Inpatient bladder retraining: is it beneficial on its own? (original) (raw)
Related papers
International journal of …, 2009
Behavioural interventions are effective treatments for overactive bladder (OAB) and urgency urinary incontinence (UUI). They are in part aimed at improving symptoms with patient education on healthy bladder habits and lifestyle modifications, including the establishment of normal voiding intervals, elimination of bladder irritants from the diet, management of fluid intake, weight control, management of bowel regularity and smoking cessation. Behavioural interventions also include specific training techniques aimed at re-establishing normal voiding intervals and continence. Training techniques include bladder training, which includes a progressive voiding schedule together with relaxation and distraction for urgency suppression, and multicomponent behavioural training, which, in conjunction with pelvic floor muscle (PFM) exercises, includes PFM contraction to control urgency and increase the interval between voids. Guidelines for the conservative treatment of OAB and UUI have been published by several organisations and the physiological basis and evidence for the effectiveness of behavioural interventions, including lifestyle modifications, in the treatment of OAB and UUI have been described. However, many primary care clinicians may have a limited awareness of the evidence supporting the often straight-forward treatment recommendations and guidance for incorporating behavioural interventions into busy primary care practices, because most of this information has appeared in the specialty literature. The purpose of this review is to provide an overview of behavioural interventions for OAB and UUI that can be incorporated with minimal time and effort into the treatment armamentarium of all clinicians that care for patients with bladder problems. Practical supporting materials that will facilitate the use of these interventions in the clinic are included; these can be used to help patients understand lifestyle choices and voiding behaviours that may improve function in patients experiencing OAB symptoms and/or UUI as well as promote healthy bladder behaviours and perhaps even prevent future bladder problems. Interventions for stress urinary incontinence are beyond the scope of this review.
Background The International Continence Society recommends that first-line treatment of overactive bladder syndrome symptoms and urgency urinary incontinence is performed by conservative interventions. Bladder training is considered one of the types of behavioral intervention, which is characterized by health education associated with scheduled voiding regimen with gradually adjusted voiding intervals. The aim of this study will be to investigate and update whether bladder training can promote improvement of symptoms of individuals with overactive bladder with or without urgency urinary incontinence. Methods A bibliographic search will be conducted in eight databases, no data or language restrictions: PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE, CINAHL, by handing searching. A combination of search terms including ‘bladder training’, 'overactive bladder', ‘urinary incontinence’ and 'urinary urgency incontinence' with common Boolean operato...
Efficacy of bladder training in adults with overactive bladder: A systematic review protocol
2022
IntroductionThe aim of this systematic review will be to investigate and update whether bladder training can promote improvement of symptoms of overactive bladder syndrome with or without urgency urinary incontinence in adults.MethodsWe will perform a systematic review according to the Cochrane methodology of randomized controlled trials. An overall search strategy will be developed and adapted for each database. A bibliographic search will be conducted in eight databases - PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE, CINAHL, by manual searching. The MeSH terms will be “Bladder Training”, “Bladder Drill”, “Bladder Re-education”, “Bladder Retraining”, “Bladder Discipline”, “Overactive Bladder”, “Bladder, Overactive”, “Overactive Urinary Bladder”, “Urinary Bladder”, “Overactive, Urinary Bladder”, “Bladder, Urinary”, “Urinary Bladder Disease”, “Bladder Disease”, “Bladder Detrusor Muscle” and “Detrusor Muscle, Bladder”. Meta-analysis, if plausible, will be pe...
International Urogynecology Journal, 2012
Introduction and hypothesis Our goal was to compare the long-term efficacy of bladder training (BT), pelvic floor muscle training (PFMT), combined pelvic floor rehabilitation (CPFR), and drug therapy (DT) in patients with urgency urinary incontinence (UUI). Methods This multicenter single-blind randomized controlled trial compared the efficacy of BT, PFMT, DT, and CPFR at baseline and 3-and 12-month follow-ups. Outcome measures included number of voids/24 h, number of UUI episodes, Quality of Life related to UUI (QOL-rUI), urogynecologic visual analog scale, and self-reported function and disability. Results A significant improvement was found for all treatment groups at 3 and 12 months in urinary frequency, UUI episodes, QOL-rUI, and number of daily pads. Only CPFR showed a significant decrease of 4 voids/24 h and a significant increase in self-reported function. Conclusions The study demonstrated long-term benefits of DT, BT, PFMT, and CPFR in the treatment of UUI with a slight advantage for CPFR. Keywords Bladder training . Drug therapy . Long-term efficacy . Pelvic floor rehabilitation . Pelvic floor muscle training . Urgency urinary incontinence Abbreviations DT Drug therapy BT Bladder training CPFR Combined pelvic floor rehabilitation LLFDI Late-Life Function and Disability Instrument PFMT Pelvic floor muscle training QOL-rUI Quality of Life related to UUI SUI Stress urinary incontinence UI Urinary incontinence UUI Urgency urinary incontinence
Rating improvements in urinary incontinence: do patients and their physicians agree?
