Behavioral treatment of urinary incontinence: a guideline-driven narrative review.

Abstract

Background and objective: Urinary incontinence (UI) is a highly prevalent condition affecting women and men across the lifespan, with substantial clinical, psychosocial, and economic impact on quality of life, functional status, and healthcare utilization. International clinical practice guidelines consistently recommend behavioral and conservative interventions as the primary of first-line strategy for most UI subtypes, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI)/overactive bladder (OAB), and mixed urinary incontinence (MUI). This narrative review aims to critically synthesize contemporary evidence on behavioral treatment of UI, integrating international guideline recommendations with key primary and secondary literature to support optimal translation into routine clinical care.

Methods: A guideline-driven narrative review was conducted based on the most recent recommendations from the European Association of Urology (EAU), the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU), and the International Continence Society (ICS). Evidence cited within these guidelines was traced to randomized controlled trials, systematic reviews, and meta-analyses. Additional PubMed-indexed studies were included to address special populations, evolving models of care delivery, and implementation barriers. The literature reviewed was published predominantly between 2005 and 2025 and limited to English-language sources.

Key content and findings: Behavioral interventions-including pelvic floor muscle training (PFMT), bladder training, timed or prompted voiding, urgency suppression strategies, lifestyle modification, and structured patient education-demonstrate robust and clinically meaningful improvements in symptom burden and health-related quality of life across UI phenotypes. PFMT remains the central evidence-based intervention for SUI in women and post-prostatectomy incontinence in men, whereas bladder training and urgency suppression strategies are core components of UUI/OAB management. In older adults, frail individuals, and cognitively impaired populations, multicomponent and caregiver-supported behavioral programs are particularly effective and feasible. Emerging telehealth and digital delivery platforms show promise in improving access, adherence, and scalability, although long-term effectiveness and comparative implementation data are still needed.

Conclusions: Behavioral therapy provides a safe, effective, and highly adaptable foundation for UI management across diverse populations and care settings. Despite heterogeneity in study design, intervention protocols, and outcome reporting, international guidelines consistently endorse conservative strategies as first-line treatment. Future research should prioritize intervention standardization, harmonized outcome frameworks, inclusion of underrepresented groups, and integration of implementation science and digital health innovations to maximize long-term effectiveness and global uptake.