Clinical Section

Gerontology 2008;54:224231
DOI: 10.1159/000133565

Received: August 7, 2007

Accepted: February 14, 2008
Published online: May 16, 2008

Bladder Training and Kegel Exercises for

Women with Urinary Complaints Living
in a Rest Home
Ergul Aslan a Nuran Komurcu c Nezihe Kizilkaya Beji a Onay Yalcin b
a

Department of Obstetrics and Gynecologic Nursing, Florence Nightingale School of Nursing, and
Department of Gynecology and Obstetrics, Istanbul Medical Faculty, Istanbul University, and
c
Faculty of Health Sciences, Department of Nursing, Marmara University, Istanbul, Turkey
b

Key Words
Urinary incontinence Bladder training Kegel exercises
Old age

Abstract
Background: Urinary incontinence is an annoying, uncomfortable and unpleasant condition affecting the elderly. The
problem of bedwetting and other urinary complaints are
common in rest homes. Objective: Our study aimed to determine the efficiency of bladder training and Kegel exercises for older women living in a rest home. Methods: This is
an experimental prospective research study. Through a randomization process, 25 women were included in the treatment group, and another 25 were included in the control
group. Participants were living in a rest home for women
aged older than 65 years with urinary complaints. The pretreatment interview form, Quality of Life Scale, Mini-Mental
Test, Rankin Scale, daily urinary forms and pad tests were
administered to the treatment and control groups. Bladder
training and Kegel exercises were given to the treatment
group for 68 weeks. The second evaluation was performed
8 weeks after treatment, and the last evaluation was carried
out 6 months after treatment. Results: The average age of
the treatment group was 78.88 8 4.80 years, and the average age of the control group 79.44 8 5.32 years. Urgency,
frequency and nocturia were common complaints. Pretreat-

2008 S. Karger AG, Basel

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ment, 8-week and 6-month evaluations revealed that the

amount of urinary incontinence with urgency, frequency
and nocturia complaints statistically and significantly decreased in the treatment group compared to the control
group. In the pad test results, a statistically significant decrease was observed in the treatment group compared to
the control group. A significant increase in pelvic floor
strength was observed in the treatment group compared to
the control group upon all evaluations. Conclusion: Behavioral therapy can be used easily as an effective treatment for
urinary incontinence in elderly women living at a rest
home.
Copyright 2008 S. Karger AG, Basel

Introduction

Urinary incontinence is a multifactorial syndrome

emerging as a result of pathologies developing due to agedependent changes in the genitourinary system and/or
systemic problems affecting normal urination [1]. It is an
annoying, uncomfortable and unpleasant condition affecting the elderly. The bladder capacity decreases with
age, and problems like stress incontinence, difficulty urinating, urgency and urge incontinence, nocturia and increased urination frequency are experienced more often
[24].
Ergul Aslan
Florence Nightingale Hemsirelik Yuksekokulu Abide-i Hurriyet cad.
TR34381 Sisli, Istanbul (Turkey)
Tel. +90 212 440 00 00/27 088, Fax +90 212 224 49 90
E-Mail ergul34tr@hotmail.com

Table 1. Test-retest reliability

Test-retest reliabil- Cronbachs

ity (Pearsons r)

King health questionnaire

General health perceptions
Incontinence impact
Role limitations
Physical limitations
Social limitations
Personal relationships
Emotions
Sleep/energy
Severity measures
Mini-mental test
Total score
Orientation
Recording
Attention
Recall
Language

0.78
0.80
0.80
0.99
0.90
0
0.87
0.90
0.83

0.81
0.89
0.89
0.99
0.94
0
0.93
0.93
0.91

0.94
0.69
1
0.98
0.73
0.98

0.86
0.82
1
0.99
0.85
0.99

The problem of bedwetting and other urinary complaints are common in rest homes. Urinary incontinence
is seen in 30% of elderly patients in hospitals and in approximately 5070% of elderly persons living in rest
homes [2, 5]. In a prevalence study that was conducted in
rest homes belonging to state institutions in Istanbul,
Aslan et al. [6] found that 43.4% of females and 20.9% of
males suffered urinary incontinence with a mean duration of symptoms of five years. The majority of elderly
persons with complaints of urinary incontinence did not
seek treatment because of the thought that urinary incontinence is something to be ashamed of, and the perception that it is natural to experience it in old age [5, 7].
A wide range of treatment options are available in
terms of conservative treatment techniques for elderly
patients who are incontinent. These treatment techniques
may lead to a decrease in complaints of up to 3050%, and
this effect can last 12 months [2]. Independent continence
is the desired result in the treatment of urinary incontinence. Achieving this will not be as rapid as social continence (dryness with the use of tools). Dependant continence (dryness with the assistance of others) is an appropriate and realistic option for female patients. The patient
will be able to remain dry with various coping strategies,
such as realizing the need to urinate and finding a toilet,
mobility and skillfulness. When success is achieved, the
elderly person will feel self-confident and happy [2]. There
are no studies on behavioral therapy in women with uriBladder Training and Kegel Exercises for
Older Women

