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Several types of behavioral methods are used
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.
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
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 (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 biofeedback technique during pelvic floor muscle training.
Learning biofeedback requires practice in a lab or other setting with
the guidance of a trained therapist. Home biofeedback units also are
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:
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.
These methods are often successful in reducing
or stopping urinary incontinence.
Behavioral methods may be used to treat:
There is not a lot of evidence
for biofeedback combined with other behavioral therapies for urinary incontinence. More research
Two reviews were done of men using pelvic floor muscle
training to improve continence after prostate surgery. Results were not the same, but there does seem to be a benefit in men who do pelvic floor muscle exercises. 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
Another study showed that men who did pelvic floor muscle exercises after prostate surgery had much improved urine leakage compared to men who did not do the exercises.3
Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had
fewer leakage problems a day and said their quality of life was better.4 Women who do these exercises during and after pregnancy can reduce their chance of urine leakage after delivery.4
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.5
No risks are associated with these treatments.
Behavioral methods such as bladder training require a high level of
To be effective, pelvic floor (Kegel)
exercises with or without biofeedback techniques require a high level of
motivation and frequent repetition.
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
MacDonald R, et al. (2007). Pelvic floor muscle
training to improve urinary incontinence after radical prostatectomy: A
systematic review of effectiveness. BJU International,
Hunter KF, et al. (2007). Conservative management for
postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews (2).
Goode PS, et al. (2011). Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence. JAMA, 305(2): 151–159.
Hay-Smith J, et al. (2008). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews (4).
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).
September 11, 2012
E. Gregory Thompson, MD - Internal Medicine & Avery L. Seifert, MD - Urology
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