The Principles of Bladder Retraining
Patrick Culligan, M.D.
Bladder training can be effective in the treatment of urge incontinence, mixed incontinence and urgency-frequency syndromes. It consists of a combination of strategies to control urgency and a program of scheduled urination with gradually increasing intervals. Bladder training can give women a way to re-claim control over their bladder function. Another way to think of it is “potty training for adults”.
The first step is to make a record of your baseline bladder control. That’s done by keeping a bladder diary. Click here for a copy of the bladder diary we recommend. This diary will establish your baseline fluid intake; number of leakage episodes; and urinary frequency (amount of time between trips to the bathroom). Next, you decide on your initial scheduled voiding interval. If your bladder diary shows that you go to the bathroom every hour or less, your scheduled voiding interval will start at 30 minutes. If your bladder diary indicates more than one hour between your bathroom breaks, then your first interval will be one hour.
Once you establish your initial voiding schedule, follow these instructions:
- Void every morning as soon as you wake up and every evening just before going to sleep.
- Void every time your schedule says you should – regardless of whether you think you need to.
- Make every effort to put off urinating – even if you have a very strong urge to do so – until your scheduled time comes up. In order to do this, you can try some of the techniques described at the end of this page.
- You only need to follow the schedule while you are awake. No scheduled urination is necessary during sleeping hours.
- If you absolutely have to interrupt your schedule, get back on track (with the next scheduled void) as soon as possible.
- Keep a daily record of your urination and leakage episodes, so that you can track your progress.
- When the initial schedule gets easy for you (i.e. when you virtually always make it to your scheduled time without difficulty), increase your interval by 30 minutes.
- Stay on a given interval for at least one week before increasing.
- Aim for a goal of minimal to no accidents and a voiding schedule of between 2 – 4 hours. Getting there should take you anywhere from 4 – 12 weeks.
- You may find it easier to be successful with your bladder training if you go on the “bladder diet” at the same time. CLICK HERE to view the bladder diet.
If you feel as though you are about to have an accident before your scheduled time to urinate, focus on something else to make the urge go away. Count backwards from 100 by 7’s; Sit down or lie down; Get on the phone with a friend; Perform several strong Kegel exercises;