nary complaints in rest homes. The hypothesis of this

research is that behavioral treatment is a prior and effective method of treatment for urinary complaints, and if it
is practiced on women living in rest homes, their urinary
complaints will decrease.

Methods
Our experimental prospective research study aimed to determine the efficiency of bladder training and Kegel exercises for
women of 65 years of age and above with urinary complaints, living at a rest home.
The study was conducted at the Turkish Republic Pension
Fund Nisbetiye Rest and Nursing Home between November 2002
and January 2004. This institution was selected due to its sufficient number of cases for the sample and the high educational
level of the cases. Permission to conduct the study was received by
the management, and ethics board approval was granted by the
ethics council of the rest home.
In order to obtain results for the study, the researcher administered the pretreatment interview form, Quality of Life Scale [8],
Mini-Mental Test [9] and the Rankin Scale [10]. The King Health
Questionnaire, which was adapted appropriately in terms of language in accordance with recommendations received from experts, and the Mini-Mental Test were administered twice to 25
women living at the rest home (between 1 November and 20 November 2002), with a 2-week interval in order to determine the
test-retest reliability (the changing of tested values over time) and
internal consistency (testing each concept in each item with the
same distribution). The results of test-retest reliability of the
scales are presented in table 1.
Women filled in the urinary forms daily in Turkish. All stages
of the study were applied by an experienced nurse (the first author). She is a competent and experienced urogynecology nurse,
and is a doctorate student in obstetric and gynecologic nursing.
Women in the rest home were visited 34 times a week. The first
evaluation of women for the diagnosis of urinary incontinence
and their education took approximately 1 h and follow-up visits
lasted 1530 min.
The presence and degree of incontinence was assessed with the
ICS 1-hour pad test [11]. Digital palpation was used to assess the
pelvic floor muscle strength. Pelvic floor muscle strength was evaluated by digital evaluation using a scale from 1 to 5 where: 0 = unable to contract; 1/5 = trace contraction !2 s; 2/5 = weak contraction 63 s; 3/5 = moderate contraction 46 s, posterior elevation of
fingers, repeated 3 times; 4/5 = strong contraction 79 s, posterior
elevation of fingers, repeated 45 times; 5/5 = very strong contraction 610 s, posterior elevation of fingers, repeated 45 times.
Urine analysis was conducted to identify the presence of infection. Interviews with the elderly women were randomized by assigning 1 case to the treatment group and 1 case to the control
group according to the order of applications received (fig. 1). Both
groups were randomized using envelopes.
Criteria for the inclusion of the cases in the study sample:
To have lived in the rest home for at least 6 months.
To have regular complaints of urinary wetting, urgency, frequency or nocturia. Urgency was defined as a sudden compel-

