American Board of Family Medicine (ABFM) Practice Exam

What is the first-line treatment for urge incontinence?

1. Anticholinergic drugs such as oxybutynin

2. $-Adrenergic agonists such as mirabegron

3. Duloxetine

4. Bladder training

The correct answer is: Bladder training

The first-line treatment for urge incontinence is bladder training, which focuses on behavioral modification techniques to help patients regain control over their bladder. This approach typically involves teaching patients to gradually increase the time between voiding (urination), thus helping to train the bladder to hold urine for longer periods. The goal is to improve the patient's ability to manage their urgency and reduce the frequency of incontinence episodes. Bladder training is advantageous because it emphasizes lifestyle changes and does not rely on medications, making it a suitable option for many patients, including those who may be sensitive to the side effects of drugs. Additionally, it can be combined with other treatments for enhanced effectiveness. Other treatments, such as anticholinergic drugs and beta-adrenergic agonists, are indeed beneficial and can be used in conjunction with bladder training or if bladder training alone is insufficient. However, they are generally not considered first-line treatment in isolation; rather, they are often secondary options after behavioral interventions have been attempted. Understanding the role of bladder training as a non-pharmaceutical option is essential for managing urge incontinence effectively and should be a primary consideration in treatment planning.