Age and Ageing, 2008
Objective: to determine whether patients' perceptions of improvement following behavioural interventions for urinary incontinence (UI) correspond with physicians' global ratings of change, and to compare both these ratings with more objective UI outcome measures. Methods: consecutive new female patients aged 65 years and older recruited from outpatient UI clinics in Quebec received a behavioural management protocol for UI. At 3-month follow-up, patients and physicians were independently asked for their global impression of change in UI status. Patients completed 3-day voiding diaries and a UI-specific quality-of-life index before and after treatment. Results: 108 patients (mean age 73 ± 5 years, range 65-86 years) with stress, urge and mixed UI participated. There was concordance between patients' and physicians' ratings of change in 57% of cases. Among the remaining cases, patients were 1.6 times as likely to report significant improvements compared to physicians. Patients' ratings correlated more strongly with improvements in UI episodes in the voiding diary (r = 0.4, P = 0.002 versus r = 0.3, P = 0.004 for physicians) and on the quality-of-life index (r = −0.5, P<0.0001 versus r = −0.4, P<0.0001 for physicians). Conclusion: physicians underestimate clinically meaningful changes in UI in older women following behavioural interventions.
International Urogynecology Journal, 1996
Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the impatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.
Physiotherapy for urinary incontinence
Australian family physician, 2008
International guidelines recommend treatment for urinary incontinence by a health professional such as a pelvic floor or continence physiotherapist with specialised training in the management of pelvic floor disorders. This article discusses the role of a physiotherapy program in treating women with urinary incontinence. Treatment usually involves five consultations with a pelvic floor physiotherapist over 4-6 months. After an assessment of bladder function and the pelvic floor muscles, an individualised training program is prescribed. The focus of pelvic floor muscle training is to build strength, endurance, speed and the coordination of the pelvic floor muscles in different situations. An effective program has been shown to increase contractile strength as well as increased resting tone of the pelvic floor, which then provides improved support of the pelvic organs higher in the pelvis. Women may be offered an annual review by their physiotherapist in order to promote long term con...
The Role Of Conservative Methods In The Today's Treatment of Urinary Incontinence
2019
Urinary incontinence (UI) is a condition that aggravates the performance status of the patient, decreases the quality of life, and has a high prevalence. When the incidence of urinary incontinence is observed, stress urinary incontinence (SUI) is the most common (49%), mixed urinary incontinence (MUI) is the second (29%) and urge urinary incontinence (UUI) (21%) is the least frequent in all ages . Conservative methods are effective, well-tolerated, noninvasive, and safe treatment options for the treatment of UI. Conservative approaches can be summarized as lifestyle changes, bladder training, and pelvic floor muscle training (PFMT). PFMT includes biofeedback, vaginal pressure, PFM exercises, electrical stimulation (ES), electromagnetic stimulation (EMS). The goal of rehabilitation is to achieve urethral stability by increasing the strength of the pelvic floor muscles. These approaches can result in approximately 26% reduction in incontinence episodes. This article was conducted by ex...
Bju International, 2006
OBJECTIVESTo assess the efficacy and cost-effectiveness of pelvic floor muscle therapies (PFMT) in women aged ≥ 40 years with urodynamic stress incontinence (USI) and mixed UI.To assess the efficacy and cost-effectiveness of pelvic floor muscle therapies (PFMT) in women aged ≥ 40 years with urodynamic stress incontinence (USI) and mixed UI.PATIENTS AND METHODSIn a three-arm randomized controlled trial in Leicestershire and Rutland UK, 238 community-dwelling women aged ≥ 40 years with USI in whom previous primary behavioural intervention had failed were randomized to receive either intensive PFMT (79), vaginal cone therapy (80) or to continue with primary behavioural intervention (79) for 3 months. The main outcome measure was the frequency of primary UI episodes, and secondary measures were pad-test urine loss, patient perception of problem, assessment of PF function, voiding frequency, and pad usage. Validated scales for urinary dysfunction, and impact on quality of life and satisfaction were collected at an independent interview.In a three-arm randomized controlled trial in Leicestershire and Rutland UK, 238 community-dwelling women aged ≥ 40 years with USI in whom previous primary behavioural intervention had failed were randomized to receive either intensive PFMT (79), vaginal cone therapy (80) or to continue with primary behavioural intervention (79) for 3 months. The main outcome measure was the frequency of primary UI episodes, and secondary measures were pad-test urine loss, patient perception of problem, assessment of PF function, voiding frequency, and pad usage. Validated scales for urinary dysfunction, and impact on quality of life and satisfaction were collected at an independent interview.RESULTSAll three groups had a moderate reduction in UI episodes after intervention but there was no statistically significant difference among the groups. There were marginal improvements in voiding frequency for all groups, with no statistically significant difference among them.All three groups had a moderate reduction in UI episodes after intervention but there was no statistically significant difference among the groups. There were marginal improvements in voiding frequency for all groups, with no statistically significant difference among them.CONCLUSIONSIn women who have already had simple behavioural therapies (including advice on PFM exercises) for urinary dysfunction, the continuation of these behavioural therapies can lead to further improvement. The addition of vaginal cone therapy or intensive PFMT does not seem to contribute to further improvement. The improvement in pelvic floor function was significantly greater in the PFMT arm than in the control arm although this did not translate into changes in urinary symptoms.In women who have already had simple behavioural therapies (including advice on PFM exercises) for urinary dysfunction, the continuation of these behavioural therapies can lead to further improvement. The addition of vaginal cone therapy or intensive PFMT does not seem to contribute to further improvement. The improvement in pelvic floor function was significantly greater in the PFMT arm than in the control arm although this did not translate into changes in urinary symptoms.