Behavioral Methods for Urinary Incontinence
Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. People who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.
Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. You are taught about the structure of the lower urinary tract and the causes of incontinence.
A schedule for urinating is established, and you are trained to resist the first urge to urinate and to refrain from urinating until the scheduled time. The interval between scheduled bathroom visits is increased until you can refrain from urinating for several hours.
Biofeedback is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.
People with incontinence are taught bladder-sphincter biofeedback methods along with 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 muscles and contract your pelvic floor muscles based on the information displayed.
Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.
Pelvic floor muscle training
Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:
- Squeeze the same muscles you would use to stop your urine. Your belly and rear end (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 can be 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.
Kegel exercises are often combined with biofeedback techniques to teach the proper exercise 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 of motivation and frequent repetition.
What To Expect After Treatment
These methods are often successful in decreasing or stopping urinary incontinence.
Why It Is Done
Behavioral methods may be used to treat:
- Urge incontinence (using bladder training).
- Stress and urge incontinence (using pelvic muscle exercises).
- Functional incontinence (using timed and prompted voiding).
How Well It Works
- Bladder training does not work well for everyone. But some people benefit significantly.
- Many people who use bladder training have fewer symptoms of incontinence. For some people, the incontinence completely stops.
There is not a lot of evidence for biofeedback combined with other behavioral therapies for urinary incontinence. More research is needed.
Pelvic floor muscle training
Two reviews were done of men using pelvic-floor muscle training to improve continence after prostate surgery. Results were not the same. One review showed that pelvic-floor muscle training did help men control leakage of urine after a radical prostatectomy for prostate cancer.1 But the other review showed no benefit overall in men trying pelvic-floor muscle training after any prostate surgery.2
Women who did these exercises for urinary incontinence (urge, stress, or mixed incontinence) got better. The exercises seem to work better in women who have stress urinary incontinence and who keep doing the exercises.3
What To Think About
Behavioral methods such as bladder training require a high level of motivation.
To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.
- MacDonald R, et al. (2007). Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness. BJU International, 100(1): 76–81.
- Hunter KF, et al. (2007). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews (2).
- Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).
Last Revised: March 23, 2011
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