From the Guidelines
The most appropriate initial non-pharmacological management for this patient is to recommend bladder training, as it is a strongly recommended treatment for urgency UI with moderate-quality evidence 1. This approach involves having the patient gradually increase the intervals between voiding to improve bladder capacity and reduce symptoms of urgency and frequency. Bladder training is particularly suitable for this 74-year-old woman with symptoms of overactive bladder (frequency, urgency, nocturia) who has expressed reluctance to take additional medication. The patient's type 2 diabetes mellitus (T2DM) and hypertension (HTN) should be considered when developing a treatment plan, and lifestyle modifications such as weight loss and exercise may also be beneficial in improving urinary incontinence symptoms, as supported by moderate-quality evidence 1. Some key points to consider when implementing bladder training include:
- Starting with a voiding schedule based on the patient's current habits
- Gradually increasing the intervals between voiding over time
- Encouraging the patient to delay voiding when they feel the urge to urinate
- Providing education on pelvic floor muscle exercises to help improve bladder control After initiating bladder training, the healthcare provider can assess the patient's response to treatment and consider additional interventions, such as pelvic floor muscle training or behavioral modifications, if necessary. It is essential to prioritize non-pharmacological treatments, as they are generally associated with fewer adverse effects and can be effective in improving symptoms and quality of life, as supported by high-quality evidence 1.
From the Research
Initial Non-Pharmacological Management
The most appropriate initial non-pharmacological management for a 74-year-old woman with urinary frequency, urgency, and nocturia, who has type 2 diabetes mellitus (T2DM) and hypertension (HTN), and refuses to take additional medication includes:
- Behavioral modification, such as bladder training and pelvic floor muscle exercises (Kegel exercises) 2, 3, 4, 5, 6
- Lifestyle modification, including dietary changes and fluid management 3, 6
Bladder Training
Bladder training focuses on modifying bladder function by changing voiding habits, and a bladder diary is indispensable 4. This approach can help improve bladder control and reduce symptoms of urinary frequency, urgency, and nocturia.
Pelvic Floor Muscle Exercises
Pelvic floor muscle exercises, such as Kegel exercises, can help strengthen the muscles that support the bladder and urethra, improving bladder control and reducing symptoms of urinary incontinence 2, 3, 5, 6.
Importance of Patient Education
Patient education and identification of the underlying causes of urinary incontinence are crucial in developing an effective treatment plan 2, 3, 4, 5, 6. A healthcare provider should work with the patient to design a behavioral program that incorporates education and lifestyle modification to manage urinary incontinence.