Community-Based Continence Promotion: Mind over Matter; Healthy Bowels, Healthy Bladder

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Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM) has the potential for high public health impact, as evidenced by its effectiveness, implementation with fidelity, and high adoption and maintenance by community agencies.

At a Glance

Most older women in Wisconsin experience incontinence, which impacts quality of life, but they may not seek care due to stigma. The “Mind over Matter: Healthy Bowels, Healthy Bladder (MOM)” workshop teaches women skills to improve symptoms without a medical professional.

Participants in the MOM workshop reported significant improvement in both bladder and bowel symptoms. Since the trial, more than a dozen additional MOM workshops have taken place and more widespread workshops and trainings are planned for 2020, in partnership with the Wisconsin Institute for Healthy Aging (www.wihealthyaging.org).

The Challenge

Incontinence is surprisingly common, especially among older women; as many as 60 percent of women over age 65 experience bladder or bowel incontinence. In Wisconsin, 200,000 women are affected. Incontinence can be associated with other health problems, like depression and falls, and can decrease independence and increase the risk of institutionalization. The stigma associated with incontinence can also make seeking treatment difficult.

Fortunately, symptoms can often be improved without surgery or medicine via pelvic floor exercises, dietary changes and increased self-efficacy. The MOM workshop brings information and tools to build skills to prevent or improve symptoms to women outside the medical system, at senior centers and other community spaces.

Project Goals

Broadly, the goal of “Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM)” is to improve older women’s symptoms and quality of life by reducing or preventing incontinence via group workshops that teach participants how to set goals and track progress while they make dietary changes and incorporate regular pelvic floor exercises.

In order to maximize the reach of the project, MOM partnered with the Wisconsin Institute for Healthy Aging (WIHA) to lead trainings for community members to learn how to facilitate the workshops.

The specific aims identified by the researchers were to determine MOM’s impact on bladder and bowel incontinence and rates of care-seeking among older women in eight Wisconsin communities; and to explore potential barriers to and facilitators of widespread adoption, implementation and maintenance of MOM workshops by community partners.

The grantees are currently in the process of developing a digital format which will enable more communities to offer MOM and maintain it without the time, money and staff commitments required of the in-person group sessions. An online option will also be helpful for women who are unable to or choose not to participate in the group workshop, since it can be accessed from home.

Results

This research study showed that “Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM),” an educational group workshop for older women, improved bladder and bowel incontinence through low-impact exercises and dietary changes. The study engaged eight community partners and enrolled 121 study participants across southern Wisconsin to test how well MOM improved bladder and bowel symptoms and whether communities were able to continue to offer the MOM workshop after the trial was completed.

• Rates of improvement in the treatment group were 71% for bladder and 55% for bowel symptoms, versus 23% and 27% in the control group, demonstrating that MOM’s impact on symptoms is significant.
• Eight MOM workshops were held in the year following this trial, with two-thirds of partner communities continuing to offer a MOM workshop, indicating that MOM is sustainable once communities have trained facilitators.
• The Wisconsin Institute for Healthy Aging (WIHA) piloted dissemination of MOM in spring of 2019 and launched full-scale dissemination through its statewide network in fall of 2019.
• A pilot dissemination and implementation research grant from UW’s Institute for Clinical and Translational Research is currently helping the research team to adapt the in-person MOM program to an online version in order to reach those women who cannot attend an in-person program.

In addition to the positive results for the study participants, the work resulting from this grant was awarded a Best in Category prize from the International Continence Society and was published in a peer-reviewed manuscript in Obstetrics & Gynecology in September 2019. This work was also featured in five popular science articles and/or broadcasts, including a news article by Reuters, and was presented in eight poster presentations at local, national, and international scientific meetings.

Lasting Impact

The larger public health impact of this research is profound. While research has shown the benefit of bladder health classes since 2004, this bladder health class is the first one to target both bladder and bowel symptoms, and to have been developed specifically for communities to offer without needing a healthcare professional or expert.

• The educational workshop, “Mind Over Matter, Healthy Bowels, Healthy Bladder (MOM),” was feasible for Wisconsin communities to implement and sustain beyond the time of the research study, and does not require a specially trained healthcare professional.
• Participating communities that attended the MOM leader training and offered the MOM workshop in this study remarked at how manageable the commitment was for MOM, compared to some other evidence-based health promotion workshops for older adults, since the facilitator training is only 2 days and the workshop has only 3 sessions instead of 6 or more.
• There is already interest in MOM from other communities across the country, meaning that MOM will ultimately reach women not just throughout Wisconsin but beyond our state’s borders.

Via continued dissemination in communities around Wisconsin and the country and the new on-line version of the workshop, many more women will have the opportunity to gain confidence and independence through better management of bladder and bowel incontinence: a significant positive impact and high return on investment for the project.