Behavioral and Physical Therapies for Incontinence and Overactive Bladder

19-08-2013
Update on behavioral and physical therapies for incontinence and overactive bladder: The role of pelvic floor muscle training. Burgio KL. University of Alabama at Birmingham, USA.
 
Pelvic Floor Muscle Training and Exercise (PFMT)
The literature on the effectiveness of PFMT is extensive, with the majority of studies focusing on stress or urge incontinence in women. Effectiveness is best established in women, particularly older women and women in the postpartum period. The literature on men is smaller, and focused on the effectiveness of PFMT for treating post-prostatectomy incontinence, which is predominantly stress incontinence.
 
Urge Suppression Strategies
Most studies of urge suppression have focused on reducing incontinence. Controlled trials using intention-to-treat models have shown mean reductions of incontinence ranging from 60 to 80 %.
 
The Role of Biofeedback
Although studies are inconsistent, there does not appear to be a clear benefit of adding clinic or home-based biofeedback to a PFMT program. Thus, it appears that biofeedback can be reserved for those patients who cannot successfully identify their muscles by other methods. This suggests that behavioral training, because it does not require biofeedback in most patients, can be used more widely, and particularly in settings where biofeedback is not available.
 
The Role of Electrical Stimulation
Pelvic floor muscle electrical stimulation is an effective treatment for urge or stress incontinence,but it does not appear to enhance outcomes over that which is achieved through PFMT alone.
 
Combining Behavioral Treatment with Medication
Less is known about combining behavioral and drug treatments for stress incontinence. A single study has compared the effects of PFMT combined with duloxetine to duloxetine alone, PFMT alone, and placebo. The results indicated that combined therapy was not superior to drug treatment alone.
 
Combining Behavioral Treatment with Surgery
In recent years, interest has emerged in peri-operative behavioral or physical therapy for patients undergoing surgery for pelvic floor disorders. This interest is due to many women having concurrent symptoms, which may worsen, and the possibility that new symptoms may develop as a result of surgery. In addition, there is the possibility that optimizing pelvic floor tone and circulation may enhance the effects of surgery or support long-term efficacy.`
 
Conclusions
Behavioral and physical therapies have been used for many years to improve continence status and other lower urinary tract symptoms. They do not require special equipment, but they do require a knowledgeable clinician and active patient participation. The collective literature on PFMT demonstrates that it is effective for reducing stress, urge, and mixed incontinence, as well as urgency, frequency, and nocturia. Although most patients are not cured, the majority of those who participate actively experience meaningful reductions in symptoms and improvements in quality of life. PFMT should be a mainstay in the treatment of incontinence and OAB in men and women of all ages. Further, it can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms.

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