Behavioral Therapies

Behavioral therapy includes bladder drills, bladder train-ing,habit training,timed voiding,pelvic floor muscle training, and biofeedback. It is a means for the patient to regain cortical control over the detrusor muscle and bladder outlet. Bladder training incorporates timed voiding habits and bladder function,whereas pelvic floor training emphasizes control of the bladder outlet and increased sphincter resistance. Current approaches include combinations of voiding schedules, bladder diaries, fluid and diet management, and pelvic floor exercises.

In a prospective, randomized study comparing behavioral pelvic floor therapy to oxybutynin therapy and placebo, behavioral therapy provided an 80.7% reduction (30% cure) in incontinence episodes; it was significantly more effective than drug treatment (mean 68.5% reduction; P = .04), and both treatments together were more effective than placebo (mean 39.4% reduction; P < .001 and P ± .009, respectively).2 In a later randomized, controlled trial with a modified crossover design, it was demonstrated that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence. In this study, single therapy resulted in a mean reduction of incontinence episodes of 57.5%, whereas addition of oxybutynin chloride to behavioral therapy reduced incontinence episodes by 88.5% (P = .034), and similarly, addition of pelvic floor therapy to isolated drug therapy reduced incontinence episodes from 72.7% to 84.3% (P = .001).3

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