Bladder Training is the first treatment that doctors recommend to help control urinary incontinence and prevent leaks. It also helps improve and control your bladders’ performance of storing and emptying urine.
As the Illinois Department of Public Health explains on their published work ‘Facts about Incontinence’: “Bladder retraining therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
Incontinence is a problem of the urinary system, which is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle, called the sphincter, controls the activity of the urethra. It is not a part of the urinary system but can play a role in incontinence.
Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence can result.1
Most people take bladder control for granted – until something goes wrong – When unintended loss of urine is significant enough to make it difficult for them to maintain good hygiene and carry on ordinary social and work lives.2
As the National Association for Continence regarding Bladder Training explains: “The bladder is controlled by muscles, it can be trained. While training the bladder and sphincter muscles is more challenging than working out your quadriceps and biceps, it can be done. Plus, there is good news: many studies over the years support the success of bladder retraining programs for both women and men experiencing symptoms of urge incontinence and urgency associated with overactive bladder (OAB).”3
Information published in the National Center for Biotechnology from the Institute for Quality and Efficiency in Health Care regarding Science Advances on Bladder Training asserts that: “The bladder muscle can be trained to stretch more so that the bladder is able to hold more urine. Bladder training also includes various behavioral treatment approaches and a particular drinking and voiding schedule (bathroom visit schedule).” 4
Bladder training teaches you how to hold your desire to urinate for an extended period to avoid having to rush to the bathroom and to minimize accidental leakage. More than 30 percent of Americans suffer from urinary incontinence. It is more common in women, especially after giving birth and menopause. This training helps people with an overactive bladder (OAB), stress incontinence, or incontinence after surgery. A healthy bladder can hold urine for up to 3 or 4 hours before it is released. If you experience emergency bathroom visits very often, we recommend that you practice bladder training.
Health Guides on their work ‘What to Know about Bladder Retraining’ recommend that: “Before embarking on a bladder retraining program, talk with your doctor. He or she can tell you if you’re ready for bladder retraining and help develop a program to follow. If your symptoms are fairly mild, you can try bladder retraining on your own. 5
Results from Management of Urinary Incontinence in Women and Men explain that: The skill of contracting the PFMs prior to and during circumstances of increased abdominal pressure (a cough, sneeze, laugh, lifting a heavy object) has been termed the “stress strategy” or “knack.” Miller et al showed that after 1 week of knack instruction only, women with mild stress UI reduced UI episodes associated with a medium and deep cough by 98% and 73%, respectively. Women with moderate or severe stress UI symptoms may need more time before they gain skill in the use of the knack or “stress strategy.”
In several studies, a multicomponent behavioral training program that included 45 to 50 PFM contractions/day (working up to a 10-second contraction) was found to reduce UI by a mean 76% to 86% in women with urge UI and mixed UI. 6
According to the clinical research work ‘Evidence-Based Physical Therapy for the Pelvic Floor’: “Pelvic muscle exercise has been shown to be effective in alleviating SUI in many, but not all, women. Having a patient cough with a full bladder and measuring the amount of urine leakage is quite simple. If the muscle is normally innervated and is sufficiently attached to the endopelvic fascia, and if by contracting her pelvic muscles before and during a cough a woman is able to decrease that leakage, then simply learning when and how to use her pelvic muscles may be an effective therapy. If this is the case, then the challenge is for the subject to remember to use this skill during activities that transiently increase abdominal pressure.”7
“The effect of learning the ‘Knack’ (pre-contracting the pelvic muscles before a cough) on reducing the total amount of urine leaked during three separate medium-intensity coughs (left panel) and during three separate deep coughs (right panel) measured 1 week after the women had learned the skill. Each line joins the wet area on one trifold paper towel for each of the 27 women observed coughing without the Knack (denoted by ‘Without’) with that observed on a second paper towel when the same women used the Knack (denoted ‘With’) (Miller et al., 1998b). With regard to the units on the ordinate, a calibration test showed that every cm2 of the wetted area was caused by 0.039 ml urine leakage.” 8
The volume of released urine may vary each time, from 200 to 400 milliliters (for normal adults). The total volume of urine in 24 hours ranges from 800 to 2000 ml. Normal urinary frequency per day may be between 6 to 10 if you drink a lot of water
In the elderly, these training patterns change because their bladder has experienced a reduction in size and they have a more frequent need to go to the bathroom during day and night. Bladder training is excellent for elders; it gives back control to them.
