Online management of female urinary incontinence

Urinary incontinence is a common problem concerning half a million of Swedes. The problem is more prevalent among women than men, and increases with age. Urinary incontinence may affect quality of life and is associated with high societal costs, mainly costs for incontinence aids. Different studies have shown that 7-9 percent of women experience urinary leakage of such severity that they want treatment. We also know that basic investigation and treatment in primary care may help two thirds of women that seek help. Women often use the Internet for information and advice on symptoms and health problems, especially if they are perceived as “embarrassing”. An advantage with an Internet based treatment is that the individual retain the control of the treatment. A cognitive behavioural therapy (CBT) programme via the Internet has shown to be effective in studies of headache, social phobia, tinnitus and other health problems. We therefore want to study if women with urinary leakage want to participate in an investigation and treatment programme via the Internet. The treatment is based on information, pelvic floor muscle training and a programme according to CBT principles, where thoughts, emotions and behaviour connected with the problem is dealt with. The effect of the Internet programme will be compared to the effect of an ordinary information and exercise programme sent by letter. Women, aged 20 to 70 years, are invited to the study via an official web-site (1177). The treatment period is three months. In the first study, with start autumn 2009, women with stress urinary incontinence (leakage during cough, jumping and sneezing) are invited. In the Internet programme, different exercises and information are introduced weekly according to established principles for Internet-based CBT programmes. “Homework” is corresponded via e-mail. An inquiry service is associated with the programme and questions are answered by an urotherapist, a doctor and a psychologist.