Non-Invasive Treatments – Behavior Modification

Fluid and dietary manipulations can promote general bladder health and relieve mild urgency and urge incontinence. 

Weight Control. In women, pelvic floor muscle tone weakens with significant weight gain, so women are urged to eat healthful foods in moderation and to exercise regularly.

Fluid Intake. A common misconception among people with incontinence is that drinking less water will prevent accidents. In reality, limiting fluid intake has the following effects:

• The lining of the urethra and bladder becomes irritated, which may actually increase leakage.
• Concentrated urine also has a stronger pungency, so drinking plenty of fluids can help reduce odor.

Some experts recommend drinking two to three quarts a day.

Drinking plenty of cranberry juice may be particularly helpful. It is known to help prevent urinary tract infections. (Low calorie juices are available.)

People with incontinence, however, should stop drinking beverages two to four hours before going to bed, particularly those who experience leakage or accidents during the night.

Fiber-Rich Foods. Constipation can exacerbate urinary incontinence, so diets should be high in fiber, fruits, and vegetables. A diet rich in these foods is highly recommended anyway for overall well being.

Fluid and Food Restrictions. A number of foods and beverages have been reported to increase the incidence of incontinence. Some experts suggest that people who eat or drink the following items should try eliminating one a day over a 10-day period and check to see if removing them improves continence:

• Caffeinated beverages  (In one major 2003 study, tea drinking–but not coffee drinking–was associated with incontinence. In general, however, it might be useful to try avoiding coffee as well, including decaf coffee.)
• Carbonated beverages
• Alcoholic beverages
• Citrus fruits and juices
• Tomatoes and tomato-based foods
• Spicy foods
• Chocolate
• Sugars and honey
• Artificial sweeteners
• Milk and milk products

Bladder training is using a formalized voiding technique to increase functional bladder capacity and reduce UI frequency by gradually increasing the amount of time between voiding. Bladder training is indicated in patients who are motivated to self-manage their voiding habits and who have stress, urge, or mixed urinary incontinence. During waking hours, the patient is put on schedule of voiding routinely by the clock, regardless of the desire to urinate. The time interval between voids is gradually increased, usually by 15 to 30 minutes on a weekly basis until less than 25% of voiding intervals are interrupted by episodes of incontinence. You may be asked to keep a voiding log prior to, or during bladder training.

The ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. You must also have the ability to recognize and respond to the urge to urinate.

The average adult bladder can hold over 2 cups (350ml – 550 ml) of urine. Two muscles are involved in the control of urine flow:

• The sphincter, which is a circular muscle surrounding the urethra. You must be able to squeeze this muscle to prevent urine from leaking out.
• The detrusor, which is the muscle of the bladder wall. This must stay relaxed so that the bladder can expand.

In stress incontinence, the sphincter muscle and the pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen (such as when you cough, laugh, or lift something heavy).

Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises improve the strength and function of the urethral sphincter.

Some women may use a device called a vaginal cone along with pelvic exercises. The cone is placed into the vagina, and the woman tries to contract the pelvic floor muscles in an effort to hold it in place. The device may be worn for up to 15 minutes. This procedure should be done two times a day. Within 4 – 6 weeks, most women have some improvement in their symptoms.

Biofeedback and electrical stimulation may be helpful for those who have trouble doing pelvic muscle training exercises. These two methods can help you identify the correct muscle group to work. Biofeedback is a method that helps you learn how to control certain involuntary body responses.

Electrical stimulation therapy uses low-voltage electrical current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the physical therapist’s office or at home.

Treatment sessions usually last 20 minutes and may be done every 1 – 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.