Gerontology 2008;54:224231

225

ling desire to pass urine, which is difficult to defer, according

to the suggestions of the International Continence Society;
nocturia as more than 2 micturition at night; frequency as
more than 8 micturition in the daytime [1]. Thomas et al. [12]
used a definition of incontinence that includes information
regarding the number of incontinence episodes (more than 2
in a month). Women who reported these complaints were included in the study.
Must not have a chronic or neurological illness that effects
their daily lives (severe paralyses, dementia, arthritis, fractures, etc.).
Must obtain a score of 123 in the Mini-Mental Test, which
shows their mental condition [9].
Must obtain a score between 0 and 3 in the Rankin Scale,
which evaluated their functional condition [10].
To have a sufficient level of literacy and hand motor skills in
order to record their data.
In accordance with the literature, the rate of improvement for
the control group was taken as 15% and the improvement rate for
the treatment group as 50% [2]. According to this data, it was determined that the number of cases was 36 for which the volume
of the sample representing the population is p = 0.15 (control
group) and p = 0.50 (treatment group) at a 95% confidence interval with = 0.05, = 0.20 and power = 0.80 (1 ) and n = 18
cases (for each group). The software Statistical Program for Social
Sciences (SPSS, Primer Biostatistics, version 4.0) was used.
During a period of 68 weeks, the treatment group was given
bladder training, and Kegel exercises were administered. The
training included an explanation of the structure of the lower urinary system, the continence mechanism, the structure of the pelvic floor muscles, problems concerning urination, how to perform the bladder training and pelvic floor muscle exercises
(PFME), and issues in keeping records. When the PFME were being taught, the method of digital palpation was used in order for
the women to become aware of their pelvic floor muscles [2, 14,
15]. However, 30% of elderly women did not accept the use of the
palpation method or other instruments like the perineometer. So,
the structure of pelvic floor and how to contract the pelvic muscles was explained to them with pictures, and they were asked to
stop voiding during micturition to feel the pelvic floor muscles.
In addition, in order to visually represent the concept of contraction, an open-close movement was shown by making the hand
into a fist. By doing this, the relax-contract concept and the repetitions, duration and speed were more easily demonstrated. Instructions on how to perform the exercises were given to the women in the treatment group (see appendix 1).
They were encouraged to abide by the program as much as
possible, and they were interviewed at the end of each week to assess how the program went. If the exercises were not performed
because of difficulties or some other reason, they followed the
same weekly program. This was decided upon by obtaining the
opinion of the woman. The women were given written instructions as to how they were to practice the pelvic floor muscle exercises.
During weekly intervals, the patients were taught to urinate
only at regular intervals in the bladder training, and the formal
program lasted for 68 weeks [2, 16, 17]. The bladder training
program developed by Wyman and Fantl [17] was used. The average voiding interval while awake was calculated from the diary
data. Women were advised to begin their bladder training by ob-

226

Gerontology 2008;54:224231

Total female population of rest home = 191

Total women with urinary incontinence = 85

Total women who were interviewed for behavioral therapy = 76

Received intervention = 64

Treatment = 33

Refused to participate = 12

Control = 31

8-week and 6-month follow-ups

Treatment
Dropped = 7
Died = 1

Control
Dropped = 5
Died = 1

Analyzed = 25

Analyzed = 25

Fig. 1. Flowchart of the study. Reasons for refusing to participate

included: reluctance, a lack of interest and preferring using pads.
Reasons for being dropped from the study included: not performing the interventions regularly, being absent in controls, not to be
able to take records and a poor general health status.

serving a schedule that was consistent with their current micturition interval. It was requested that the patients urinated only at
the times defined by the program during waking hours. It was
recommended that the patients try to refrain from urination until the scheduled time for urination came, even if they felt the need
to urinate. In addition, they were taught ways to overcome the
urge when the need to urinate emerged, e.g. taking deep breaths,
solving crossword puzzles, playing mind games. As the patient
gained adequate control in the periods that were determined, the
periods in-between were increased to 30 min each week and the
regular times to urinate were increased gradually to 34 h. The
procedure for recording on the continence card the times they
urinated or wet themselves was explained. During those 8 weeks,
weekly meetings were held with the women and the program for
the next week was scheduled. If there were difficulties using the
program, then the same program was administered unchanged in
the next week. The women were encouraged to abide by the program as closely as possible during bladder training. The bladder
training and the PFME were not mentioned to the control
group.
Eight weeks after the first meeting, the first follow-up was
conducted; the second follow-up was conducted 6 months after
the first meeting. In these visits, the urinary complaints were
evaluated, the monitoring form and the daily urinary form were
filled in, the quality of life scale and the pad test were administered, and measurements of the pelvic floor muscle strength were
conducted.

Aslan /Komurcu /Beji /Yalcin

Table 2. Demographical characteristics of women

Age, years
7079
8089
Education
Primary school
High school
University
Marital Status
Never married
Divorced
Widowed
Married and living with their partner
Time living in the rest home, years
The number of persons in the room
1
2
Presence of chronic illnesses
Yes
No

Treatment (n = 25)

Control (n = 25)

Total (n = 50)

