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How Can I Retrain My Bladder?

.Hi friends!  Are you in control of your bladder?  Do you immediately look for the bathroom whenever you go somewhere new?  Does it stress you out when the bathroom only has one stall and someone is in there?  Do you find yourself pulling off at the nearest gas station to go pee while on your way to places?  These can all be signs of overactive bladder (OAB) which can lead to urge urinary incontinence.  This can be distressing, embarrassing, and costly, but the good news: we can train our bladders so that we are in control.  We should be the boss of our bladders and our bladders should not be the boss of us.

 

When your bladder fills, tiny stretch receptors send messages to tell your brain that it is time to go pee. As it continues to fill, the reports become more urgent and more frequent. Normally the first sensation to void is when the bladder is 40% full, and the first desire to void is when the bladder is 60% full (Fowler, 2006).

 

If you choose to empty your bladder after the first signal, you aren't letting your bladder fill to its normal capacity. Over time, this can cause the bladder to become more irritable and hold less urine. At this point, your brain begins to think it's full when it isn't! The good news is that we can retrain our bladder out of these bad habits.


 

Bladder retraining is a treatment for overactive bladder (OAB), stress incontinence, and mixed urinary incontinence (Fantl, 1996; Moore, 2013).  Bladder retraining helps to restore normal function of the bladder by allowing it to fill to normal capacity without strong, sudden urges or urinary leakage (Bo, 2015).

 

Bladder retraining is a great first line treatment for most individuals, as it is simple, relatively inexpensive, and without side effects (Fantl, 1996).   It is an alternative to overactive bladder medications that often have undesirable side effects (Rovner, 2011).  However, it can be used on it’s own or in combination with other treatments like medications or pelvic floor muscle training (Bo, 2015).  Individuals who have cognitive or physical disabilities may have less success with bladder retraining techniques (Wallace 2009).

 

Bladder retraining usually has three main parts: education on bladder health and normal bladder functioning, a scheduled voiding regimen that is slowly progressed, and positive reinforcement techniques (Fantl, 1996).

 

Education can compose of many different topics depending on the individual’s symptoms, but often includes fluid and caffeine modifications (Bryant, 2000). Some foods and beverages are irritating to the bladder when consumed and can cause more urinary urgency and leakage.  While it is often not necessary to avoid bladder irritants entirely, being aware of them and minimizing intake can help you  manage your symptoms.  You may also be educated on the importance of good bowel health, as constipation can make urinary symptoms worse (Dougherty, 2002).

 


Timed voiding or scheduled voiding is a technique to help the bladder tolerate filling to normal capacity again.  Timed voiding often starts at 1 hour intervals, although it can be less, and is progressed by 15-30 minute intervals each week if tolerated.  Tolerance is usually measured by the number of incontinent episodes, and control over urgency (Bo, 2015).  This would mean you would start going to the bathroom once per hour and slowly progress each week until you are regularly able to wait two to four hours between trips to the bathroom to pee.

 


To help with the progression of intervals, distraction and relaxation techniques and pelvic floor muscle contractions can help to control urgency episodes (Bo, 2015).  Use the techniques below to help with urgency and to prevent leakage.

 

Stop what you are doing, sit down. Do not give into the urge and rush to the bathroom. Rushing can make the urgency worse and potentially lead to leakage.

 

Take slow deep breaths. This will help to keep you and your body calm to prevent leakage.

 

Perform 5 quick, but strong, pelvic floor muscle contractions. Contracting the pelvic floor muscles will cause a reflex that helps the muscle of the bladder to relax (and will stop the urge to go). (Note: if you’re pelvic floor muscles are weak or you are unable to contract them this technique will not work well. seeing a pelvic floor physical therapist can help.)

 

Apply pressure to the perineal area (the area around the vagina/vulva). This can help to reduce the urgency. Children often do this instinctively when they need to pee.

 

Use mental distraction. There are many different distraction techniques you can use to help with the urge. You can try counting backwards by 7s, making a shopping list, checking your email, calling a friend, etc. Try different techniques to see what works best for you, but the ultimate goal is to get your brain to think about something besides getting to the bathroom to pee.



Overall, more research is needed to determine the true effectiveness of bladder retraining, but it is a low-cost treatment with no known adverse effects (Bo, 2015).  It is suggested that is there is no symptom improvement after 3 weeks, other treatment options should be considered (Bo, 2015)

 

If you are experiencing symptoms of overactive bladder, stress urinary incontinence, or mixed urinary incontinence it is important to discuss this with your healthcare providers for appropriate assessment and treatment.  Ask your provider for a referral to a pelvic floor therapist near you or find one at www.mypfm.com/find-a-pt.

 


To learn more about your pelvic floor muscles, check out these great resources:


For providers, join our Ambassador Program and most of our courses are included with your membership!

  • Treatments for OAB with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS

  • Urinary Incontinence and Urogynecology with Dr. Tessa Krantz, MD

 

Written by Emily Reul, PT, DPT

 

References

  1. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015.

  2. Bryant CM, Dowell CJ, Fairbrother G.  A randomized control trial of the effects of caffeine upon frequency, urgency, and urge incontinence.  Neurourol Urodyn.  2000;19:501-502.

  3. Dougherty MC et al.  A randomized trial of behavioral management for continence with older rural women.  Res Nurs Health. 2002;25:3-13.

  4. Fantl JA et al.  Urinary Incontinence in Adults: Acute and Chronic Management. Rockville, MD: US Dept of Health and Human Services.  Public Health Service.  Agency for Heath Care Policy and Research; 1996.

  5. Fowler CJ, Griffiths D, de Groat WC. The Neural Control of Micturition. Nat Rev Neurosci. June 2008:9(6): 453-466.

  6. Moore K et al.  Committee 12: Adult conservative management.  In: Abrams P et al (Eds.) Incontinence: Fifth International Consultation on Incontinence. European Association of Urology, Arnhem. 2013;1101-1227.

  7. Rovner ES et al.  Urinary incontinence.   In: DiPiro JT et al (Eds.) Pharmacotherapy: A Physiologic Approach, eighth ed. 2013.  McGraw-Hill, New York, pp 1467-1486.

  8. Wallace SA et al.  Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev. 2009;No CD001308.

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