Bladder retraining is a simple and effective method that benefits those women who frequently have an urgent need to pass urine or who wet themselves in this situation. It is also helpful in cases of urinary frequency (going more than 7 times a day) and getting up more than once during the night. The purpose is to regain control of your bladder and enable it to hold a normal volume. The technique is simple, and if you think positively and adhere to the program excellent results can be expected.
The aim of bladder retraining
The aim of bladder retraining is to increase the capacity of the bladder until it can hold the normal amount of urine (300 - 500 ml.), enabling you to reduce visits to the toile to 5-7 times during the day and 0-1 time at night. This involves adopting good bladder habits and learning to suppress bladder contractions using a number of techniques. The program takes 3 months to significantly improve bladder function though some improvement may be noticed in a few weeks.
Good bladder habits
- Drink 6-8 cups (2 litres) of fluids a day. More than this is excessive. Avoid drinking anything within 2 hours of going to bed.
- Limit caffeine intake to 3 cups per day or switch to decaffeinated if the urgency or frequency is bad
- Avoid 'just in case' visits to the toilet
- No straining or 'hovering' over the toilet. Lean forwards when passing water with feet flat on the floor and elbows resting on knees
- Limit alcohol intake
- Ensure good bowel habits all your life.
The training program
The technique involves increasing the amount of fluid the bladder can hold by gradually 'stretching' it. Instead of going to the toilet as soon as you get the urge to void, you should wait 5 minutes, each time. Use urge control techniques to help stave off this urge. At first this may be difficult and you may only initially be able to get the urge under control before going, but persist! Slowly increase the period of deferment from 5-10 minutes and then from 10-20 or 30 minutes. During the time you are putting off going to the toilet you are learning how to suppress bladder contractions. By filling the bladder with more urine, its walls are being stretched and so will hold more. You should only empty the bladder when it is full and you have done your 'hold on' exercise.
Urge control techniques
One of more of these techniques may be helpful in controlling the bladder when the urge is there, and allow voiding to be delayed. They all require practice and can also be used together.
1. Pelvic floor contraction
This helps prevent urine leakage when there is an urgent desire to void by suppressing the unwanted bladder contraction via a spinal cord reflex. It works best if applied early on in an unstable contraction.
2. Perineal Pressure
Achieved by sitting on a firm surface such as the arm of a chair or squatting with heel pressure.
3. Toe curling
4. Cross thighs and tighten buttocks
5. Sitting where possible
The bladder muscle cannot be quietened whilst moving or walking. You must either stand still or sit in order to gain control over the bladder. The above techniques must be applied before the urge reaches its peak in order for them to work.
6. Mental Distraction
Once you have quietened the bladder, stand carefully, keeping abdomen and chest loose, and walk to the toilet with the mind focussed on something else. Counting every step until sitting on the toilet or focussing on your breathing can be good distractions. Once your confidence in your ability to control the bladder has increase, attempt to defer for 5 minutes before going. Try to distract your mind by concentrating on something other than the toilet and emptying your bladder - anything will do eg. Mental arithmetic, the shopping list etc. As you improve, you will find you will be able to hold off for longer and longer periods.
The Townsville Hospital,
J. Hagerty, A. Corstiaans & Prof. A. Rane: Updated January 2006