Behavior therapy for urinary frequency in a patient with neurogenic bladder: a case report.

A 32-year-old female with a seven year history of multiple sclerosis was hospitalized due to an exacerbation of symptoms, and complained of a high frequency of urination and occasional urinary incontinence. A urologic consult was obtained and the patient was diagnosed as having neurogenic (spastic) bladder, resulting in a reflexive voiding whenever the accumulation of urine in the bladder reacher 100 mls. A behavioral management program using feedback and goal-setting was implemented. Whenever she voided, the patient recorded the time of day, and measured the amount by using a graduated urinal. Following a 5-day baseline the patient and experimenter, on a daily basis, established a goal specifying a minimum waiting period between voidings, even when waiting might result in incontinence. Feedback on average duration between voidings was given daily. After 13 days of treatment, the duration between voidings had increased from a baseline of 58 min to 130 min and the average amount of urine had increased from 95 ml to 160 ml. At three and six month follow-ups, the patient reported that she was able to maintain treatment gains without difficulty; however, she had been unable to increase the time between voidings beyond approximately two hours.