Changing Habits for Better Bladder Health - Diane Newman

July 21, 2023

Diane Newman introduces her educational series on her website, Awaken Pelvic Health, which aims to help clinicians, patients, and their loved ones better understand and manage lower urinary tract symptoms. In her presentations, she covers the basics of behavioral therapy for urinary tract dysfunction, a non-invasive first-line treatment recommended by many professional organizations. She explains the various symptoms associated with bladder storage and emptying issues and post-urination problems. Behavioral therapy, which she likens to toilet training in children, is a conservative approach designed to modify harmful habits like smoking or obesity and promote healthy behaviors like bladder control. She reiterates that continence is a learned behavior, reliant on an intact nervous system, and with the right guidance and reinforcement, one can learn to manage their symptoms effectively. Further detailed presentations are available for those seeking additional information.


Diane K. Newman, DNP, ANP-BC, BCB-PMD, FAAN, Adjunct Professor of Urology in Surgery, Research Investigator Senior, Perelman School of Medicine, University of Pennsylvania, and Former Co-Director of the Penn Center for Continence and Pelvic Health, Philadelphia, PA

Read the Full Video Transcript

Diane Newman: Hello, I'm Diane Newman. I'm a continence nurse specialist and I'm an adult nurse practitioner. I've been practicing in a pelvic floor dysfunction, seeing men and women with lower urinary tract symptoms for now over 35 years. I have a series of presentations on my website Awaken Pelvic Health, so I want people to have a healthy bladder and I'm hopeful this is very informative for you, whether you're a clinician treating these patients or you want to treat these patients, or if you have someone who has the problems or you have a loved one that has the problems. Please go through this series of educational slides and talk that I give. I created these conversations and these presentations for you who may be a clinician who treats these patients, or you may be a patient yourself, or you may have a loved one who has this problem, but the series of slides and presentations really are to inform you on the basics of lower urinary tract dysfunction and conservative behavioral therapy.

I'm going to do a quick overview of behavioral therapy because not a lot of people understand what it is. It seems like most clinicians don't understand what behavioral therapies for lower urinary tract symptoms, what that group of interventions are. But this is first-line treatment that is recommended by all major professional organizations, including the American College of Physicians. Basically, what it is, is it's called conservative treatment because it's non-invasive and it's behavioral treatment. We'll talk a little bit about what that means. And then I have separate presentations on lifestyle, pelvic floor muscle training, and bladder training that you can also view.

So, what is behavioral conservative treatments? Well, they're interventions for lower urinary tract symptoms. The bladder either stores or empties, and these are the symptoms that we see in patients that have storage problems. You have urinary urgency, frequency, you'll have nocturia, which means they get up at night to urinate, and you'll have incontinence. You'll have stress incontinence or urgency incontinence. Voiding symptoms or symptoms that occur when you pee, when you void, and that might be a poor urine flow, starts and stops, intermittency, which people say it stops and then it kind of goes again and it stops again, so it's intermittent, and they may strain to actually urinate or they may have difficulty urinating.

And then postmicturition symptoms. One of the symptoms that I hear a lot in men who may or may not have prostate treatment is post-void dribbling, and that's because the fact is they'll tell me they urinate, they walk away from the toilet, and they drip some more. And actually that's because the urine is sitting either at the base or the neck of the bladder or in the urethra. Because remember, men have a long urethra with a curves, like an S-curve.

These are all the behavioral treatments, and really it's called conservative treatment, which means that tries to identify what is the symptom and how we can possibly change it with behavioral therapy. Education, lifestyle, pelvic floor muscle training, bladder training, and voiding schedules are things that we use to train someone with behavioral interventions.

What you do is you find out what the habit is. So, what is the habit? One example may be smoking. And can they change it? So you want to modify or alleviate the smoking because we know that those who smoke have increased risks of bladder symptoms. Someone who is obese. Losing weight has been shown to improve bladder symptoms, so can we work with them on trying to do it before go on a diet. And then the training, say they have low urinary urgency, like they have bladder urgency, they're rushing to the bathroom all the time, can we teach them how to control urgency? So that's where they find out the habit and then how can you train them to alleviate that.

The thing that I always bring up is the fact that continence is a learned behavior. One of the things I start with when I start my behavioral treatment program with an individual patient is the fact of, what is continence? Continence is the opposite of incontinence. So becoming continent is a learned behavior. We were toilet trained as children. How are we toilet trained? Well, we were rewarded for peeing in the proper place, which in Western cultures is in the toilet. I always say I had three girls. How I trained my girls is with M&M's. If Emily went on the toilet like mommy wanted, she got an M&M. If you have a son who pees on the kitchen floor, you don't say, "wonderful, Johnny. That's a great thing. Mommy loves it." No, you don't scold them, but you say, "listen, no, we don't want you to do that. This is where you should go to the bathroom." So we train them.

In a sense, behavioral therapy is like that. We really teach them how to reverse whatever symptom they have through positive reinforcement basically with behavioral training. So really, continence is a learned behavior, and you must have intact brain and spinal cord, so you have to have an intact nervous system, for it to work. And that's why at a certain age, a child is able to be continent because they have neurologic development, usually by the age of 3 to 4. The issue is that really continence is a learned behavior. And I explain that to patients. Your brain tells you when you have to go to the bathroom, your nerves, the bladder is distended, there's a message from your brain to go to the bathroom. So really that is what behavioral therapy is. It combines some of those information messages.

If you want further information on the specifics around behavioral therapy, please listen to the other presentations on lifestyle pelvic floor muscle training and bladder training. Thank you for listening.