[Training of patients with urinary incontinence]

The different types of urinary incontinence are defined and the possible educational treatment modalities are described. Stress incontinence may be treated by pelvic floor exercise and bio-feed-back. The object is training in muscle awareness with the purpose of teaching the patients to squeeze without activating the abdominal muscles. Significant improvement can be obtained in 22-63% of the patients. Urge incontinence can be treated by bladder drill and bio-feed-back. Voluntary control over the detrusor reflex is re-educated and the patients are instructed to adhere to a fixed voiding schedule every three hours. In women, 80% may be improved. In reflex incontinence, prophylactic bladder emptying may be initiated by stimulation of specific trigger points. Overflow incontinence may be reduced by optimal voiding technique and clean intermittent self-catheterization. Postmicturition dribble can be relieved by manual emptying of the urethra. No treatment is known for giggle incontinence. In nocturnal enuresis, conditioning treatment is recommended. Immediate waking is essential. Environmental incontinence is treated by securing easy access to voiding facilities and by training in toileting skills. Half of the patients are curable.