Behavioral Methods for Urinary Incontinence

Treatment Overview

Several types of behavioral methods are used for treating urinary incontinence: bladder training, pelvic muscle exercises (Kegels), and biofeedback. People who have incontinence due to physical or mental limitations (functional incontinence) also have options. They can plan to use the toilet before they feel like they need to go. Or they can schedule regular times to use the toilet.

Bladder training

Bladder training helps to increase how long you can wait before having to urinate. You can start by keeping a voiding diary for 24 hours. This will help you track the shortest time you have before you need to urinate again.

Using your shortest time, make a schedule to go to the toilet at this interval all day long. Go to the toilet at these times whether or not you feel the need. Once you can avoid leaking for a full day, increase your scheduled time by 15 minutes. Do this until you are able to be comfortable urinating every three to four hours.

Biofeedback

Biofeedback can be helpful if you are having difficulty doing pelvic floor exercises. During biofeedback, you'll get information on how well you are contracting your pelvic floor muscles.

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 physical therapist.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working.

What To Expect

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

Why It Is Done

Behavioral 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 can be helpful for people with urge incontinence, stress incontinence, and mixed incontinence. Many people who use bladder training have fewer symptoms of incontinence. For some people, the incontinence completely stops.

Pelvic floor exercises

Pelvic floor exercises, or Kegels, can be helpful for people with urge incontinence, stress incontinence, and mixed incontinence. They are often the first type of treatment suggested since these exercises can be done at home and don't cause side effects.

Biofeedback

Biofeedback can help people having difficulty with doing pelvic floor exercises. Pelvic floor exercises can be effective for people without biofeedback. But many people find that it helps to work with a pelvic floor physical therapist and use biofeedback.

Risks

No risks are associated with these treatments.