What is the role of behavioral therapy in urinary incontinence treatment?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

A level A guideline from the ACOG recommends behavioral therapy, including bladder training and prompted voiding, as a noninvasive method for improving symptoms of urge and mixed incontinence in women. [86] Timed, frequent voiding can be used to minimize incontinence, especially if the bladder is kept empty before incontinence-producing activities.

Bladder training is most useful in young women. It may not be successful in frail older women. It is difficult to implement in cognitively impaired persons.

Bladder training involves relearning how to urinate. This method of rehabilitation most often is used for active women with urge incontinence and sensory urge symptoms; however, it also may be used for stress and mixed incontinence. Often, these patients find that when they respond to symptoms of urge and return to the bathroom soon after they have voided, they do not urinate much. In other words, although their bladder is not full, it is signaling for them to void.

Bladder training generally consists of self-education, scheduled voiding with conscious delay of voiding, and positive reinforcement. Bladder training requires the patient to resist or inhibit the sensation of urgency and postpone voiding. Patients urinate according to a scheduled timetable rather than the symptoms of urge.

Bladder training also uses dietary tactics such as adjustment in fluid intake and avoidance of dietary stimulants. In addition, distraction and relaxation techniques allow delayed voiding to help distend the urinary bladder. By using these strategies, patients can induce the bladder to accommodate progressively larger voiding volumes.

Initially, the interval goal is determined by the patient's current voiding habits and is not enforced at night. The interval goal between each void usually is set at 2-3 hours, but may be set further apart if desired.

As the bladder becomes accustomed to this delay in voiding, the interval between mandatory voids is increased progressively, in 15- to 30-minute increments, with simultaneous distraction or relaxation techniques and dietary modification. Typically, the interval is increased by 15 minutes per week until the patient reaches a voiding interval of approximately 3-4 hours.

Another method of bladder training is to maintain the prearranged schedule and disregard the unscheduled voids. However, patients need to continue to maintain the prearranged voiding times. They need to continue this program for several months.


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