In particular, it is essential for women to understand that their therapeutic outcomes will depend on their active participation and daily practice.Īs women consider whether their efforts could lead to a positive outcome, it is important they understand that behavioral treatments yield significant improvements for most patients who comply, but they are not usually curative. This enables patients to ascertain their ability to change their habits and learn new skills and be prepared to engage in the treatment process. Patients also need to understand their role in the treatment process, which begins with discussing the relevant treatment options and informing patients about what each treatment entails. Patient education includes an explanation of the anatomy of the bladder and pelvic floor, how they function normally, and the causes and mechanisms of urinary incontinence. Thus, it is important that any behavioral program begin by providing basic patient education, so that the patient can understand her condition, the treatment process and the therapeutic goals. Social cognitive theory tells us that patients will adopt new behaviors if they believe they can perform them, and if they believe that doing so will lead to a good outcome. Most behavioral programs can be considered self-management programs requiring the active engagement of the patient. 1, 2, 3, 4, 5, Further they are recommended as first-line therapies by several consensus panels and societies, including the International Consultation on Incontinence and the American Urological Association Guideline on Diagnosis and Treatment of Overactive Bladder in Adults. Other behavioral interventions, such as fluid management and reducing bladder irritants, have less evidence, but they are used widely because they are safe and without the risks and side effects associated with some other therapies.Īlthough they are not curative in most patients, it is well established that behavioral interventions are effective for improving symptoms, as described in several systematic reviews. Each of these programs has a central defining characteristic, but they are multi-component by nature and have been implemented successfully using a wide variety of specific parameters. The behavioral programs with the most evidence are pelvic floor muscle training, behavioral training with urge suppression, and bladder training. It is generally accepted that the best behavioral programs are implemented with the supervision of a health care provider to ensure that the patient is guided in the correct skills, and to facilitate adherence in the early phases of treatment. Among the techniques included in behavioral treatment programs are: self-monitoring with a bladder diary, pelvic floor muscle training techniques (including biofeedback or digital teaching), pelvic floor muscle exercise regimens, active use of pelvic floor muscles for urethral occlusion (stress strategies, the knack), urge control and urge suppression strategies, urge avoidance strategies, scheduled voiding regimens (including bladder training), delayed voiding, teaching normal voiding techniques, fluid management, dietary changes to avoid bladder irritants (including caffeine), weight loss, management of constipation, and other lifestyle changes. In clinical practice, behavioral interventions are usually comprised of multiple components, tailored to the individual needs of the patient, the characteristics of her symptoms, and her life circumstances. Another basic approach focuses on the bladder outlet, strengthening pelvic floor muscles and using them to prevent leakage and control bladder function. One basic approach to behavioral treatment focuses on improving bladder control by modifying voiding habits, such as with scheduled voiding or delayed voiding. Behavioral treatments are a group of interventions that improve urinary incontinence and other lower urinary tract symptoms by changing the patient’s daily habits or environment or teaching new skills.
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