Behavioral Therapy in Combination with Pharmacotherapy
Behavioral treatments (BT) are a group of therapies that aim to improve overactive bladder symptoms by modifying patient behavior or his/her environment. They may include bladder diary, timed voiding, delayed voiding, pelvic floor muscle training, urge suppression, biofeedback, electrical stimulation, fluid management, dietary changes, weight loss, and other lifestyle changes. Guidelines designate BT as first-line treatments because they are as effective in improving symptoms as pharmacological treatment and are relatively noninvasive and rarely associated with adverse events. However, they demand active participation of the patient as well as time and effort from the clinician. Behavioral and drug therapies are frequently used in combination in clinical practice to enhance patient symptom control and quality of life. A number of studies indicate that starting behavioral and pharmacological therapy simultaneously may improve outcomes. Alternatively, patients who are not significantly improved on behavioral or drug therapy alone may benefit from adding the alternate therapy in a stepped approach. In this chapter we review the use of behavioral therapy in combination with pharmacotherapy for the treatment of non-neurogenic overactive bladder.
KeywordsOveractive bladder Management Muscarinic antagonists Behavioral treatment Multimodal therapy
- 1.Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, Hunter K, et al. Adult conservative management. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. International consultation on incontinence. 6th ed. 6th International Consultation on Incontinence, Tokyo, September 2016. pp. 1443–628. Bristol: The International Continence Society (ICS) and the International Consultation on Urological Diseases (ICUD); 2017.Google Scholar
- 3.Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ; American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. 2012; amended 2014. http://www.auanet.org/guidelines/overactive-bladder-(oab)-(aua/sufu-guideline-2012-amended-2014). Accessed 27 Apr 2018.
- 5.Burkhard FC, Bosch, JLHR, Cruz F, Lemack GE, Nambiar N, Thiruchelvam A, et al. EAU guidelines on urinary incontinence in adults. Arnhem: EAU Guidelines Office; 2017. http://uroweb.org/guideline/urinary-incontinence/. Accessed 26 Apr 2018.
- 18.Elser DM, Wyman JF, McClish DK, Robinson D, Fantl JA, Bump RC. The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence. Continence Program for Women Research Group. Neurourol Urodyn. 1999;18(5):427–36.CrossRefGoogle Scholar
- 20.Millard RJ; Asia Pacific Tolterodine Study G. Clinical efficacy of tolterodine with or without a simplified pelvic floor exercise regimen. Neurourol Urodyn. 2004;23(1):48–53.Google Scholar
- 32.Andersson KE, Cardozo L, Cruz F, Lee K-S, Suhai A, Wein AJ. Pharmacological treatment of urinary incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th International Consultation on Incontinence, Tokyo, September 2016, pp. 805–957. The International Continence Society (ICS) and the International Consultation on Urological Diseases (ICUD); 2017.Google Scholar
- 40.Abdelbary AM, El-Dessoukey AA, Massoud AM, Moussa AS, Zayed AS, Elsheikh MG, et al. Combined vaginal pelvic floor electrical stimulation (PFS) and local vaginal estrogen for treatment of overactive bladder (OAB) in perimenopausal females. Randomized controlled trial (RCT). Urology. 2015;86(3):482–6.CrossRefGoogle Scholar