14
11

56
44

12
13

48
52

26
24

52
48

12
8
5

48
32
20

14
8
3

56
32
12

26
16
8

52
32
16

2
8
12
3

8
32
48
12
8.2484.47

4
28
64
4
6.4484.45

3
15
28
4

6
30
56
8
7.3484.46

15
10

60
40

16
9

64
36

31
19

62
38

21
4

84
16

22
3

88
12

43
7

86
14

Results

The women in the treatment and control groups with

urinary complaints were similar in terms of demographical, obstetrical and gynecological characteristics, general health information, the presence of urinary complaints, nocturia, frequency, urgency, pelvic floor muscle
strength, pad test results, the amount of liquid intake and
quality of life assessments (p 1 0.05).
The average ages for the treatment group and control
group were 78.88 8 4.80 and 79.44 8 5.32 years, respectively. The average score for the women in the Mini-Mental Test was 26.54 8 1.82; there were no mental incapacities (table 2).
The average number of urinations in the treatment
group was 8.76 8 2.44 during the day and 3.80 8 1.71
during the night. For the control group, these averages
were 6.40 8 1.76 for the number of urinations during the
day and 3.32 8 12.15 during the night. The difference in
the number of voids in the daytime was statistically significant (p = 0.000), while there was no significant difference in the number of voids at night (p = 0.196). In terms
of the types of urinary incontinence, the treatment group
had the mixed incontinence complaint (the complaint of
involuntary leakage associated with urgency and also
Bladder Training and Kegel Exercises for
Older Women

1
7
16
1

2 = 0.32
SD = 1
p = 0.57
2 = 0.65
SD = 2
p = 0.72
2 = 1.97
SD = 3
p = 0.58
t = 1.425, p = 0.160
2 = 0.85
SD = 1
p = 0.77
2 = 1.66
SD = 1
p = 0.68

with exertion, effort, sneezing or coughing) in general

(52%), and the control group had urge incontinence (the
complaint of involuntary leakage accompanied by or immediately preceded by urgency) in general (60%). The
distribution of types of lower urinary tract symptoms in
women are in table 3.
The findings for the digital palpation administered in
order to evaluate the pelvic floor muscle strength showed
12/5 weakness in 52% of women in the treatment group
and 48% of women in the control group. Twenty-four percent of women did not consent to examination.
According to the pad tests of the treatment group, the
percentage of severe wetting (1159 g) was 24%, while the
percentage of wetting for the control group was 16%
(treatment group: 7.12 8 12.07 g, control group: 8.20 8
14.13 g). There was not a statistically significant difference in the pad test results of both groups (p = 0.137).
King Health Questionnaire results showed that urinary incontinence did not affect the women to a serious
degree. In the items which were scored out of 100, it was
identified that the highest scores for the treatment group
were for general health perceptions and severity measures, while for the control group the items with the highest scores were for general health perceptions, incontinence impact, emotions and severity measures.
Gerontology 2008;54:224231

227

Table 3. Presence of lower urinary tract symptoms in women

Treatment

Urgency
Yes
No
Frequency
Yes
No
Nocturia
Yes
No
Urinary incontinence types
Stress incontinence
Urge incontinence
Mixed incontinence
Continenta
Frequency of urinary incontinence
1 or more in a day
1 or more in a week
A few times in a month
Continent
a

Control

15
10

60
40

19
6

76
24

34
16

68
32

18
7

72
28

16
9

64
36

34
16

68
32

17
8

68
32

14
11

56
44

31
19

62
38

3
6
13
3

12
24
52
12

2
15
7
1

8
60
28
4

5
21
20
4

10
42
40
8

12
7
3
3

48
28
12
12

14
7
3
1

56
28
12
4

26
14
6
4

52
28
12
8

2 = 1.47
SD = 1
p = 0.225
2 = 0.37
SD = 1
p = 0.544
2 = 0.76
SD = 1
p = 0.382
2 = 5.08
SD = 2
p = 0.079
2 = 6.05
SD = 3
p = 0.109

Not included in statistical analysis.

In the comparisons carried out for the urgency and

frequency complaints, it was found that there were significant decreases in the treatment group compared to
the control group between the pretreatment evaluation
and the 8-week and 6-month evaluations (p ! 0.05); however, there were no significant differences between the
8-week and 6-month evaluations (p 1 0.05). It was also
found that there was a significant decrease in the nocturia complaints of the treatment group compared to the
control group between the 8-week and 6-month evaluations (p ! 0.05; table 4).
It was determined from the pad test results that there
was a highly significant decrease from pretreatment levels in involuntary urination in the treatment group at the
8-week and 6-month evaluations, as compared to the
control group (p = 0.000). However, there were no significant differences between the groups for the 8-week
and 6-month evaluations (p = 0.126; table 5).
Pelvic floor muscle strength, assessed by digital palpation at the 8-week and 6-month evaluations, increased
significantly in the treatment group when compared to
the control group (p = 0.000), and also increased significantly between the 8-week and 6-month evaluations (p =
0.005; table 6).
228

