Bladder health

Bladder retraining

A program to return you to a more normal and convenient pattern of urinating.

The goal of bladder retraining is to return you to a more normal and convenient pattern of urinating. People who experience urinary urgency, frequency, excessive nighttime urination, and leakage can show improvement with this technique. Bladder retraining helps restore your bladder capacity to normal. The program includes education about bladder function, urge control, record keeping, and following a schedule of urinating (voluntarily emptying your bladder). Success depends on your effort to keep a specific schedule consistently and to have follow-up appointments with your health care provider.

The retraining program

• Each morning upon arising, go to the toilet and completely empty your bladder. Your voiding schedule begins when you get out of bed and ends at bedtime.
• Your voiding schedule is set by your therapist. Follow the interval as closely as possible. The important part is practicing telling your bladder when to empty and when to hold.
• Go to the toilet at the scheduled time even if you do not feel the need. The amount you urinate is not important. It is important to relax and not strain.
• If you feel the need to urinate before the scheduled time, use urge delay techniques.
• If you have to interrupt the schedule, get back on schedule at the assigned time for the next void.

Recording on the voiding log

• Record each urination in the voiding log (in the amount voided section) with a check at the corresponding time of day.
• If leakage occurs, record the time and amount in the “amount of leakage” column with small, medium, or large at the corresponding hour. Do not be discouraged if leakage occurs. Note the next scheduled time for voiding and set a timer to keep on schedule.

A printable bladder diary is available, with instructions for filling it in.

Progressing the program

• The goal is to go 3 to 4 hours between urinating.
• You will change the time between urination in minute or hour intervals.
• Your daily log helps you record progress and decide the next retraining interval. Bring the log to all your appointments.

Tips for controlling the urge to urinate

• Perform some quick pelvic floor contractions to suppress the urge.
• Use mental distraction: visualize your favorite vacation spot, count backwards, breathe deeply, or tell yourself “I can control my bladder.”
• Pressure to the perineal area helps control the urge. Place your hand or a rolled-up towel against the crotch of your underwear and apply firm pressure, or sit on a rolled-up towel on a firm chair.
• Never rush or run to the toilet. Always feel in control when you stand up to go.

Tips for success

• Avoid foods and drinks that irritate your bladder. See How diet can affect your bladder.
• Drink at least 4 to 8 glasses of water each day.
• Maintain regular bowel habits. If you are constipated, add fiber to your diet.

Dealing with problems and setbacks

Setbacks are not uncommon if you have been ill with a cold or flu, are tired, cannot fully concentrate on the program, feel nervous or tense, are sensitive to cold weather or the sound of running water, or are about to start your menstrual period.

If all the techniques fail and you still have an overwhelming urge to go, you may use the toilet. If this happens, record it in the amount urinated column, and in the “activity with leakage” and “was urge present” columns, at the hour the urge and voiding occurred.