Bladder retraining is designed to restore normal function to your bladder. Anyone who experiences urinary urgency, frequency, urinary leakage, excessive nighttime voids, pelvic pain, bladder pain, and/or pain with urination will improve by retraining their bladder. The more disciplined and compliant you are to the program the more success you will have in a short period of time.
THE RETRAINING PROGRAM
- The first part of the program is to eliminate all Bladder Irritants by drinking plain water only for at least 2 weeks or until your bladder has reached normal capacity again (ability to hold urine for 3 hours comfortably). Drink on average 4-6oz of water an hour from the time you wake until 3 hours before bed (this will still average 64oz of water for the day but how you drink it is most important!). See Misconceptions and Bathroom 101 for further information.
- Each morning upon arising, go to the toilet and completely empty your bladder. Your voiding schedule will begin upon getting out of bed and end at bedtime. The goal is 3 hours but you may not be able to start on a 3 hour schedule yet. Choose a time interval that you can do consistently all day. If you choose to start at 2 hours for example then you will void every 2 hours from the time you wake until bedtime. For example: 7am, 9am, 11am, 1pm, 3pm, 5pm, etc. until bedtime–whether your feel the urge or not!
- Follow this interval as closely as possible. If it is time to void per your voiding schedule and you don’t feel an urge, void anyway. In the beginning of the program consistency is key. That is why it’s important to choose a time interval that you can be successful at. The important part of the retraining is that you practice telling your bladder when to empty and when to hold. Remember a normal healthy bladder should take 3 hours to fill up with the appropriate amount of fluid intake (4-6oz of water an hour). That is why it is important to eliminate irritants especially caffeinated beverages that increase urine production. Once you are comfortable with your voiding schedule then increase your time until you get to 3 hours. Although your bladder has the capacity to stretch to 4-5 hours this should not be the normal. 3 hours is the max on average that you should be holding your urine.
- If you feel the need to urinate before the scheduled time, use urge delay techniques. Remember your bladder is not full yet despite the feeling so take control and wait until your scheduled time!
- If you have to interrupt the schedule, for example you have a bowel movement and urinate then, just get back on schedule at the assigned time for the next void (do not reset your timer/schedule)
URGE SUPPRESSION TECHNIQUES
- When you feel the urge, stop the activity and sit down if possible. Try to stay very still to maintain control. Avoid rushing to the toilet.
- Perform Kegels by contracting pelvic floor muscles quickly 5-10x. Pelvic floor contractions send a message to the bladder to relax and hold urine. Try to distract yourself by thinking of something other than going to the bathroom. If you are not a candidate for performing Kegels then take 5 big belly breaths instead of contracting the pelvic floor muscles.
- Relax. Do not rush to the toilet. Take a deep diaphragm breath and let it out slowly. Let the urge to urinate pass by using distraction techniques and positive thoughts.
- Repeat the above steps until you feel you have control over the urge. When you feel the urge subside, walk normally to the bathroom. You can urinate once the urge has subsided; unless you are on a voiding schedule then wait until your next scheduled time. Remember you are retraining your bladder, giving into the urges and urinated too early is letting the bladder have control of you.
OTHER TECHNIQUES INCLUDE:
- Mental distraction techniques including visualization of your favorite relaxing vacation, counting slowly, deep breathing, and positive self-talk such as “I am in control of my bladder”.
- Apply pressure to your perineum (at the crotch of your underwear) with a towel or sitting on your heal to reduce urge.
- If all of the above techniques fail and you still have to an overwhelming urge to go, you may use the toilet.
DEALING WITH PROBLEMS AND SET BACKS
Setbacks are not uncommon if you have been ill with a cold or flu, are tired, cannot completely concentrate on the program, feel nervous or tense, are sensitive to cold weather or the sound of running water, or are about to start your menstrual period. When this happens and you get off track simply restart the bladder retraining program the next day or as soon as you can.
The urge needs to be suppressed on a consistent basis; be patient and stick with the program. It works!!! Before you begin, decide what type of strategy will work for you and use it faithfully.