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Behavior Modification. Jerry G. Blaivas, MD Clinical Professor of Urology Weil Cornell Medical College New York Presbyterian Hospital Adjunct Professor of Urology SUNY-Downstate Medical Center. Education: physiology common sense. PFE Biofeedback. Bladder Diary. Behavioral

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behavior modification
Behavior Modification

Jerry G. Blaivas, MD

Clinical Professor of Urology

Weil Cornell Medical College

New York Presbyterian Hospital

Adjunct Professor of Urology

SUNY-Downstate Medical Center

slide2

Education:

physiologycommon sense

PFE

Biofeedback

Bladder Diary

Behavioral

Modification

For OAB & SUI

Pelvic floor Education

Bladder training

Fluid/Diet

Management

behavior modification general principles
Behavior Modification:General Principles

Patient keeps voiding diary

Therapist & patient evaluate diary

Recognize patterns

Develop Rx strategies

slide4

OAB Bladder Diary Instructions

Why did you urinate?

(0) Convenience (no urge or desire)

(1) Mild urge (can delay urination for an hour)

(2) Moderate urge (can delay > 10 but <60 min)

(3) Severe urge (can delay for < 10 min)

(4) Desperate urge (must go immediately)

Incontinence grade.

Grade 1 - some drops Grade 2 - moderate loss (wet underpants) Grade 3 - extensive loss (wet outer clothes)

diary assessment
Diary Assessment

Assess voided volumes

MVV = functional bladder capacity

Relationship between VV & UPS

Incontinent episodes

When

Where

What activity engaged in

Recognize patterns

pattern recognition
Pattern Recognition

Garage door

Door key

Running water

Sitting to standing

Elevator

Relationship to bladder volume

Preoccupation

Computer

Reading

Movie

Types of food or fluid

No pattern

slide13

The more you drink

The

more

You

urinate

bladder training
Bladder Training
  • Review bladder diary
  • Determine comfortable voiding interval
  • Patient instructed to void:
    • first thing in morning
    • by the clock at the predetermined interval
    • just before going to sleep
  • Monitor & adjust fluid & food intake
diet modification
Diet Modification

Timing & amount of fluid intake

Purposeful (one at a time) elimination of

Caffeine, tomatoes, citrus

alcohol

Salt

Spicy foods

Treat constipation

bladder training1
Bladder Training
  • Gradually increase inter-voiding interval:
    • by 15 – 30 minutes
    • when comfortable for 3 – 7 days
  • Pattern recognition
  • Teach coping strategies (stress & urge)
urge coping strategies
Urge Coping Strategies

Anticipate those activities that bring on symptoms

contract pelvic muscles quickly

concentrate on suppressing the urge

wait until the urge subsides do not rush — stop and stay still

walk to the bathroom at a normal pace

urge wave
Urge Wave

Courtesy of Katherine Burgio

rushing to the bathroom
Rushing to the Bathroom
  • Increases pabd:> afferent bladder stimulation > stimulates detrusor overactivity
  • Triggers the urge to void
  • Interferes with focus for bladder control
  • Reinforces Pavlovian response
when to void
When to Void

BestTime

WorstTime

WorstTime

CalmPeriod

Courtesy of Katherine Burgio

stress coping strategies
Stress Coping Strategies
  • Anticipate activities that promote SUI
  • Restrict fluid
  • Wear absorbent pad
  • Kegel maneuver just before increase in abdominal pressure
conclusions
Conclusions

Behavioral Rx effective in most patients

Requires motivation and compliance

Require a skilled and trained therapist

Generally inadequate insurance coverage