BOWEL AND BLADDER RETRAINING
The goal of bowel and bladder retraining is to return you to a normal and convenient pattern. People who experience fecal and urinary leakage, urinary urgency, frequency, and excessive nighttime voiding can show improvement with this retraining technique. Bladder retraining helps restore your bladder capacity to normal. Bowel retraining helps to keep you regular with normal stool consistency of Type 4 per Bristol Stool Chart so that defecation is easy (no straining, pushing, or forcing). The program includes education about bowel and bladder function, urge control, and following a schedule of urinating (voluntarily emptying your bladder) and defecating. The success of the program depends on your effort to consistently keep a specific schedule and to have follow-up appointments with your health care provider.
THE RETRAINING PROGRAM
- Each morning upon arising, go to the toilet and completely empty your bladder. Then sit on the toilet for an additional 5 minutes with your feet on a stool. This is to give your body opportunity to have a bowel movement by taking advantage of the orthoreflex. Repeat this process (urinate and then sit an additional 5 minutes with feet on stool) after eating Breakfast, Lunch and Dinner. Try to get to the toilet within 5 minutes of finishing your meal. I refer to this as the 5/5 rule because within 5 minutes of waking and finishing your meals, you will sit on the toilet for 5 minutes.
- Do not push or strain or try to force a BM. Nothing may happen during those 5 minutes and that’s okay (not a failure!) Or maybe you’ll pass gas or have a BM. Just focus on diaphragm breathing and relaxing your pelvic floor. Having your feet on a stool allows the puborectalis muscle to relax which straightens out the rectal angle allowing for easier normal defecation.
- Coordinating your voiding schedule with your bowel schedule can be challenging. The general rule for urinating is every 3 hours. However, because you will naturally urinate when you sit on the toilet after meals, focus more on not urinating sooner than 2 hours or longer than 4 hours in between the times you are sitting on the toilet. Normal urination is 5-7x/day from the time you wake for the day until you go to bed. Always urinate before going to bed!
- The important part of the retraining is that you practice telling your bladder when to empty and when to hold. It is okay to suppress a bladder urge prior to 3 hours, however, it is never okay to suppress a bowel urge. Even if you already had a BM you still need to follow schedule and sit on the toilet on your scheduled times. Remember, we are retraining for proper frequency and regularity. So go to the toilet at the scheduled time even if you do not feel the need to urinate or defecate. The amount you urinate is not important. It is important to relax and not strain while voiding or defecating.
TIPS FOR CONTROLLING THE URGE TO URINATE
- Perform some quick pelvic floor contractions to suppress the bladder urge (5 quick flicks and/or 5 belly breaths).
Mental distraction techniques including visualization of your favorite vacation spot, counting backwards, deep breathing or positive self-thoughts, for example, “I can control my bladder” will help control the urge.
- Pressure to the perineal area helps control the urge. Place your hand or a rolled up towel against the crotch of your underwear and apply firm pressure. Alternatively, sit on a rolled up towel placed on a firm chair.
- Never rush or run to get to the toilet when it’s time to go. Always feel “in control” when you stand up to go to the toilet.
EATING AND DRINKING
- What you eat and drink influences your bowel and bladder function. Avoid foods that are constipating such as cheese, bananas, etc.
- You must get between 25-35g of fiber a day. This should be spread out between meals (i.e. approximately 9-12g at each meal). Do not take a fiber supplement that gives you a high dose of fiber all at once (i.e. 20g of fiber in a fiber bar or cereal). Too much at one time can have adverse effects. And remember you need a balance of insoluble and soluble fiber.
- You must drink water for fiber to work! You must sip water throughout the day averaging 4-6oz every hour. Do not go several hours without water and then drink a lot of water (>12 oz) quickly to “make up for it”—that’s not how it works! Create a habit of sipping water consistently throughout the day. Your urine should be a pale yellow color (not clear or dark!). Also you must stop your fluids 2-3 hours before bed to avoid nighttime urination. A normal healthy bladder should not wake you to urinate (unless you’re older than 65, then one void at night is considered normal).
- You need to take a probiotic that has 10-20 billion cultures in one dose, once daily with food for digestive health.
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, traveling, or are about to start your menstrual period.
If you do not have a foot stool (at work or at a restaurant) raise your heels to bring your knees higher than your hips, however, try to keep the tension out of your pelvic floor if you do this. It is best to have a stool when possible so you can relax.
The urge feeling 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.
EXAMPLE SCHEDULE AND SUMMARY:
Wake up: Pee and “Poo” (meaning sit on toilet for 5 mins)
Breakfast: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee (3 hours later)
Lunch: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee (3 hours later)
Dinner: Pee and “Poo” (within 5 minutes of finishing meal, sit for 5 mins)
Pee before bed.
Depending on how much time is between breakfast, lunch, and dinner you may have to urinate again (if it is greater than 3 hours). For example if you eat breakfast at 7 and lunch at 1 then you will need to urinate at 10 because 6 hours between voids is too long. On the other hand, if you get up at 5 and eat at 6, you would not void again between waking and eating breakfast. Try not to urinate sooner than 2 hours unless that conflicts with when you have to sit to “Poo”.