Treatment Overview

Several types of behavioural methods are used for treating 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

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 washroom visits is increased until you can refrain from urinating for several hours.

Biofeedback

Biofeedback is 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 blood pressure.

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 available.

Pelvic floor muscle training

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:

• Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
• Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.

If you are having trouble finding out what muscles to squeeze, you can try stopping the flow of urine a few times. But don't make it a practice to do Kegels while urinating.

If doing these exercises causes pain, stop doing them and talk with your doctor. Sometimes people have pelvic floor muscles that are too tight. In these cases, doing Kegel exercises may cause more problems.

If you aren't sure how to do these exercises, talk to your doctor about getting a referral to a pelvic floor physiotherapist.

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.

What To Expect

These methods are often successful in reducing or stopping urinary incontinence.

Why It Is Done

Behavioural methods may be used to treat:

• Urge incontinence (using bladder training).
• Stress and urge incontinence (using pelvic muscle exercises).

How Well It Works

Bladder training

• Bladder training does not work well for everyone. But some people benefit significantly.
• Many people who use bladder training have fewer symptoms of incontinence. For some people, the incontinence completely stops.

Biofeedback

There is not a lot of evidence for biofeedback combined with other behavioural therapies for urinary incontinence. More research is needed.

Pelvic floor muscle training in men

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.^{footnote 1} But the other review showed no benefit overall in men trying pelvic floor muscle training after any prostate surgery.^{footnote 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.^{footnote 3}

Pelvic floor muscle training in women

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.^{footnote 4} Women who do these exercises during and after pregnancy can reduce their chance of urine leakage after delivery.^{footnote 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.^{footnote 5}

Risks

No risks are associated with these treatments.