Total

Gerontology 2008;54:224231

The effect of urinary complaints on the quality of life

was evaluated by the King Health Questionnaire. Low
scores in the subdivisions of the scale indicated an increase in the quality of life. For the treatment group, there
was a significant decrease (p ! 0.05) in the 8-week scores
of general health perception, role limitations, physical
limitations and emotions when compared to pretreatment scores. However, there was no difference between
the 8-week and 6-month scores (p 1 0.05). When the subdivision of incontinence impact was considered in each
of the 3 observations, it was seen that scores were lower
for the treatment group in comparison to the control
group (p ! 0.05). It was also found that there was a highly significant difference for the treatment group in the
sleep/energy subdivision in the pretreatment to 8-week
scores and the 8-week to 6-month scores (p = 0.000).
There was no significant difference between the 8-week
and 6-month evaluations (p = 0.111). According to the
severity measures, the treatment group showed a highly
significant decrease between pretreatment and 8-week
evaluations, pretreatment and 6-month evaluations, and
8-week and 6-month evaluations (p = 0.000 and p = 0.112,
respectively).

Aslan /Komurcu /Beji /Yalcin

Table 4. Urgency, frequency and nocturia at pretreatment, 8-week

and 6-month evaluations

Comparison
categories and
time/result

Treatment

Control

Urgency
Pretreatment and 8-week evaluations
13
52
4
Decreased
1
4
3
Increased
Unchanged
11
44
18
Pretreatment and 6-month evaluations
Decreased
13
52
4
Increased
2
8
0
Unchanged
10
40
18
8-week and 6-month evaluations
Decreased1

Increased
1
4

Unchanged
24
96
25
Frequency
Pretreatment and 8-week evaluations
Decreased
16
64
3
Increased

4
Unchanged
9
36
18
Pretreatment and 6-month evaluations
3
52
13
Decreased
4
4
1
Increased
18
44
11
Unchanged
8-week and 6-month evaluations
Decreased
3
12

Increased1

Unchanged
22
88
25
Nocturia
Pretreatment and 8-week evaluations
Decreased
8
32

Increased1
1
4
3
Unchanged
16
64
22
Pretreatment and 6-month evaluations

56
14
Decreased
3
4
1
Increased
22
40
10
Unchanged
8-week and 6-month evaluations

28
7
Decreased

4
1
Increased1
25
68
17
Unchanged
1
2

16
12
72

2 = 7.45
SD = 2
p = 0.024

16
12
72

2 = 7.25
SD = 2
p = 0.027

100

2 = 1.02
SD = 1
p = 0.312

12
16
72

2 = 15.89
SD = 2
p = 0.000

12
16
72

2 = 15.89
SD = 2
p = 0.008

100

2 = 3.19
SD = 1
p = 0.074

12
88

p = 0.0042

12
88

2 = 19.50
SD = 2
p = 0.000

100

p = 0.0042

Not included in statistical analysis.

Fishers exact test.

Discussion

Urinary incontinence is a medical condition that can

be seen in women of any age group; however, its prevalence
increases with age. Studies show that urinary incontinence
Bladder Training and Kegel Exercises for
Older Women

negatively affects the daily activities of women, their social

relationships and emotional state, and as a result lowers
their quality of life [8, 18]. There are a limited number of
studies about the urinary incontinence problems in rest
homes. Many of them were epidemiological or descriptive
studies that explained the prevalence and the effects of
urinary incontinence in elderly women. However, none
examined the effects of behavioral therapy methods.
Compared to the control group a significant decrease
was found in urgency (52%), frequency (64%) and nocturia (32%) complaints in treatment group after treatment
(table 4). In the literature, it has been stated that frequency, urgency and urge incontinence can be improved at a
rate of 4490% with bladder training alone [16]. In a randomized clinic study, Wyman et al. [19] administered
bladder training, PFME and combined treatments to 204
women with an average age of 61 years. In the after-treatment observations, it was found that the improvement ratios between the bladder training and pelvic floor muscle
groups were similar (18 and 13%, respectively); however,
the combined treatment results were better (58%). After 3
months of observations, no significant difference was observed between the groups. The quality of life scores in the
area of combined treatment have also been found to be
low. In a randomized control study to evaluate the effectiveness of bladder training, Fantl et al. [20] found that
there was a significant decrease in stress, urge and mix
incontinence. Combinations of behavioral treatments are
more effective than just one. There was a decrease in frequency of between 50 and 70% after a 12-week intensive
combined behavioral therapy, as shown 3 months later
[21]. Pelvic floor muscles were found to be strengthened
by 56% after treatment in our study (table 6). Studies concerning bladder training and PFME have shown that there
is a 5070% increase in strength in the elderly population
[2]. OBrein et al. [22] concluded that as a result of bladder
training and PFME treatment, 68% of incontinent adult
women (out of a sample of 276) recovered or improved.
The best results for improvement are seen in the younger
age groups; however, the success rate in the elderly is over
50%. In terms of the control group, over a 6-month observation/monitoring period there was no difference. Fonda
[2] randomly selected 78 patients aged 60 years and over
who had come to an incontinence clinic for treatment and
were administered a conservative treatment. As a result of
this treatment, 25% of these patients had fully recovered
after 4 months of observation, 58% experienced improvement, and it was also found that there were significant
improvements in the control group in the 4-month and
12-month follow-ups.
Gerontology 2008;54:224231

