- What is the clinical effectiveness of behavioural modification for the treatment of adults with urinary incontinence resulting from neurogenic bladder?
- What are the evidence-based guidelines associated with the use of behavioural modification for the treatment of adults with urinary incontinence resulting from neurogenic bladder?
There was no evidence found that directly compared behavioural modification to pharmacologic treatment such as anticholinergics for the treatment of adults with urinary continence from neurogenic bladder. Data from a 2014 systematic review on the effects of pelvic floor muscle training (PFMT) suggested that it lead to better control of stress urinary incontinence (SUI) in women as compared to no treatment or inactive control treatments, as determined by patient-reported or clinician-reported measures, with few adverse effects. When the type of urinary incontinence was unspecified, the effect size was reduced. There were no data on urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI) alone. Women with either SUI or any type of urinary incontinence were also more satisfied with PFMT treatment than controls, while women in the control groups were more likely to seek further treatment. The American College of Physicians (ACP) recommends PFMT as first-line therapy for SUI, and recommends against treatment with systemic pharmacologic therapy. For UUI, ACP recommends bladder training as first-line therapy, and pharmacologic treatment if bladder training was unsuccessful. ACP recommends PFMT plus bladder training for MUI (no algorithm relative to pharmacologic therapy stated).