Bladder Training

BLADDER TRAINING

Bladder training can be an effective treatment for urge incontinence, mixed incontinence, urgency-frequency syndrome, and stress incontinence. Studies have shown that bladder training can cut the leakage episode frequency in half for 60-70% of women. Better yet, it has no side effects. It consists of a combination of strategies to control the strong urge to urinate and the amount of urine your bladder can hold without leaking. This is done by scheduling your trips to the bathroom, with a gradual increase in the time interval between trips, to get your bladder used to holding more urine. These techniques are best combined with pelvic floor muscle exercises to strengthen the muscles of your pelvic floor so they do their job better. Click on the following link to view information on Kegel exercises. Bladder training can give women a way to reclaim their bladder control and change her life.

Normal urge feelings come in waves. You feel a slight urge; it grows, peaks, and finally subsides. People with urge incontinence have temporarily lost the ability to make the urge subside, or they don’t take the time to make urges subside. They rush to the bathroom, believing the faster they get there the better. However, the act of rushing only makes things worse, putting extra abdominal pressure on the bladder so it contracts more. Getting to the bathroom just in time reinforces your belief that rushing is the only alternative. Breaking this habit – convincing yourself and your bladder that there are alternatives – will take time, perseverance, and consistent work on strengthening your pelvic floor muscles.

The first step is to keep a 24 hour bladder diary. This will help you see how often you are urinating, your fluid intake, when you leak urine, and whether a sudden urge to urinate is present when you leak. You may have completed a bladder diary for your initial visit with us. This is a necessary tool for this treatment, and will be an effective way to see if this treatment is helping. Click on the following link to view information on bladder diaries.

If you completed a bladder diary for your first physician office visit, your physician should be able to establish a baseline urination frequency (the time between trips to the bathroom) to begin bladder training. If you have not seen a physician yet, look at your bladder diary and find out the shortest time interval between urinations (what is the shortest time between your trips to the bathroom to “pee”, or episodes of uncontrollable urine leakage?). For example, if your bladder diary shows that you go to the bathroom every hour, your “scheduled voiding interval” should begin at 60 minutes, or before you would otherwise leak. If your bladder diary indicates more than one hour between urinations, your “scheduled voiding interval” should begin at 60 minutes.

Once you have found out this information from your bladder diary, you can begin retraining your bladder.

· Void every morning as soon as you wake up, and every evening just before going to sleep.

· Using your “scheduled voiding interval”, schedule trips to the bathroom, whether or not you feel the urge to go. If your bladder diary shows you that you are going to the bathroom every 30 minutes, go every 30 minutes, whether or not you think you need to go. If your bladder diary shows you go every hour, then schedule your trips to the bathroom on the hour, whether you think you need to go or not. This will prevent the bladder from overfilling, which could lead to uncontrollable urine leakage associated with a sudden urge to urinate, or with a cough, laugh or sneeze.

· If you feel the urge to urinate in between your scheduled trips to the bathroom, make every effort to put it off, even if you have a strong urge to go. Have a strategy planned to get your mind off your need to urinate. For instance, sit or stand very still, do a series of quick squeezes of your pelvic floor muscles, relax the rest of your body, take some deep breaths, listen to music, “self-talk” or meditate, until the strong urge passes. Break the habit of rushing to the bathroom – this actually makes things worse. Think about a wave and wait for it to peak. It will subside. Your job is to wait it out. Once the urge has subsided, get involved in some activity until your next scheduled trip to the bathroom.

· If you absolutely have to go to the bathroom outside of your schedule, get back on track as soon as possible with your “scheduled voiding interval”.

· You only need to follow this schedule while you are awake.

· You may consider using a bladder diary to keep a daily record of your urination and leakage episodes so you can track your progress. This is a great way to provide feedback on how well you are doing. As you gain control over your bladder, you may notice a decrease in the number of uncontrollable urine leakage episodes recorded on the diary and a decrease in the frequency of your trips to the bathroom.

· When you get to the point where you can make it to your scheduled time without difficulty, increase your “scheduled voiding interval” by 30 minutes. If you initially were going to the bathroom every hour, now begin going every 1 ½ hours. Continue on this schedule for at least one week before changing the interval again.

· The goal of this training is to be able to go 2-4 hours in between trips to the bathroom without leaking urine. Depending on your urination frequency before beginning bladder training, it may take 1-3 months to meet this goal.

· Don’t become discouraged. It has probably taken some months or years to get where you are now. You may have gotten into the habit of such frequent trips to the bathroom that your bladder is used to holding less than a cup of fluid (less than 8 ounces) in it. Encouraging your bladder to become fuller than it is used to may cause you to have a strong urge to go to the bathroom or may cause a spasm or cramping sensation in your bladder. This symptom will improve as your bladder gets used to this new program.

· Do not increase your fluid intake beyond 6-8 eight ounce glasses per day. Excessive fluid intake will make you go to the bathroom more frequently and limit the effectiveness of bladder retraining.

· You may want to combine bladder retraining with some changes in your diet, such as limiting or eliminating caffeine intake. Click on the following link to view information on diet and bladder control.

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