Behavioral interventions have been used for decades to treat
urge incontinence and other symptoms of
overactive bladder. Perhaps the earliest form of treatment was the bladder drill, an intensive intervention designed to increase the interval between voids to establish a normal frequency of urination and normalization of bladder function. Bladder training is a modification of bladder drill that is conducted more gradually on an outpatient basis and has resulted in significant reduction of incontinence in older, community-dwelling women. Multicomponent behavioral training is another form of behavioral treatment that includes pelvic floor muscle training and exercise. This intervention focuses less on voiding habits and more on altering the physiologic responses of the bladder and pelvic floor muscles. Using
biofeedback or other teaching methods, patients learn strategies to inhibit bladder contraction using pelvic floor muscle contraction and other urge suppression strategies. Although behavioral and
drug therapies are known to be highly effective for reducing
urge incontinence, few patients are cured with either treatment alone. Thus, future research should explore ways to enhance the effectiveness of these
conservative therapies. Although the mechanisms by which behavioral treatments work have not been established, there is some evidence that behavioral and
drug interventions may operate by different mechanisms, suggesting that they may have additive effects and that combining them may result in better outcomes. Future research needs to examine the mechanisms by which these
therapies reduce incontinence and whether combining behavioral and
drug treatment will result in better outcomes than either
therapy alone.