Research Article| Volume 146, P42-48, April 2021

Effects of unsupervised behavioral and pelvic floor muscle training programs on nocturia, urinary urgency, and urinary frequency in postmenopausal women: Secondary analysis of a randomized, two-arm, parallel design, superiority trial (TULIP study)


      • The 2-hrClass format unsupervised behavioral and pelvic floor muscle training program improved urinary outcomes of women.
      • The 20-minVideo format unsupervised behavioral and pelvic floor muscle training program improved urinary outcomes of women.
      • The moderating effects of the intervention delivery formats could not be determined.



      To determine and compare the effects of an unsupervised behavioral and pelvic floor muscle training (B-PFMT) program delivered in two formats on nocturia, urinary urgency, and urinary frequency in postmenopausal women.

      Study design

      A secondary analysis used data collected from women enrolled in the TULIP study. Women aged 55 years or more with no urinary incontinence were provided the B-PFMT program. Each woman was randomly assigned to a face-to-face class that took about 2 h (2-hrClass) or to a DVD showing essentially the same information as a 20-minute video (20-minVideo). All women were instructed to independently continue the program following their education session. Three urinary outcomes were assessed at baseline, 3, 12, and 24 months.

      Main outcome measures

      Nocturia and urinary urgency were examined with one item each from the questionnaire-based voiding diary, and urinary frequency was assessed with patients’ self-documenting 3-day bladder diary.


      Women in the 2-hrClass group experienced significantly fewer nocturia episodes and longer average inter-void interval at each follow-up and fewer urinary urgency episodes at 12 months. Women in the 20-minVideo group experienced significantly fewer episodes of nocturia and urinary urgency and longer average inter-void interval at each follow-up time point. No significant between-group differences were found for any outcome, except for nocturia at 24 months, when effectiveness favored women in the 20-minVideo group.


      Unsupervised B-PFMT programs are effective for improving postmenopausal women’s urinary outcomes regardless of the format. The optimal format to deliver B-PFMT programs in terms of effectiveness should be explored in future studies.


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