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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. Education: physiology common sense. PFE Biofeedback. Bladder Diary. Behavioral

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Behavior Modification

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  1. 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

  2. Education: physiologycommon sense PFE Biofeedback Bladder Diary Behavioral Modification For OAB & SUI Pelvic floor Education Bladder training Fluid/Diet Management

  3. Behavior Modification:General Principles Patient keeps voiding diary Therapist & patient evaluate diary Recognize patterns Develop Rx strategies

  4. 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)

  5. OAB Diary

  6. Bladder Diary Summary

  7. volume

  8. volume

  9. volume

  10. volume

  11. Diary Assessment Assess voided volumes MVV = functional bladder capacity Relationship between VV & UPS Incontinent episodes When Where What activity engaged in Recognize patterns

  12. 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

  13. The more you drink The more You urinate

  14. 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

  15. Diet Modification Timing & amount of fluid intake Purposeful (one at a time) elimination of Caffeine, tomatoes, citrus alcohol Salt Spicy foods Treat constipation

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

  17. 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

  18. Urge Wave Courtesy of Katherine Burgio

  19. 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

  20. When to Void BestTime WorstTime WorstTime CalmPeriod Courtesy of Katherine Burgio

  21. Stress Coping Strategies • Anticipate activities that promote SUI • Restrict fluid • Wear absorbent pad • Kegel maneuver just before increase in abdominal pressure

  22. Conclusions Behavioral Rx effective in most patients Requires motivation and compliance Require a skilled and trained therapist Generally inadequate insurance coverage

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