The medical publication ‘Strategies to Maintain Continence in Elders from Occupational Therapy with Elders’ (Fourth Edition), 2019 explains how Pelvic Floor Exercises for elders are executed: “Pelvic floor exercises are also known as Kegel, or childbirth, exercises. Kegel exercises are commonly used and have a 30% to 90% success rate in women with stress incontinence. Elders are taught to relax the abdominal muscles while contracting the pelvic floor muscles. After assistance is given to identify the correct muscles, elders are told to complete a minimum of 60 contractions of the pelvic floor muscles per day, working up to 150 contractions per day if possible.” 9
By strengthening the muscles that are directly and indirectly involved with urination, you will be able to better control when you have to go.10
As the medical research ‘Management of Urinary Incontinence in Women and Men’ published in ‘Science Direct’ states: “Urinary incontinence (UI), a common health condition among older adults, is defined as the complaint of any involuntary leakage of urine. Although UI affects both genders, women have a greater risk of developing this condition. In a recent epidemiological study of a racially and ethnically diverse cohort of midlife women, the prevalence of UI that occurred at least monthly was 46.7%; and the prevalence of more frequent UI (occurring several days per week or more) was 15.3%. Although the prevalence of “any UI” does not increase substantially beyond the 5th decade in women, the prevalence of severe UI (daily or a few times/week) does increase from 24.9% (5th decade) to 38.9% (80 year-olds). In men, UI prevalence estimates are substantially lower, reaching 5% and 34% for younger and older men, respectively.
Urinary incontinence can seriously affect physical function, psychological well-being, and quality of life. In older adults, UI has been associated with depressive symptoms, poor life satisfaction, social isolation, sleep disturbances, increased risks of falls, and a twofold increased risk of institutionalization. Urinary incontinence also poses a significant economic burden to the individual and society”.11
Benefits of Bladder Training.
- Better control of your bladder by swaying the urge to visit the restroom.
- Improves bladder capacity, helping it increase the amount of urine it can comfortably hold.
- Increases the amount of time between bathroom visits by decreasing an excessive feeling of urgency.
According to the ‘Pelvic Floor First Organization’s publication named ‘working your pelvic floor’:
Pelvic floor muscle exercises can help:
- improve bladder and bowel control.
- reduce the risk of prolapse.
- in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping.
- in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go.
- improve recovery from childbirth and gynecological surgery (in women).
- improve recovery after prostate surgery (in men).
- increase sexual sensation and orgasmic potential.
- Increase social confidence and quality of life.
The Pelvic Floor Clinic on their ‘Pelvic Floor Muscle Assessment and Programs’ indicates that: “The pelvic floor muscles are a group of muscles that run like a hammock at the base of your pelvis. The urethra, vagina, and anus pass through the muscles.
Functions of the Pelvic Floor Muscles.
- Help support the bladder, uterus, and bowel within the pelvis, preventing prolapse.
- Help prevent bladder and bowel leakage.
- Form the base of the ‘core’ working together with the deep tummy muscles to optimize core stability.
- Must be able to relax to allow complete bladder and bowel emptying.12
Bladder Training Technique
Is based on following a programmed schedule by recording visits to the restroom with a diary. Begin with intervals of 15-minute increments. So, if your usual interval is every 2 hours, try to extend it to every 2 hours and 15 min. Once you feel comfortable, strive for an average of 3 to 4 hours between each miction.
Health care specialists from the ‘UCSF Medical Center’ show: “How to Locate the Pelvic Floor Muscles.
* Squeeze the area of the rectum to tighten the anus as if trying not to pass gas. Feel the sensation of the muscles pulling inward and upward.
* Another method to identify your pelvic floor muscles is to imagine stopping the flow of urine and holding inflatus (wind) at the same time. This can be done lying down, sitting or standing with legs about shoulder width apart.13
Remember not to tense your stomach, buttock or thigh muscles. Using other muscles will defeat the purpose of the exercise and slow your progress.
When you have located the correct muscle, set aside a short time each day for three exercise sessions. At breakfast, lunch, dinner or before bed are convenient and easy to remember. Make it a habit to exercise at regularly scheduled times each day. Squeeze your muscle for a slow count of three. Then relax the muscle completely to a slow count of three. Do not “push out” during the relaxation of the muscle. Repeat the exercise 15 times. Fifteen exercises are one set. Be sure to do three complete sets each day. As you feel your muscle strength growing, increase the count to five for each squeeze and each relaxation.
