What is the recommended treatment for urinary incontinence or overactive bladder syndrome using bladder training?

From the Guidelines

Bladder training is a highly recommended first-line treatment for urinary incontinence and overactive bladder syndrome, as it has been shown to be effective in reducing symptom levels with minimal adverse effects. The approach involves following a fixed voiding schedule that gradually increases the time between urinations, starting with every 30-60 minutes during waking hours, regardless of whether the patient feels the urge, and then gradually increasing this interval by 15-30 minutes each week until reaching a normal voiding pattern of every 3-4 hours 1. When feeling the urge to urinate between scheduled times, patients should use urge suppression techniques such as deep breathing, relaxation, distraction, and pelvic floor muscle contractions to delay voiding until the scheduled time.

Key Components of Bladder Training

• A bladder diary should be maintained to track progress, recording fluid intake, voiding times, and incontinence episodes
• The program should be combined with pelvic floor muscle exercises and fluid management, avoiding bladder irritants like caffeine and alcohol
• Patients should understand that occasional setbacks are normal, and persistence with the program is key to long-term success

Evidence Supporting Bladder Training

The most recent and highest quality study, published in 2024, recommends offering behavioral therapies, including bladder training, to all patients with overactive bladder, citing strong evidence for its effectiveness and excellent safety profile 1. Previous studies have also supported the use of bladder training as a first-line treatment, highlighting its ability to reduce symptom levels and improve quality of life 1.

Implementation and Outcomes

Bladder training typically requires 6-12 weeks of consistent practice to achieve significant improvement. By helping patients regain cortical control over bladder function, reducing detrusor muscle overactivity, and increasing bladder capacity, bladder training can lead to improved symptoms and quality of life. As the most recent guideline recommends, clinicians should offer behavioral therapies, including bladder training, to all patients with overactive bladder 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Bladder Training for Urinary Incontinence or Overactive Bladder Syndrome

• Bladder training is a widely prescribed treatment for overactive bladder (OAB) and urinary incontinence, aiming to increase the interval between voids 2, 3.
• The efficacy of bladder training has been evaluated in several studies, with varying results:
  • A 2023 study found that bladder training may cure or improve OAB compared to no treatment, and may be more effective than anticholinergics, with fewer adverse events 2.
  • A 2004 study suggested that bladder training may be helpful for the treatment of urinary incontinence, but the evidence was limited and of variable quality 3.
• Bladder training can be used in combination with other treatments, such as pelvic floor muscle training (PFMT) or pharmacological treatments like anticholinergics or β3-adrenoceptor agonists:
  • A 2020 study recommended a stepwise treatment approach for OAB, starting with conservative measures like weight reduction, fluid optimization, and pelvic floor exercises, and progressing to pharmacological treatments if necessary 4.
  • A 2006 study found that combination therapy with bladder training and tolterodine was more effective than either treatment alone in reducing OAB symptoms 5.
• The evidence for the effectiveness of bladder training is generally of low to very low certainty, and more well-designed trials are needed to reach a firm conclusion:
  • A 2000 study highlighted the need for high-quality, randomized controlled trials to evaluate the effect of pelvic floor muscle training on overactive bladder symptoms 6.

Key Findings

• Bladder training may be effective in reducing symptoms of OAB and urinary incontinence.
• Combination therapy with bladder training and other treatments may be more effective than single treatments.
• The evidence for bladder training is generally of low to very low certainty, and more research is needed to confirm its effectiveness.

Treatment Options

• Bladder training can be used as a first-line treatment for OAB and urinary incontinence.
• Pharmacological treatments like anticholinergics or β3-adrenoceptor agonists may be used in combination with bladder training.
• Pelvic floor muscle training (PFMT) may also be used in combination with bladder training to improve treatment outcomes.