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Behavioral Therapy For An Overactive Bladder

Medically reviewed by Steven N. Gange, MDSusan Kerrigan, MD and Marianne Madsen on January 28, 2023

The signs of aging in the human body can appear in any limb or organ with little to no warning. These signs differ between individuals based on a wide variety of factors, including general distinctions like gender and dietary habits, all the way down to the specifics of certain lifestyle choices. One of the more common signs of getting older, though, is the gradual degradation of bodily functions, including urination.


Types of Incontinence


Incontinence (inability to hold urine) is a known affliction of older adults and has been treated in the past with a variety of chemical and physical measures, such as drugs to improve self-control and slow metabolism or catheterization of patients. While these measures can be effective, and many continue to this day, doctors are always seeking new means of treating their older adult patients for a relatively common affliction.


There are a variety of reasons why someone is incontinent. One of the most common is stress incontinence. This happens when you exert pressure on your bladder and urine leaks out, usually when you cough, sneeze, laugh, lift something heavy, or exercise. Stress incontinence can be a problem for women who have had children or anyone else who has had issues with pelvic floor strength. Another common type of incontinence is overflow incontinence. This happens when your bladder doesn’t empty completely, so you have frequent or even constant dribbling. Usually, this means that the muscles in the bladder aren’t strong enough to hold urine in and then squeeze it all out. Some diseases, like Parkinson’s disease, multiple sclerosis, or even an enlarged prostate, can contribute to overflow incontinence. Urge incontinence is another type of incontinence that is characterized by an intense, sudden urge to urinate that you can’t control so you involuntarily leak urine. People who are experiencing this often have to get up in the night to urinate. This can be caused by bladder muscles that are overactive–thus the name “overactive bladder.”


Behavioral Therapy


Behavioral therapy hasn’t been an effective type of therapy for stress or overflow incontinence, but it has been shown to be helpful with urge incontinence. A study published in May 2020 found that a careful regimen of pelvic floor exercises and relaxation techniques could be used to effectively reduce problematic urinary behavior in older males by close to 80%. This shows a significant improvement over existing methods of treatment. Conventional treatment for urinary incontinence–particularly in terms of nocturnal urges–has until now focused on chemical treatments and achieved a maximum of 53% success.


The National Association for Continence recommends a behavioral-based approach to treating incontinence. According to a 2018 treatise on the subject, regular exercise of the pelvic floor can strengthen the muscles along the urinary tract, allowing the individual patient to exercise greater control over their bodily urges. Other recommendations for the same affliction include the elimination of caffeine and high-sugar snacks to reduce diuretic effects and irritation of the urinary tract. 


Both of these treatment methods were originally recorded in male patients but have proven to be  equally or more effective in female patients as well. Additionally, the statistical differences in treatment success remain the same between genders. According to a comparative study arranged by The National Library of Medicine, the difference between male and female patients’ statistical success is below 2%, indicating that this treatment is effective no matter the gender or anatomy to which it is being applied.


The therapy in question involves measured exercises of the pelvic floor by contracting and holding the muscles therein to improve the patient’s voluntary control of those muscles. The more these muscles are trained, the less likely they are to give into the involuntary reflex of urinary release without the conscious involvement of the patient.


It should be noted that although these exercises were so successful that the National Library of Medicine changed their recommendation for treating incontinence, they are far from 100% effective. Patients who suffer from overactive bladder syndrome and its symptoms, such as incontinence, may want to consider combining chemical treatments and lifestyle changes with behavioral therapy for additional reassurance. For those with a chronic condition or in advanced stages of overactive bladder, it may be advisable to use an exterior preventative such as a catheter or adult incontinence briefs as well. When all else fails, these measures can prevent an embarrassing incident.




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