Editing Urinary incontinence (section)

=== Behavioral therapy, physical therapy and exercise ===
Behavioral therapy involves the use of both suppressive techniques (distraction, relaxation) and learning to avoid foods that may worsen urinary incontinence. This may involve avoiding or limiting consumption of caffeine and alcohol. Behavioral therapies, including bladder training, biofeedback, and pelvic floor muscle training, are most effective for improving urinary incontinence in women, with a low risk of adverse events.<ref>{{cite journal | vauthors = Balk EM, Adam GP, Corsi K, Mogul A, Trikalinos TA, Jeppson PC | title = Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review | journal = Journal of General Internal Medicine | volume = 34 | issue = 8 | pages = 1615–1625 | date = August 2019 | pmid = 31062225 | pmc = 6667523 | doi = 10.1007/s11606-019-05028-0 }}</ref><ref name="auto2">{{cite journal | vauthors = Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D | title = Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 9 | pages = CD012337 | date = September 2022 | pmid = 36053030 | pmc = 9437962 | doi = 10.1002/14651858.CD012337.pub2 | collaboration = Cochrane Incontinence Group }}</ref><ref>{{cite journal | vauthors = Imamura M, Williams K, Wells M, McGrother C | title = Lifestyle interventions for the treatment of urinary incontinence in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 12 | pages = CD003505 | date = December 2015 | pmid = 26630349 | pmc = 8612696 | doi = 10.1002/14651858.CD003505.pub5 | collaboration = Cochrane Incontinence Group }}</ref><ref name="auto" /> Behavioral therapy is not curative for urinary incontinence, but it can improve a person's quality of life. Behavioral therapy has benefits as both a monotherapy (behaviorial therapy alone) and as an adjunct to medications (combining different therapies) for symptom reduction.<ref name="Elavsky DrugTopics">{{cite journal| vauthors = Elavsky M |title=Urinary Incontinence: What Pharmacists Should Know|journal=DrugTopics|date=February 2018|volume=162|issue=2|page=24}}</ref> Time voiding while urinating and bladder training are techniques that use biofeedback. In time voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak.<ref name="auto" /> Biofeedback and muscle conditioning, known as bladder training, can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.<ref>{{cite web |author=Beaumont Health |title=Treatment for Incontinence |url=https://www.beaumont.org/treatments/incontinence-treatment |access-date=19 October 2018 |website=www.beaumont.org}}</ref>

Avoiding heavy lifting and preventing constipation may help with uncontrollable urine leakage. Stopping smoking is also recommended as it is associated with improvements in urinary incontinence in men and women.<ref>{{cite journal | vauthors = Wyman JF, Burgio KL, Newman DK | title = Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence | journal = International Journal of Clinical Practice | volume = 63 | issue = 8 | pages = 1177–1191 | date = August 2009 | pmid = 19575724 | pmc = 2734927 | doi = 10.1111/j.1742-1241.2009.02078.x }}</ref> Weight loss may also be helpful for people who are overweight to improve symptoms of incontinence.<ref name="Qa2014" /><ref>{{cite journal | vauthors = Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK | display-authors = 6 | title = Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis | journal = Clinical Obesity | volume = 11 | issue = 4 | pages = e12450 | date = August 2021 | pmid = 33955687 | doi = 10.1111/cob.12450 | hdl-access = free | s2cid = 233869987 | hdl = 10044/1/89229 | url = https://pure.ulster.ac.uk/en/publications/0730378b-974c-4c2d-bb92-2dc159a27548 }}</ref><ref name="auto2" />

