Editing AUA: Overactive Bladder (2019) (section)

=== Behavioral Therapies (first-line) ===

* A group of risk-free tailorable therapies, which improve individual symptoms by changing patient behavior or the patient’s environment.
*'''<span style="color:#ff0000">Approaches (2):</span>'''
*# '''<span style="color:#ff0000">Changing voiding habits</span>, such as with bladder training and delayed voiding'''
*# '''<span style="color:#ff0000">Behavioral training</span>''', including self-monitoring (bladder diary), scheduled voiding, delayed voiding, double voiding, '''pelvic floor muscle training''', and exercise (including pelvic floor relaxation), active use of pelvic floor muscles for urethral occlusion and urge suppression (urge strategies), urge control techniques (distraction, self-assertions), normal voiding techniques, biofeedback, electrical stimulation, '''fluid management, caffeine reduction,''' dietary changes (avoiding bladder irritants), '''weight loss''' and other life style changes
*#*25% reduction in fluid intake reduces frequency and urgency
*#*Weight loss may improve incontinence specifically
*#*Behavioral therapies are most often implemented by advance practice nurses (e.g., continence nurses) or physical therapists with training in pelvic floor therapy.
*#*No single component of behavioral therapy appears to be essential to efficacy, and no single type of behavioral therapy appears to be superior in efficacy
*'''<span style="color:#ff0000">Should be offered to all patients</span>'''
**'''First-line treatments because they are''' 
**#'''Relatively non-invasive'''
**#'''Associated with virtually no adverse events'''
**#'''As effective in reducing symptom levels as are antimuscarinic medications.'''
**#*Randomized trials indicates that behavioral treatments are generally either equivalent to or superior to medications in terms of reducing incontinence episodes, improving frequency and nocturia and improving QoL.
**Behavioral therapies require an investment of time and effort by the patient to achieve maximum benefits and may require sustained and regular contact with the clinician to maintain regimen adherence and consequent efficacy.
**While most patients do not experience complete symptom relief, most patients experience significant reductions in symptoms and improvements in QoL.
*'''May be combined with pharmacologic management.'''
*In patients who are unwilling or unable to comply with behavioral therapy regimens and instructions, it is appropriate to move to second-line pharmacologic therapies.