First-line treatment for urge incontinence?

• A. Bladder retraining
• B. Antimuscarinic medication
• C. Sacral nerve stimulation
• D. Urinary diversion

Answer: (A)

Behavioral therapy to retrain the bladder is the first step in managing urge incontinence. Bladder retraining teaches patients to resist the urge to void and to void at scheduled intervals, gradually lengthening the time between voids to increase functional bladder capacity. This approach targets the underlying pattern of detrusor overactivity by conditioning the bladder to hold urine longer and by reducing the frequency of reflexive bladder contractions. When paired with urge-suppression techniques and, if appropriate, pelvic floor muscle training, many patients experience fewer leakage episodes and improved control without medications or procedures.

Pharmacologic options, like antimuscarinic medications, can help by dampening detrusor contractions, but they introduce systemic side effects (such as dry mouth, constipation, or cognitive effects in older adults) and are typically considered after behavioral strategies have been tried or when they are more feasible for the patient. More invasive or specialized treatments—sacral nerve stimulation or urinary diversion—are reserved for refractory or complex cases and are not viewed as first-line options.