Bladder training

Bladder training may be used to treat urge and mixed urinary incontinence, frequency and urgency symptoms. It restores normal bladder function by increasing the time interval between voids and reducing the sensation of urgency. Successful bladder training leads to the person feeling they have more control over their bladder

People who experience urgency will usually void frequently, to relieve their sensation of urgency. Frequently voiding low urine volumes prevents the bladder from expanding and contracting properly and the person’s functional bladder capacity is reduced as a result. The low storage capacity and urgency symptoms cause more frequent voiding and the cycle is established.

Changing the frequent voiding habit is very difficult and requires the person to be highly motivated and cognitively intact to achieve success.

Bladder training is an intensive behavioural intervention involving four key steps:

  1. Education: to enable the person to understand their own bladder patterns and habits, and why their bladder behaves as it does. A three day bladder diary will provide information about the frequency of voiding, volume of urine voided and intensity of urgency and allow the person to identify their voiding habits. Raising awareness of voiding habits, such as ‘anticipatory’ or ‘just-in-case’ voiding before the urge to void is felt, can help people to recognise and change their habits

  2. Use of a voiding programme, with progressively increasing voiding intervals: An ultimate goal of 3-4 hourly voiding is the aim, during waking hours. This is usually built up in 5 to 15 minute increments over a period of weeks, beginning with deferment of 5 minutes after the urge to void is felt

  3. Learning and using urge suppression techniques: The sense of urgency is usually experienced as a ‘wave’[1]. Rushing to the toilet immediately the urge to void is felt can worsen urgency and sense of panic, and this can increase bladder contractions. Using urge suppression techniques allows the person to control their urge and therefore their panic.

    Urge suppression techniques include:

    • stopping and sitting down if possible, taking two deep breaths
    • doing five fast pelvic floor muscle contractions
    • walking slowly to the toilet, not rushing
    • use of distraction techniques eg identifying names or vegetables for each letter in the alphabet; reciting poetry; counting backwards by 7s or 14s; singing loudly; sudoku or crosswords; writing lists etc. These cognitive activities should not be repetitive and should make the person ‘think’, so they are distracted away from focusing on their urgency to void
  4. Psychological reinforcement of efforts and successes. Praise for successful deferment and extended voiding intervals encourages the person to continue with their efforts and build their confidence in their ability to change their bladder habits and ‘gain control over their bladder, instead of their bladder controlling them’.

    Self-affirmation by saying out loud ‘I can do this’; ‘I can control my bladder’ is a form of self-praise which reinforces the person’s successes.

NICE recommends a minimum of six weeks is required for bladder training[2].


References

1. Newman DK, Borello-France D, Sung VW. Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms. Neurourology and Urodynamics. 2017;37:1;14-26. [Cited 28 August 2018] Available from: https://doi.org/10.1002/nau.23244

2. NICE Quality standard [QS77]. Urinary incontinence in women. January 2015. [Cited 28 August 2018] Available from: https://www.nice.org.uk/guidance/qs77/chapter/Quality-statement-5-Bladder-training

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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