Continence, Urology and Colorectal (CUCS) Bladder Retraining
Bladder Retraining
Bladder retraining is most suitable for people who have symptoms of frequency, urgency, urge incontinence, night time frequency and bed wetting.
The bladder is a storage tank which expands on filling, (like a Balloon). As the bladder fills, the muscle of the bladder stretches and then sends messages along the nerves up the spinal cord and into a specialised area of the brain. These messages keep us aware of how full the bladder is. Some people can hold more urine than others before they feel the need to go to the toilet, but this can depend on how well we have trained our bladders to respond.
A healthy bladder will:
- empty between four to seven times a day (three to four hourly)
- hold up to 400ml-500ml of urine but actually feel quite full at 200ml-250ml
- wake you up once or twice at night to go to the toilet
- tell you when it is nearly full but gives you time to find a toilet
- empty comfortably each time you pass urine unless you consciously stop it
- not leak urine.
A number of things can aggravate an already sensitive bladder:
- caffeinated tea or coffee and fizzy drinks. Try to cut these out altogether or reduce them as much as possible
- anxiety and depression can affect our bladder functioning
- constipation can cause a full bowel to press on the bladder and make it more “irritable”
- alcohol can increase the need to go to the toilet as it causes more urine to be produced more quickly
- conditions such as diabetes, stroke, MS and Parkinson’s disease.
- infection in the urine will also cause frequency as the infection irritates the bladder wall.
Frequent emptying of the bladder becomes a habit, and this habit prevents the bladder from filling to its true capacity. It causes the bladder to become even more irritable and so a vicious cycle develops.
How to retrain your bladder
Definitions and Terminology
Definitions and Terminology
Passing urine
Passing urine often and frequently may be due to an overactive bladder.
Frequency
This is when the bladder only holds a small amount of urine before you feel it has to be emptied. You then visit the toilet much more frequently which can be inconvenient.
Urgency
This is when the bladder has to be emptied very quickly, often not giving you a great deal of time to reach the toilet.
Night time frequency
This means getting up more than twice in the night.
Bladder retraining at home
Bladder retraining at home
A frequent, urgent need to pass water may be due to the bladder muscle producing frequent contractions, or you may be receiving strong signals from your brain telling you that you need to pass water (sensory urgency). Both of these may be helped by bladder training.
A positive attitude is one of the most important aspects of this treatment and a great deal of motivation is required to maintain the effectiveness of this technique.
But bladder retraining will help you regain control of your symptoms. By gradually increasing the time interval between going to the toilet. You will slowly increase the capacity of your bladder.
During the next two to three days, keep a record of:
- the time you go to the toilet to pass water
- the volume of urine passed. Measure it in an old jug
- the time you have a drink
- what drink it was
- the volume of the drink or just write cup/mug, etc
This is your baseline chart. After you have done this, look for the largest amount of urine passed at one time. This is usually the first one of the morning and shows how much your bladder can actually hold.
| Time | Drink (Type/ Amount) | Volume of urine passed |
| 07:00 | 350mls | |
| 07:30 | Cup of tea | |
| 08:00 | 75mls | |
| 08:45 | ||
| 09:00 | Cup of tea | |
| 09:35 | ||
| 10:00 | Glass of water | |
| 11:00 | 150mls | |
| 12:00 | ||
| 12:45 | Cup of tea | |
| 13:30 | 100mls | |
| 13:45 |
This is an example of a record of the fluid intake and output.
Once you have recorded your baseline chart it is then time for you to see if you can extend the intervals in between.
If you notice from your chart that you go to the toilet on average every hour during the day, try to extend this to every hour and five minutes.
Take note of the time you are next due to go to the toilet and do not go before this time.
If “holding on” is difficult try distracting your attention from your bladder. Mental activity, such as reciting a poem or repeating the multiplication tables, may be helpful, read a page out of a magazine or use the telephone. If you find it too difficult to hang on until the desired time, go to the toilet but instead of passing water straight away try to count to five or ten before you let go.
Try holding on for 5 minutes longer (each time you need to pass urine) for 1 week. Then for the next week, try holding for 10 minutes longer. The week after that, try holding on for 15 minutes longer. Keep increasing the time each week.
Try not to hold on for too long at the start and try to not increase the times before the end of each week. If you do you may find it too difficult and you may give up.
By training your bladder in this way you will notice a gradual Improvement. This will continue to improve as you gain confidence.
Practising pelvic floor exercises may also help you to “hold on”. You can identify these muscles by trying to stop your flow of urine when you go to the toilet (“stop test”). Once they have been found, they can be exercised by tightening them and relaxing them, quickly and slowly, at regular intervals during the day.
Do not do the “stop test” every time you pass urine; this should only be done once to check you are using the right muscles. The nurse will explain how to exercise and use the pelvic floor exercises in more detail.
By persevering with bladder retraining and avoiding known irritants, you should find that your symptoms improve and once again you will be able to enjoy trips without worrying where the nearest toilet is.
