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Behavioral Methods for Urinary Incontinence

Treatment Overview

Several types of behavioral methods are used for treatingurinary incontinence:bladder training, habit training, biofeedback, andpelvic muscle exercises.Peoplewho have incontinence due to physical or mental limitations (functionalincontinence)can trytimed voiding and prompted voiding.

Bladder trainingBladder training (also called bladder retraining) is used to treat urge incontinence.Bladder training attempts to increase how long you can wait before having tourinate. You are taught about the structure of the lower urinary tract and the causesof incontinence.

A schedule for urinating is established, and you are trained to resist the first urge tourinate and to refrain from urinating until the scheduled time. The interval betweenscheduled bathroom visits is increased until you can refrain from urinating forseveral hours.

BiofeedbackBiofeedbackis a technique for learning to control a body function that is notnormally under conscious control, such as skin temperature, muscle tension, heartrate, or blood pressure.

People with incontinence are taught bladder-sphincter biofeedback methods alongwith pelvic floor exercises. During biofeedback, bladder, rectal sphincter, and

abdominal pressures as well as electrical activity are recorded and displayed for you.By watching the information, you learn to relax your bladder and abdominal (belly)muscles and contract your pelvic floor muscles based on the information displayed.

Women may also use a weighted cone inserted in the vagina as a biofeedbacktechnique during pelvic floor muscle training.

Learning biofeedback requires practice in a lab or other setting with the guidance ofa trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that controlthe flow of urine. These exercises are used to treat urge or stress incontinence. Todo Kegel exercises:

Squeeze the same muscles you would use to stop your urine. Your belly and rearend (buttocks) should not move.

Hold the squeeze for 3 seconds, then relax for 3 seconds. Repeat the exercise 10 to 15 times a session. Do three or more sessions a day.

Kegel exercises can be done when you are at home or away from home. They canbe done at any time of day. No one will be aware that you are doing the exercises.

So you can do them often, no matter where you are.

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Kegel exercises are often combined with biofeedback techniques to teach the properexercise methods and to make sure the exercise is working. To be effective, pelvic

floor (Kegel) exercises with or without biofeedback techniques require a high level ofmotivation and frequent repetition.

What To Expect After TreatmentThese methods are often successful in reducing or stopping urinary incontinence.

Why It Is DoneBehavioral methods may be used to treat:

Urge incontinence (using bladder training). Stress and urge incontinence (using pelvic muscle exercises).

How Well It Works

Bladder training

Bladder training does not work well for everyone. But some people benefitsignificantly.

Many people who use bladder training have fewer symptoms of incontinence. Forsome people, the incontinence completely stops.

BiofeedbackThere is not a lot of evidence for biofeedback combined with other behavioraltherapies for urinary incontinence. More research is needed.

Pelvic floor muscle training in menTwo reviews were done of men using pelvic floor muscle training to improvecontinence after prostate surgery. Results were not the same, but there does seemto be a benefit in men who do pelvic floor muscle exercises. One review showed thatpelvic floor muscle training did help men control leakage of urine after a radicalprostatectomy for prostate cancer.1But the other review showed no benefit overallin men trying pelvic floor muscle training after any prostate surgery.2

Another study showed that men who did pelvic floor muscle exercises after prostatesurgery had much improved urine leakage compared to men who did not do the

exercises.

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Pelvic floor muscle training in womenWomen who do Kegel exercises are more likely to improve, and even cure, theirincontinence. These women had fewer leakage problems a day and said their qualityof life was better.4Women who do these exercises during and after pregnancy canreduce their chance of urine leakage after delivery.4

Women who did these exercises for urinary incontinence (urge, stress, or mixedincontinence) got better. The exercises seem to work better in women who havestress urinary incontinence and who keep doing the exercises.5

Risks

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No risks are associated with these treatments.

What To Think AboutBehavioral methods such as bladder training require a high level of motivation.

To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniquesrequire a high level of motivation and frequent repetition.

Complete thespecial treatment information form (PDF) (What isaPDFdocument?)to help you understand this treatment.

References

Citations

1. MacDonald R, et al. (2007). Pelvic floor muscle training to improveurinary incontinence after radical prostatectomy: A systematic review

of effectiveness. BJU International, 100(1): 7681.

2. Hunter KF, et al. (2007). Conservative management forpostprostatectomy urinary incontinence. Cochrane Database of

Systematic Reviews (2).

3. Goode PS, et al. (2011). Behavioral therapy with or withoutbiofeedback and pelvic floor electrical stimulation for persistent

postprostatectomy incontinence. JAMA, 305(2): 151159.

4.

Hay-Smith J, et al. (2008). Pelvic floor muscle training for preventionand treatment of urinary and faecal incontinence in antenatal and

postnatal women. Cochrane Database of Systematic Reviews(4).

5. Dumoulin C, Hay-Smith J (2010). Pelvic floor muscletraining versus no treatment, or inactive control

treatments, for urinary incontinence in women. Cochrane

Database of Systematic Reviews (1).

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