Behavioral intervention for community-dwelling individuals with urinary incontinence

• Published in: Urology (Ridgewood, N.J.) Vol. 51; no. 2; pp. 30 - 34
• Main Author: Fantl, J.A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-02-1998; Elsevier Science
• Subjects: Behavior Therapy; Biological and medical sciences; Diseases of the urinary system; Female; Humans; Medical sciences; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Remission Induction; Urinary Incontinence - therapy; Human; Urinary incontinence; Urodynamics; Voiding dysfunction; Urinary system disease; Treatment; Exploration; Bladder disease; Urinary tract disease; Behavior; Rehabilitation; Technique
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(98)90006-1

Objectives. To review the use of behavioral modification as a treatment for urinary incontinence (UI) among individuals in the community.
Methods. The implementation of pelvic floor rehabilitation and bladder training is discussed. “Cure rates” reported in studies of community-dwelling women with UI are presented, and possible mechanisms of the treatment effect are described.
Results. Clinical trials of behavioral modification for UI have incorporated different therapeutic regimens and outcome measurements. On average, however, pelvic muscle rehabilitation has produced complete resolution in approximately 20% of patients and a 50% to 75% reduction in most individuals. Bladder training has produced complete resolution in fewer than 15% of patients and a 50% to 75% reduction in more than 50% of subjects. Although the mechanism of the treatment effect remains undetermined, it may involve modification of voluntary striated muscle contractility, reflex striated muscle contractility, cortical inhibition, and cortical facilitation. The structure and implementation of the technique, rather than the specific technique itself, may be responsible for the treatment effect.
Conclusions. Behavioral interventions have a definite place in the management of UI. Most such therapies will reduce, rather than abolish, UI. However, the reduction in symptoms may improve the quality of life.