Bladder Training

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What is bladder training?

Bladder training is a way of teaching your bladder to regain control by suppressing the unwanted contractions and allowing it to hold larger amounts of urine. It helps the bladder to become less overactive. Bladder training is about restoring normal sensation in the bladder, so that patients go to the toilet less frequently and pass larger volumes.

What is an overactive bladder?

If your bladder contracts with little or no warning it can give you an urgent need to pass urine. This gives you little or no time to get to the toilet. Uncontrolled bladder contractions are not dangerous but are a common cause of frequent voiding, a feeling of urgency and leakage of urine.

What causes overactive bladder?

For most people the cause of an overactive bladder is unknown. There could be a neurological cause for the problem (relating to the brain or spinal nerves) but this is uncommon. Stress can make the problem worse and the type of fluids you drink can also influence your symptoms. It can occur at any age.

How much can a bladder hold?

The bladder acts as a storage tank, which expands on filling, like a balloon. A normal bladder in a healthy adult can comfortably hold a pint (500mls) of urine. You need to aim for 300 to 400 mls. You can use a jug to measure your urine.

The bladder should be emptied three to four hourly. This also depends on how much you drink and your bladder capacity.

How can the bladder be retrained?

Instead of bladder controlling you, you need to learn how to control your bladder. Instead of rushing to the toilet as soon as you get the urge to pass urine it is important to try to learn to ‘hold on’. Don’t go straight away. Try to increase the time you hang on for, start with few minutes first, and then gradually increase this. For example if you find you are going to the toilet every half an hour, try holding on for another 10 minutes for a week, then by 15 minutes for a week and then 30 minutes etc. Eventually your bladder capacity will increase and you should be able to hold on for 3 to 4 hours between toilet visits.

To begin with progress may seem small but, provided you persevere, you should see a great improvement. You will need to continue the treatment for at least three months or longer, by which time you should be regaining control of your bladder and the improvement will be long lasting.

How can I suppress the urgency?

There are different techniques for this. Here are some suggestions:

1. Sit straight on a hard seat.
2. Distract yourself by: counting down from 100, try doing a crossword or word search, read a book, reciting the alphabet or wait for the next break on television.
3. Try holding on to something, like a rolled up towel on a chair, sitting on the edge of a bath tub, hopping from one foot to another, crossings legs or standing on tiptoes.
4. Contract your pelvic floor muscle. Contracting these muscles may help to suppress both urgency and incontinence.

What else can I do?

You will find it useful to keep a diary of when you go to the toilet at the start of bladder training and then again a few months later. Some patients may get the urge when doing particular activities, like before going out, getting out of the car, putting keys in the door, returning home, undressing or running the tap.

In order to stop this urge try squeezing your pelvic floor muscle and taking more time to get out of car or back into the house.

What should I avoid?

There are number of drinks that can irritate the bladder:

• Caffeinated drinks such as tea, coffee and coke
• Carbonated or fizzy drinks.
• Artificially sweetened drinks such as diet drinks
• Hot chocolate
• Alcohol
• Green tea and mint tea
• Blackcurrant juice
• Citrus fruit juices

Try avoiding these or drink in moderation.

Drinks that do not irritate bladder are:

• Water
• Fruit teas
• Caffeine-free drinks
• Milk
• Diluted fruit juices

Aim to drink 6 to 8 cups of fluid a day or 1.5 to 2 litres. If you drink less then your urine can become concentrated which can irritate the bladder even further. Have your last drink 2 hours before you go to bed.

What are pelvic floor muscle exercises?

These exercises are designed to strengthen the muscle which close off the bladder outlet and will help you to prevent leakage when a strong or urgent desire to pass waters occurs.

Which muscles?

The pelvic muscles help to support and control your bladder.

It can be identified in the following way:

• When you are in the middle of passing urine, try to stop your flow momentarily and then restart it. By doing this you will become aware of the muscles involved and how to contract them
• In a similar way imagine you are trying to stop a motion or control diarrhoea by tensing the muscles. Do this several times until you are certain you can identify the muscles and how to activate them without tensing the legs or buttocks. This should not be used as an exercise

The exercises

Once you have worked out how to contract these muscles they should be exercised regularly as follows:

Starting with the back (bowel) muscles and then the front (bladder), pull up both counting to 4 slowly and then release them. Do this 4 times. Be sure you have a feeling of a lift and not straining or pulling down.

Repeat the exercises at least 4 times a day, but never whilst voiding, and up to once an hour if possible. You can do these exercises anywhere, sitting or standing, watching TV or waiting for a bus, and so there is no need to interrupt your normal daily routine.

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