Simple and it works: bladder retraining aids detrusor overactivity.(Gynecology)

UNIVERSAL CITY, CALIF. -- What patient wouldn't opt for stress and urgency incontinence therapy that is simple, noninvasive, inexpensive, and uncomplicated by side effects?

Such an alternative exists in the form of bladder retraining, but few patients--and unfortunately, few physicians--have the motivation and determination to make it work, Dr. Alfred Bent said at the annual meeting of the Obstetrical and Gynecological Assembly of Southern California.

Bladder retraining involves written, visual, and verbal instruction and regular reinforcement through follow-up visits.

It can generally be employed after a simple evaluation that includes a thorough history and physical examination (including a local neurologic examination), completion of a voiding diary, urinalysis and culture, and residual urine determination through ultrasound.

To save time, Dr. Bent's office sends patients instructions to complete the voiding diary before his examination. (See box.)

After examining the patient's 24-hour record of voiding times, amounts, and symptoms, the physician establishes an individualized voiding schedule for the patient. For example, if she voids every 2 hours but is wet in between, she is instructed to begin voiding every hour. When that step successfully keeps her dry, the voiding schedule is extended to 1 hour, 15 minutes, and gradually increased until she is dry virtually all of the time.

Like other incontinence therapies, bladder retraining should be used in conjunction with fluid management and restriction of bladder irritants such as coffee. And it is rarely 100% successful, although incontinent episodes can be reduced by 60% or more, said Dr. Bent, who chairs the department of gynecology at the Greater Baltimore Medical Center.