Behavioral Therapy in Combination with Pharmacotherapy

Abstract

Behavioral treatments (BT) are a group of therapies that aim to improve overactive bladder symptoms by modifying patient behavior or his/her environment. They may include bladder diary, timed voiding, delayed voiding, pelvic floor muscle training, urge suppression, biofeedback, electrical stimulation, fluid management, dietary changes, weight loss, and other lifestyle changes. Guidelines designate BT as first-line treatments because they are as effective in improving symptoms as pharmacological treatment and are relatively noninvasive and rarely associated with adverse events. However, they demand active participation of the patient as well as time and effort from the clinician. Behavioral and drug therapies are frequently used in combination in clinical practice to enhance patient symptom control and quality of life. A number of studies indicate that starting behavioral and pharmacological therapy simultaneously may improve outcomes. Alternatively, patients who are not significantly improved on behavioral or drug therapy alone may benefit from adding the alternate therapy in a stepped approach. In this chapter we review the use of behavioral therapy in combination with pharmacotherapy for the treatment of non-neurogenic overactive bladder.