When you have trouble controlling your bladder, you never know when you're going to feel the sudden, uncontrollable urge to go. You can get to the point where you are scheduling your entire life around the availability of a bathroom. The fear of leaking while shopping or out with friends can be embarrassing enough to make you stay home.
Bladder control problems are something most people are reluctant to talk about, even with their doctors. Yet having that discussion can help you find a solution to the problem and get you back out into the world again.
Often the first treatment doctors recommend for bladder control problems is bladder retraining, a type of behavioral therapy that helps you regain control over urination. Bladder control training gradually teaches you to hold in urine for longer and longer periods of time to prevent emergencies and leaks.
Is Bladder Training Right for Me?
The decision to try bladder training depends on what's causing the problem. Bladder control training is typically used to treat urinary incontinence, the involuntary loss of urine. Incontinence is most common in women, especially after childbirth and menopause. Different types of urinary incontinence exist, including:
- Stress incontinence: Sudden pressure on your abdomen (such as from a cough, sneeze, or laugh) causes you to accidentally lose urine.
- Urge incontinence: You feel a sudden, strong urge to go to the bathroom because your bladder contracts even when it's not full. You may not always be able to reach the toilet in time.
- Mixed incontinence: A combination of stress and urge incontinence.
- Overflow incontinence: A problem emptying the bladder completely that leads to urine leakage.
Bladder retraining may also be used to treat bed-wetting in children.
The Bladder Retraining Technique
Before you begin bladder control training, your doctor will probably ask you to keep a diary. In your bathroom diary, you'll write down every time you have the urge to go, as well as when you leak. Using your diary as a guide, you'll use the following techniques to help you gain more control over urination.
Schedule bathroom visits. Determine how often you're going to the bathroom based on your diary entries. Then add about 15 minutes to that time. For example, if you're going to the bathroom every hour, schedule bathroom visits at every one hour, 15 minutes. Use the bathroom at each scheduled visit, regardless of whether you actually feel the urge to go. Gradually increase the amount of time between bathroom breaks.
Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom. If you're feeling a strong need to go, try distracting yourself by counting backwards from 100 to one or practicing relaxation techniques such as deep breathing. When you just can't hold it any longer, use the bathroom, but go again at your next scheduled void time to stay on your bladder retraining schedule.
Kegel exercises.Kegel exercises strengthen the muscles you use to start and stop the flow of urine. Research finds that combining pelvic floor exercises with other bladder retraining techniques is very effective for treating incontinence in women. To do a Kegel, squeeze the muscles you normally use to stop the flow of urine. Hold the contraction for five seconds, and then relax for five seconds. Gradually increase to 10-second contractions with 10 seconds of rest in between. Work up to doing three sets of 10 contractions each day.
Women who can't find the right muscles to squeeze during a Kegel can either insert a finger into the vagina to feel the muscles contract or ask a doctor about trying biofeedback. During biofeedback, the doctor either inserts a small probe into the vagina or places electrodes on the skin outside of the vagina or anus. The probe or electrodes sends a display of your pelvic floor muscle contractions to a video monitor. Watching the contractions can help you learn when you are doing them correctly.
There is a non-invasive device - pants with electrical pads- that improve urinary incontinence. By stimulation the muscles of the pelvic floor the device helps strengthen and re-educate the muscles that help control bladder leakage. In addition, electrical stimulation is FDA approved for the treatment of SUI. It uses low-grade electrical current to stimulate weak or inactive pelvic muscles to contract. It's possible to have a coin-sized device called a tibial neurostimulator implanted in the lower leg thta can reduce urinary incontinence symptoms. Regular electrical stimulation sessions can supplement or augment your pelvic muscle exercise regime.
To improve your success with bladder retraining, you can also try these tips:
- Limit beverages that increase urination, including caffeinated drinks like sodas, coffee, and tea.
- Drink less fluid before bedtime.
- Go to the bathroom before you go to bed at night, and as soon as you get up in the morning.
Continue to keep a diary while you are doing your bladder control training. Go over the diary with your doctor at regular intervals to make sure you're on track.
How Bladder Training Can Help
After going through bladder training, you should be able to:
- Go longer periods of time between bathroom visits
- Hold more liquid in your bladder
- Have more control over the urge to go
Although you probably want to see results right away, be patient. Bladder retraining can take six to 12 weeks to be successful.
If you've been trying bladder training for several weeks and it still isn't working, check back in with your doctor. You might need to try other approaches, like medication or surgery.