Physical therapy can be effective for women in reducing urinary incontinence.<ref>{{cite journal | vauthors = López-Liria R, Varverde-Martínez ML, Padilla-Góngora D, Rocamora-Pérez P | title = Effectiveness of Physiotherapy Treatment for Urinary Incontinence in Women: A Systematic Review | journal = Journal of Women's Health | volume = 28 | issue = 4 | pages = 490–501 | date = April 2019 | pmid = 30575448 | doi = 10.1089/jwh.2018.7140 | s2cid = 58590966 }}</ref> [[Pelvic floor physical therapy|Pelvic floor physical therapists]] work with patients to identify and treat underlying pelvic muscle dysfunction that can cease urinary incontinence. They may recommend exercises to strengthen the muscles, [[electrostimulation]], or [[biofeedback]] treatments.<ref>{{cite journal | vauthors = Wallace SL, Miller LD, Mishra K | title = Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women | journal = Current Opinion in Obstetrics & Gynecology | volume = 31 | issue = 6 | pages = 485–493 | date = December 2019 | pmid = 31609735 | doi = 10.1097/GCO.0000000000000584 | s2cid = 204703488 }}</ref><ref>{{cite journal | vauthors = Rosenbaum TY | title = Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review | journal = The Journal of Sexual Medicine | volume = 4 | issue = 1 | pages = 4–13 | date = January 2007 | pmid = 17233772 | doi = 10.1111/j.1743-6109.2006.00393.x }}</ref> Exercising the muscles of the pelvis such as with [[Kegel exercise]]s are a first line treatment for women with stress incontinence.<ref name="Qa2014">{{cite journal | vauthors = Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P | title = Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians | journal = Annals of Internal Medicine | volume = 161 | issue = 6 | pages = 429–440 | date = September 2014 | pmid = 25222388 | doi = 10.7326/m13-2410 | s2cid = 15004955 | doi-access =  }}</ref> Efforts to increase the time between urination, known as [[bladder training]], is recommended in those with urge incontinence.<ref name="Qa2014" /> Both these may be used in those with mixed incontinence.<ref name="Qa2014" />

Physical therapy, both by itself and in combination with anticholinergic drugs, was found to be more successful in reducing urinary incontinence in women than anticholinergics by themselves.<ref name="auto"/>

Small vaginal cones of increasing weight may be used to help with exercise.<ref>{{cite web|title=How to Use Vaginal Weights|url=http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-url = https://web.archive.org/web/20130329212916/http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-date = 29 March 2013 |publisher=National Incontinence|access-date=10 October 2012 |date=September 4, 2012 |author=Chelsea|work=Incontinence Blog - NationalIncontinence.com }}</ref><ref name="Herb2013">{{cite journal | vauthors = Herbison GP, Dean N | title = Weighted vaginal cones for urinary incontinence | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD002114 | date = July 2013 | volume = 2013 | pmid = 23836411 | pmc = 7086390 | doi = 10.1002/14651858.CD002114.pub2 }}</ref> They seem to be better than no active treatment in women with stress urinary incontinence, and have similar effects to training of pelvic floor muscles or [[electrostimulation]].<ref name="Herb2013" />

[[Biofeedback]] uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence. The evidence supporting the role for biofeedback devices in treating urinary incontinence is mixed.<ref name="Leonardo_2022">{{cite journal | vauthors = Leonardo K, Seno DH, Mirza H, Afriansyah A | title = Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials | journal = Neurourology and Urodynamics | volume = 41 | issue = 6 | pages = 1258–1269 | date = August 2022 | pmid = 35686543 | doi = 10.1002/nau.24984 | s2cid = 249545181 }}</ref> There is some very weak evidence that electrical stimulation that is low in frequency may be helpful in combination with other standard treatments for women with overactive bladder condition,<ref>{{cite journal | vauthors = Stewart F, Berghmans B, Bø K, Glazener CM | title = Electrical stimulation with non-implanted devices for stress urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 12 | pages = CD012390 | date = December 2017 | pmid = 29271482 | pmc = 6486295 | doi = 10.1002/14651858.CD012390.pub2 | collaboration = Cochrane Incontinence Group }}</ref> however, the evidence supporting a role for biofeedback combined with pelvic floor muscle training is very weak and likely indicates that biofeedback-assistance is not helpful when included with conservative treatments for overactive bladder.<ref name="Leonardo_2022" />

Preoperative pelvic floor muscle training in men undergoing radical prostatectomy was not effective in reducing urinary incontinence.<ref name="Wang" />

Alternative exercises have been studied for stress urinary incontinence in women.<ref name="Bø_2013">{{cite journal | vauthors = Bø K, Herbert RD | title = There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review | journal = Journal of Physiotherapy | volume = 59 | issue = 3 | pages = 159–168 | date = September 2013 | pmid = 23896331 | doi = 10.1016/S1836-9553(13)70180-2 | quote = There is not yet strong evidence that alternative exercise regimens can reduce urinary leakage in women with stress urinary incontinence. | doi-access = free }}</ref> Evidence was insufficient to support the use of [[Paula method]], [[abdominal muscle]] training, [[Pilates]], [[Tai chi]], [[breathing exercises]], postural training, and generalized fitness.<ref name="Bø_2013" />