Bladder Retraining

Frederick R. Jelovsek MD

The goal of bladder drill is to break the cycle of frequency, urgency, and urge incontinence and to allow you to reestablish voluntary control over your bladder function. The bladder needs to be fooled into thinking it never has urine. The way in which this is done is to EMPTY the bladder before it senses the urge of being full. This is done by voiding frequently during the day before any urge. After a week of voiding very frequently before there is an urge to void, the guiding principle of bladder drill is to increase the time between voiding episodes gradually. In this way you relearn to suppress the voiding reflex and raise the volume threshold at which that reflex occurs.
  1. Begin your bladder retraining program with a time interval that you can manage successfully (even if this means voiding as often as every 30 minutes). If you are able, begin this process at hourly intervals.
  2. Empty your bladder every hour on the hour while you are awake; get up and go to the toilet as soon as you wake, then at 7 AM, at 8 AM, and so on throughout the day. (It is important that you go at these time and always at these times, whether you need to go or not). Thus, if it is 9 AM, and you do not feel the urge to urinate, go to the toilet and urinate anyway. (Remember the goal is to make your bladder do what you "tell" it to do and not to have your bladder control your life). For example, if you are desperate to urinate at 9:55 AM, try to wait 5 minutes and not go before 10 AM., even if you have considerable discomfort or even urinary leakage onto a protective pad.
  3. When you can manage a regimen like this for a week, increase the time interval by 30 minutes. This means you will now be voiding at 6 AM, 7:30 AM, 9:00 AM, 10:30 AM, etc. Do not get up every hour during the night; void only when you awaken from sleep and have to go.
  4. When you are able to maintain this schedule for a week, increase the time interval again. Keep increasing on a weekly basis until you are voiding approximately 7 times per day at intervals of approximately 3 hours.
  5. Some adjustments in scheduling must obviously be made to conform to "real-life" situations, particularly if you are a working woman.
Bladder retraining is used to improve both urge urinary incontinence and also stress urinary incontinence. If a woman has overflow incontinence (bladder too big) then bladder retraining with a double void technique is used. In that case urination void is performed on the same schedule as above but in addition, immediately after emptying the bladder as best as possible, you should stand up, briefly move around or wash your hands and then immediately sit down and try to void a second time to empty the bladder even more. After voiding a second time on 5-6 occasions and having no additional urine come out, you may revert to just the single void if you feel you are completely emptying the bladder.

This program works and works dramatically. The keys to success are self-motivation and gradual increases in the time interval between voids. If you try to progress too rapidly, you will exceed your capabilities and fail. This failure can be very demoralizing.


From BackupMD