Remember that this is a muscle conditioning exercise and like any other exercise, it is important to do it correctly in order to gain the most benefit. Focus on isolating the pelvic muscle and continue to breathe normally throughout each repetition. Muscles need oxygen to grow and strengthen.14
Harvard Medical School states that: “Bladder training, enables you to gradually increase the amount of urine you can comfortably hold. Bladder training is a mainstay of treatment for urinary frequency and overactive bladder in both women and men, alone or in conjunction with medications or other techniques. It can also help prevent or lessen symptoms of overactive bladder that may emerge after surgery for stress incontinence. You can try it on your own or with the guidance and support of a health professional. Because bladder training is low-cost and low-risk, your clinician may encourage you to try it first, even before specific diagnostic tests are performed.”15
If you do your Kegel exercises (Bladder Training) regularly, as specified by the specialist from the Mayo Clinic Organization: “You can expect results — such as less frequent urine leakage — within a few weeks to a few months. For continued benefits, make Kegel exercises a permanent part of your daily routine”.16
According to educational information from the University of California San Francisco s work ‘Bladder Training therapy’: “Bladder training requires following a fixed voiding schedule, whether or not you feel the urge to urinate. If you feel an urge to urinate before the assigned interval, you should use urge suppression techniques — such as relaxation and Kegel exercises.
Keeping a diary of your bladder activity is very important. This helps your health care provider determine the correct place to start the training and to monitor your progress throughout your program.17
As pointed out by the Institute for Quality and Efficiency:
“You can use it to write down:
- How often you go to the bathroom.
- How much urine comes out.
- How much you drink throughout the day.
It is also important to record information about any medications you take and about situations in which you accidentally leak urine. These notes can be helpful when talking to your doctor and might provide important clues about the cause of the problem.”18
When you wake up to empty your bladder, wait for as much as possible until your designated interval. If you feel the need to urinate before that, try to relax and focus on any other activity to avoid going to the bathroom. Walk slowly or sit down and take deep breaths, it helps to decrease muscle tension and mitigates the sensation of extreme urgency. You can also practice Kegel exercises to help attenuate incontinence episodes and improve your bladder control. A minimum of five minutes, two or three times a day is recommended.
You can keep your diary in the bathroom to avoid forgetting to record the necessary information. Make sure to include the following:
- What you drank
- The time you drank those liquids.
- The time of miction
Keep in mind, adding 15-minute increments between miction times is just one option. If you feel like you can begin with 30-minute increments, for example, then go for it. But for the average person, it’s easier to start slower and then build from there.
Increase your interval time 15 minutes more between urination times. You will notice the difference between intervals and start to feel comfortable. You will be able to keep increasing your time intervals by 20 to 30 minutes until you reach the ideal time for a healthy bladder.
If you reach the designated interval and have no urge to urinate, go anyway. Do not skip your assigned time.
Once you start bladder training, it usually takes 2 to 4 months to see real results. Don’t worry or digress if you experience a slight setback for whatever reason, such as the weather or emotional stress. Just stay positive and keep trying. Bladder training becomes easier with practice.
“If you’re having trouble doing Kegel exercises”, as the Mayo Clinic Organization specialists indicate: “don’t be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and strengthen the correct muscles.”19
(1) Illinois Department of Public Health. Facts about Incontinence.
(2) Harvard Education.Special Health Report. Better Bladder and Bowel Control.
(3, 10) National Association for Continence. NAFC. Bladder Training
(4, 18) The National Center for Biotechnology. Science Advances. Bladder Training. Institute for Quality and Efficiency in Health Care.
(5) Health Guides. Health Grade. What to Know About Bladder Retraining
(6, 11) Management of Urinary Incontinence in Women and Men by Diane Borello-France, PT, Ph.D.
Published in Science direct.
(7, 8) Evidence-Based Physical Therapy for the Pelvic Floor (Second Edition), 2015.
Clinical Implications of Levator Functional Anatomy. Functional anatomy of the female pelvic floor result. https://www.sciencedirect.com/topics/nursing-and-health-professions/pelvic-floor-muscle-training
(9) Strategies to Maintain Continence in elders. Occupational Therapy with Elders (Fourth Edition). 2019
(12) Pelvic Floor First Organization. Working your pelvic floor.
(14) Pelvic Floor Clinic. Pelvic Floor Muscle Assessment and Programs
(13) UCSF Health. Health care specialists at UCSF Medical Center. How to Locate the Pelvic Floor Muscles.
(15) Harvard Medical School. Harvard Health Publishing. Training your bladder
(17) University of California San Francisco Health.org. ‘Bladder Training therapy’
(19) Mayo Clinic Organization. Kegel exercises.