Bladder training is a range of simple bladder holding techniques like increasing the time you hold between emptying the bladder to increase bladder capacity and also using a diary to keep track of the time of day you have leakage and going to the bathroom at that time.
How the Bladder works:
Urine is made all the time through the kidneys. The ureters (the tubes that run from the kidney to the bladder) are constantly passing a trickle of urine down the tubes. The bladder is a muscle like a balloon and as it fills with urine it expands. The pelvic floor muscles keep the urethra (the tube that runs from the bladder to outside) closed.
As your bladder begins to fill up and expand you become aware that the bladder is getting full. A person would then go to the toilet to pass urine, which makes the bladder muscle contract and squeeze, while the urethra and pelvic floor muscles relax.
The brain, the bladder and the pelvic floor muscles all intercept complex nerve messages. The nerve messages being sent tell you when your bladder is full, the exact muscles that need to contract or relax at the right time.
Normal Bladder Habits:
A healthy bladder during the day should hold about one and a half to two cups of urine, this equates to approximately 350ml to 500mls of urine. During the night a healthy bladder can hold about four cups of urine, this equates to approximately 1000mls of urine. When drinking 6 to 8 glasses of water a day it’s normal to pass urine five or six times during the day. The routine normally consists of emptying your bladder first thing in the morning when you get out of bed, four times during the day and during the night before you go to bed. Older people tend to make more urine at night and this pattern may change.
Bladder Training for Stress Incontinence:
To train your bladder you must first wait for an urge to urinate, then hold your bladder for a certain period of time before going to the bathroom. It is recommended that you aim to wait for 15 minutes the first day before releasing and going to the bathroom to urinate. For the first 5 to 7 days try to stick to the 15 minute intervals before using the bathroom. As you progress the next week you increase the amount of time. This should be done until you have a decent amount of time between each bathroom visit.
Control Urge Techniques for Women:
Women should learn several urge techniques to help reach the toilet dry. These techniques should be commenced before starting a bladder re-training program.
Learn to perform a pelvic floor contraction by trying to squeeze the buttocks, drawing in your lower abdomen, use breathing techniques, apply pressure to the clitoris or perineum by using a rolled towel or pressure from your hand or toe curling anything that will assist you in contracting the muscles and allowing you to hold on longer. Some people may prefer to try the method of distraction by thinking or doing something, like hanging the washing out, reading a book or magazine or cleaning to take your focus away from the urge to urinate.
Biofeedback is a training technique used to learn more about how your body behaves. This enables you to know when your body is not functioning properly and recognise when your bladder is overactive. There are two specific techniques:
Using a diary to record the times that you urinate or leak urine. This should be recorded daily to give you an idea of your leakage patterns that occur. To avoid leaking in the future you schedule those times into your diary and to go to the bathroom specifically at that time.
Wait to go to the bathroom by stretching out the intervals in between using the bathroom. First you should plan to go to the toilet once an hour and after following this practice for a period of time you should then change your schedule and start to go to the toilet every one and a half hours. Eventually you will be able to lengthen the interval to every two hours and gradually build up to three or four hours between bathroom visits.
Tips to assist with Bladder Training:
As always it’s important to maintain a healthy lifestyle and diet. The following steps will help improve your success with bladder training:
- Avoid caffeinated drinks including soft drinks, coffee and tea that can increase urination.
- If you do consume caffeinated beverages (even though it’s not recommended) you must avoid having them in the evening.
- Continue to drink 6 to 8 glasses of natural spring water each day.
- Drinking less fluid will make the urine more concentrated and can give you a bladder infection.
- Ensure you empty your bladder completely. After voiding wait and give an extra push to ensure the urine is completely out.
- Go to the toilet as soon as you wake up in the morning.
- Stop drinking fluids two hours before bedtime.
- Go to the toilet before going to bed.
- Avoid going to the toilet just in case.
- Avoid citrus juices, fruits or tomato products.
- Alcohol should be avoided as it can interfere with bladder control.
Drinking caffeine causes the kidneys to increase the production of urine making the bladder fill quickly and making you need to urinate more frequently causing a diuretic effect. Caffeine may also irritate the bladder causing more contractions and tightening’s and urgency to urinate – the feeling when you have to rush to get to the bathroom on time. The best solution is to drink natural spring water however if you still crave that taste try and drink decaffeinated beverages. If you do drink caffeinated drinks limit them to 1 or 2 per day however given the facts above we would highly recommend not drinking caffeine at all.
Keep a diary each day to track your progress. Over time you can celebrate your success that you have had and realise just how far along you have come. The diary also assists your doctor, to know the regularity of the problem and to track your success.
How Bladder Training will help you:
Bladder training will assist with your recovery of incontinence to maintain it or even cure it.
What should I expect to see happen?
- Longer periods of time will pass between bathroom visits.
- More control over the urge to go.
- The ability to hold more liquid in your bladder.
- Urinate larger volumes to completely empty the bladder.
- Reduce bathroom trips during the night.
- Eliminate or reduce your urinary accidents.
- Anxiety will be reduced.
- Increased confidence with your bladder habits.
Be patient bladder training does take time and you won’t see results straight away. It could take anywhere from six to twelve weeks to be successful. If you have been bladder training for several weeks without any change you should consult your doctor or try other approaches. Just remember there may be some other underlying problem or medication you need to be taking.
Stay positive and remember everyone has his or her good and bad days however stick to the program with confidence and you shall succeed.
Speak to your physiotherapist, doctor, health care professional or continence nurse about creating the best program for you.