AUA2021 Panel Discussion: Behavioral Therapies for Overactive Bladder and Urinary Incontinence in Older Adults Individualized or Group Instructions?

By: Ananais C. Diokno, MD, FACS; Diane K. Newman, DNP, CRNP, FAAN, BCP-PMD; Alayne D. Markland, DO, MSc | Posted on: 03 Sep 2021

Behavioral modification programs (BMPs) have been recommended as the first line treatment for overactive bladder (OAB) and urinary incontinence (UI) since the first Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) clinical practice guideline on urinary incontinence in adults was established in 1972. Behavioral interventions have evolved since then to include 4 basic components: 1) patient education regarding the anatomy and function of the lower urinary tract and how it can be controlled, 2) lifestyle changes including fluid modification and elimination of food irritants, 3) bladder training including toileting programs, urge suppression with delayed voiding and 4) pelvic floor muscle (PFM) training to improve the awareness, control, and strength of the PFMs. BMPs are considered a part of the bigger picture of bladder health which includes not only the focus on the urinary bladder and the PFMs but also factors affecting it including bowel control, weight control, smoking cessation, nutrition and physical well-being.1,2

Although acceptance and implementation of BMPs have been slow, those who have embraced it in their practices have incorporated mainly the individualized instructions of behavioral therapies. Many clinical practices have incorporated biofeedback and electrical stimulation into PFM training, while other modalities may include telehealth and mobile health technology to deliver BMPs. The barriers to adoption and implementations of BMPs in practitioners’ offices include lack of understanding of the elements of BMPs, and lack of sufficient time and personnel to teach all the elements of behavioral therapies. Group sessions to teach patient BMPs could obviate this barrier but is the group session effective in improving if not curing the OAB and UI?3

The Panel discussion will elaborate on these approaches, comparing and contrasting group sessions versus individualized BMPs for treating mild to severe cases of OAB and UI. These approaches will be presented by 2 panelists, Diane K. Newman, DNP, CRNP, FAAN, BCP-PMD, Adjunct Professor of Urology in Surgery at the University of Pennsylvania Perelman School of Medicine, and Alayne D. Markland, DO, MSc, Associate Professor of Gerontology and Geriatrics at the University of Alabama Birmingham. Diane Newman will present the data on how to establish group session teaching BMPs but also on the effectiveness in improving and in preventing UI.4 Alayne Markland will present the elements of the individualized approach, including the use of telehealth and mobile health, and its effectiveness in treating OAB and UI. These BMPs have been submitted to rigorous federally-funded prospective randomized controlled trials demonstrating their safety and effectiveness.1,3,5,6,7 The panelists will also present how the behavioral therapies could be positioned/combined with other nonsurgical therapies as well as an adjunctive therapy for those undergoing surgical treatments for these conditions.6,8

The moderator, Ananias C. Diokno, MD, Professor of Urology at Oakland University William Beaumont School of Medicine in Rochester, Michigan and the University of Central Florida in Orlando, Florida, will summarize the points presented by the 2 panelists. He will propose that a good starting point will be to do group sessions teaching BMPs and to use the individualized approach for those for whom the group session was not successful. This strategy could reduce the barrier of adopting and implementing behavioral therapies in their practices and enhance the success rates in managing patients with OAB and UI.3

  1. Burgio KL, Kraus SR, Johnson TM 2nd et al: Effectiveness of combined behavioral and drug therapy for overactive bladder symptoms in men: a randomized clinical trial. JAMA Intern Med 2020; 180: 411.
  2. Burgio KL, James AS, LaCoursiere DY et al: Views of normal bladder function among women experiencing lower urinary tract symptoms. Urology 2021; 150: 103.
  3. Diokno AC, Newman DK, Low LK et al: Effect of group-administered behavioral treatment on urinary incontinence in older women: a randomized clinical trial. JAMA Intern Med 2018; 178: 1333.
  4. Goode PS, Markland AD, Echt KV et al: A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: development and pilot evaluation of MyHealtheBladder. Neurourol Urodyn 2020; 39: 432.
  5. Newman DK, Sung VW and Borello-France D: Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms. Neurourol Urodyn 2018; 37: 14.
  6. Newman DK and Wein AJ: Office-based behavioral therapy for management of incontinence and other pelvic disorders. Urol Clin North Am 2013; 40: 613.
  7. Sampselle CM, Newman DK, Miller JM et al: A randomized controlled trial to compare 2 scalable interventions for lower urinary tract symptom prevention: Main outcomes of the TULIP study. J Urol 2017; 197: 1480.
  8. Scott KM, Gosai E, Bradley MH et al: Individualized pelvic physical therapy for the treatment ofpost-prostatectomystress urinaryincontinenceand pelvic pain. Int Urol Nephrol 2020; 52: 655.
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