Behavioural changes and physical therapies

The behavioural changes and physical therapies recommended by NICE for urinary incontinence in women are:

• Pelvic floor muscle training: pelvic floor muscle training (PFMT) is an effective intervention, particularly for stress and mixed incontinence, where NICE recommends it as first‑line treatment for women who can contract their pelvic floor muscles (if they try to stop urination midstream and can feel the muscles contracting to at least some degree). NICE recommends at least eight pelvic floor muscle contractions performed three times a day for a minimum of 12 weeks. The stomach, leg and buttock muscles should remain relaxed while contracting pelvic floor muscles. Several PFMT apps are available, including the NHS-recommended ‘Squeezy’ app, and pharmacy teams should make themselves familiar with these so they can recommend one where appropriate
• Bladder training for urge or mixed incontinence: bladder training, sometimes referred to as delayed urination, involves the patient learning how to hold more urine in the bladder and so reduce the number of times they need to pass urine. It also includes lifestyle advice on the amount and types of fluids to drink, and coping strategies to reduce urgency. Supervised bladder training is recommended by NICE as first-line treatment for urge or mixed urinary incontinence.