Lead Investigator
Areas of Impact
Overview
To reduce or prevent incontinence in older women, we have designed and tested a workshop led by trained leaders to increase skills to control incontinence symptoms through lifestyle changes. “Mind Over Matter: Healthy Bowels, Healthy Bladder” has been shown to improve continence, quality of life, and self-efficacy. The program was tested in a randomized controlled trial and is now being adapted for digital delivery.
The Clinical Problem
“Both fecal and urinary incontinence are surprisingly common but they’re stigmatized – so nobody wants to talk about them.” — Dr. Heidi Brown
Approximately 60% of women over the age of 50 experience occasional or frequent urinary or fecal incontinence. This increases their risk of depression, falls, hospitalization, and nursing home placement. Symptoms can be improved or even cured without medications or surgery, but most women with incontinence do not seek care and are unaware of these self-management strategies.
Our Response
“Mind Over Matter: Healthy Bowels, Healthy Bladder”
Dr. Heidi Brown, Assistant Professor in the Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health, developed a workshop for women over 50 to build skills and self-efficacy to control incontinence symptoms through exercises and lifestyle changes. The workshop, named “Mind Over Matter: Healthy Bowels, Healthy Bladder,” is a community-based, small-group behavior intervention led by a trained facilitator. The program also provides resources to help women discuss their symptoms with their doctor.
Development of “Mind Over Matter”
“Mind Over Matter” is inspired by a program offered in senior centers in the United Kingdom that was found to significantly reduce urinary incontinence. Dr. Brown was awarded an NIH K12 grant to adapt the UK program to target bowel and bladder symptoms and received a grant from the Wisconsin Partnership Program to conduct a randomized controlled trial to test the efficacy of the adapted program.
Results
“The program is not focused so much on symptoms as on things they can do to relieve them, such as changing diet, fluid intake and exercise. People realize they are in it together.” — Meg Wise, PHD
Participation in “Mind Over Matter” improved both urinary incontinence and fecal incontinence and resulted in sustained behavior change four months after initiating the intervention. The trial took place in 6 workshops in community settings, with 121 women enrolled. At 4 months after the intervention, 71% of women in the treatment group vs 23% of controls reported improvements in urinary incontinence. Fifty-five percent of women in the treatment group vs. 27% of controls reported improvements in fecal incontinence. Women in the treatment group improved more than the women in the control group on all validated instruments of urinary and fecal incontinence severity, quality of life, and self-efficacy.
Lasting Impact
The innovative product of our research, Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM), is the first and only evidence-based program in the country that improves bladder and bowel symptoms in older women. Recognized by the National Council on Aging for its evidence-base, community organizations can now use Older Americans Act funds to implement the program. Since dissemination started in WI in 2019, over 50 individuals have become certified MOM facilitators, offering more than 60 MOM workshops in 25 counties, and reaching over 500 WI women in just 2.5 years. National dissemination started in 2021 and 5 states outside WI are already licensed to disseminate MOM, including Missouri, Massachusetts, Idaho, Utah, and Arizona.
Dr. Brown was recently awarded an NIH R01 grant to understand whether, and how, tailoring an online continence intervention can increase engagement and uptake of health behaviors known to improve incontinence symptoms.
References
- Schmuhl NB, Brow KA, Wise ME, Myers S, Mahoney JE, Brown HW. After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World. J Am Geriatr Soc. 2020 Nov;68(11):2668-2674.
- Brown HW, Braun EJ, Wise ME, Myers S, Li Z, Sampene E, Jansen SM, Moberg DP, Mahoney JE, Rogers RG. Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial. Obstet Gynecol. 2019 Sep;134(3):600-610.
- Brown HW, Guan W, Schmuhl NB, Smith PD, Whitehead WE, Rogers RG. If We Don’t Ask, They Won’t Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers. J Am Board Fam Med. 2018 Sep-Oct;31(5):774-782.
- Brown HW, Wise ME, Westenberg D, Schmuhl NB, Brezoczky KL, Rogers RG, Constantine ML. Validation of an instrument to assess barriers to care-seeking for accidental bowel leakage in women: the BCABL questionnaire. Int Urogynecol J. 2017 Sep;28(9):1319-1328.
- Brown HW, Rogers RG, Wise ME. Barriers to seeking care for accidental bowel leakage: a qualitative study. Int Urogynecol J. 2017 Apr;28(4):543-551.