet 3.4 (3.4), Postal 2.9 (3.1) (P = 0.27). The mean (sd) changes in condition‐specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) (P = 0.52).
Compared with the postal‐group, more participants in the Internet‐group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001).
Health‐specific QoL improved in the Internet‐group (mean change 3.7 (10.9), P = 0.001), but not in the postal‐group (1.9 (13.0), P = 0.13).
Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%.
Conclusions
Concerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet‐based treatment was more effective.
Internet‐based treatment for SUI is a new, promising treatment alternative.