**5. Management**

The most commonly used measure of urinary incontinence (UI) treatment efficacy is a reduction in urinary incontinence episodes. Generally, this is recorded as the reduction in mean number of daily episodes, percent reduction from baseline, or reduction in leakage volume. Other outcome measures commonly used for OAB are urinary frequency (total number of daytime and nighttime voids) and frequency of urgency symptoms (with or without leakage). Cure is usually defined as complete absence of urinary incontinence. (Abrams, 2009)

One of the most important measures from the patient's perspective is quality of life. In the literature, many investigations measure patient perception of improvement of OAB, general satisfaction questions, and urinary incontinence-specific quality of life measures. The ICS recommends using patient reported outcome questionnaires that have been rigorously evaluated. (Koelbl et al, 2009)

#### **5.1 Conservative therapies**

Once the diagnosis of OAB has been made, the combination of dietary and lifestyle modification, bladder training, pelvic floor muscle training (PFMT), and biofeedback should be recommended as the initial intervention for OAB. (Burgio, 2002) The Agency for Health Care Policy and Research as well as the Third International Consultation on Incontinence recommends behavioral therapy as first-line therapy. (Wilson et al., 2005) The advantages of behavioral methods include avoidance of surgery, improved central control of bladder function and no adverse drug reactions.

Diagnosis and Treatment of Overactive Bladder 171

and to improve the patient's confidence in bladder control. It is safe and may be beneficial. (Wallace et al., 2004) Bladder training requires compliant and motivated patients and may not be suitable for those with cognitive impairment. It can be time-consuming and is

Patients can be instructed to follow the steps listed below for bladder training :(Modified

 Concentrate on making the urge decrease or even go away, anyway you can. When you feel in control of your bladder, walk slowly to the bathroom, and then

Then, increase the time between scheduled trips to the toilet by one hour

When you can go two days without urine leakage, extend the time between trips

DON'T GET DISCOURAGED! Bladder training takes time and effort, but it is an

Keep this up until you can go four hours between trips to the toilet, or until you are

effective way to get rid of incontinence without medication or surgery

A review in 2009 found that bladder training may be helpful for the treatment of urinary incontinence, but definitive research is needed to support that conclusion. (Wallace et al.,

PFMT involves exercises designed to improve the function of the pelvic floor muscles. Using PFMT to treat OAB is based on the theory that contraction of the levator ani muscles can reflexively inhibit contraction of the detrusor muscle. PFMT is defined as any program of repeated voluntary pelvic floor muscle contractions (VPFMC) taught by a trained healthcare professional. (Wilson et al., 2005) Patients are taught to squeeze the pelvic floor with three sets of 8 to 12 slow velocity contractions held for six to eight seconds each. These exercises should be performed at least three or four times a week and continued for at least 15 to 20

There is increasing evidence to support the use of PFMT for OAB. Patients with detrusor overactivity who completed a PFMT program experienced a clinically and statistically significant reduction in daily UI episodes. (Ba & Berghmans, 2000 and Nygaard et al., 1996) These investigators also reported a significant decrease in urge score. This urge score was

Go to the toilet and try to pass urine every two hours while you are awake.

If you get a strong urge to go to the bathroom before your scheduled time:

Keep this schedule until you can go two days without urine leakage.

primarily effective during waking hours. (Ouslander et al., 2001)

 You do not have to get up during the night! You must try to pass urine whether you feel the need or not You must try to pass urine even if you have just been incontinent.

RELAX. Take a deep breath and let it out slowly.

2004) However, there is very little downside to this therapy.

 Stop, don't run to the bathroom! Stand still or sit down if you can.

This may take several weeks.

**5.1.3 Pelvic floor muscle training (PFMT)** 

weeks. (Hay-Smith et al., 2009)

from DuBeau, 2011):

go.

again.

comfortable.