229

Table 5. The distribution of the data for the pad test at pretreatment, 8-week and 6-month evaluations

Comparison times

Pretreatment and 8-week evaluations

Pretreatment and 6-month evaluations

8-week and 6-month evaluations

Pad test
result

Treatment

Control

MannWhitney test

Av. rank

Av. rank

decreased
increased
unchanged

17

32

68

33.58

12
13

48
52

17.42

U = 110.5
z = 4.44
p = 0.000

decreased
increased
unchanged

5
1
19

20
4
76

36.10

21
4

84
16

14.90

U = 47.5
z = 5.47
p = 0.000

decreased
increased
unchanged

4
21

16
84

27.98

10
15

40
60

23.02

U = 250.5
z = 1.53
p = 0.126

Table 6. The distribution of the data for pelvic floor muscle strength at pretreatment, 8-week and 6-month evaluations

Comparison times

Pretreatment and 8-week evaluations

Pretreatment and 6-month evaluations

8-week and 6-month evaluations

Pelvic floor
muscle
strength

Treatment
n

Av. rank

Av. rank

decreased
increased
unchanged

14
11

56
44

18.06

23

92

32.94

U = 126.5
z = 4.43
p = 0.000

decreased
increased
unchanged

15
10

60
40

17.60

23

92

33.40

U = 115
z = 4.56
p = 0.000

decreased
increased
unchanged

7
18

28
72

22.00

25

100

29.00

U = 225
z = 2.82
p = 0.005

Although the King Health Questionnaire scores

showed that urinary incontinence did not affect the
women to a serious degree, quality of life scores in all dimensions of the scale were improved significantly after
treatment in our study. Grimby et al. [3] assessed the
quality of life of 120 incontinent women living within the
community between the ages of 65 and 84 years with the
Nottingham Health Profile Questionnaire. The women
scored highly in the areas of emotional discomfort and
social isolation. There was an improvement in the quality of life of 50% after treatment in the study of Fantl et
al. [20], in which they conducted bladder training. In the
study by Gatti [23], in which pelvic floor muscle rehabilitation for women was conducted in order to measure
its effect on the quality of life, 90 postmenopausal women
were evaluated 6 and 12 months after treatment, where it
230

Gerontology 2008;54:224231

Control

MannWhitney test

was concluded that the complaints of women had significantly decreased, and as a result the negative effects on
the quality of life decreased.
In conclusion, bladder training and PFME administered to elderly women are very effective in decreasing
urinary complaints, increasing the strength of the pelvic floor muscles and increasing the quality of life at a
rest home. Behavioral therapy can be used easily as an effective treatment for urinary incontinence in elderly
women.

Acknowledgment
This work was supported by the Research Fund of the Marmara University. Project number: SAG-078/12052003.

Aslan /Komurcu /Beji /Yalcin

Appendix 1
Instructions for the Pelvic Floor Muscle Exercises
Empty the bladder before performing the exercises
Wear comfortable clothing
If you do the exercises lying down, you should elevate your
head with a pillow
Lie down with your knees bent
Take a deep breath first
Focus on relaxing the body and concentrate on the muscles in
the vagina-anus area
Contract the muscles around the vagina-anus as if you are trying to prevent yourself from urinating or breaking wind and
pull the muscles inward

In order to be sure that you are contracting the correct muscle,

perform the exercises by placing your index finger and middle
finger upon your vagina (this instruction was later removed
from the routine because it was understood to be a part of the
actual routine)
Do not hold your breath during the contractions, do not contract your buttocks or stomach muscles
You can conduct this exercise standing up or sitting down; it
is useful to do the exercises in different positions
Practice these exercises during your daily activities

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