What is bladder training?

Bladder training is used to treat urge incontinence and stress incontinence. Urge incontinence means that the need to urinate comes on so fast that you can't get to a toilet in time. Stress incontinence means that you leak urine because of pressure on your bladder. For example, it may happen when you laugh, cough, or lift something heavy.

Bladder training can increase how long you can wait before you have to urinate. It can also help your bladder hold more urine. And it can give you better control over the urge to urinate.

It is important to remember that bladder training takes a few weeks to a few months to make a difference. You may not see results right away, but don't give up.

Several types of behavioral methods are used for treating urinary incontinence: bladder training, pelvic muscle exercises (Kegels), and biofeedback. People who have incontinence due to physical or mental limitations (functional incontinence) also have options. They can plan to use the toilet before they feel like they need to go. Or they can schedule regular times to use the toilet.

Bladder training

Bladder training helps to increase how long you can wait before having to urinate. You can start by keeping a voiding diary for 24 hours. This will help you track the shortest time you have before you need to urinate again.

Using your shortest time, make a schedule to go to the toilet at this interval all day long. Go to the toilet at these times whether or not you feel the need. Once you can avoid leaking for a full day, increase your scheduled time by 15 minutes. Do this until you are able to be comfortable urinating every three to four hours.

Biofeedback

Biofeedback can be helpful if you are having difficulty doing pelvic floor exercises. During biofeedback, you'll get information on how well you are contracting your pelvic floor muscles.

Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:

• Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
• Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.

If you are having trouble finding out what muscles to squeeze, you can try stopping the flow of urine a few times. But don't make it a practice to do Kegels while urinating.

If doing these exercises causes pain, stop doing them and talk with your doctor. Sometimes people have pelvic floor muscles that are too tight. In these cases, doing Kegel exercises may cause more problems.

If you aren't sure how to do these exercises, talk to your doctor about getting a referral to a pelvic floor physical therapist.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working.

Work with your doctor to come up with a bladder training program that is right for you. You may use one or more of the following methods.

Delayed urination

• In the beginning, try to keep from urinating for 5 minutes after you first feel the need to go.
• While you wait, take deep, slow breaths to relax. Kegel exercises can also help you delay the need to go to the bathroom.
• After some practice, when you can easily wait 5 minutes to urinate, try to wait 10 minutes before you urinate.
• Slowly increase the waiting period until you are able to control when you have to urinate.

Scheduled urination

• Empty your bladder when you first wake up in the morning.
• Schedule times throughout the day when you will urinate.
• Start by going to the bathroom every hour, even if you don't need to go.
• Slowly increase the time between trips to the bathroom.
• When you have found a schedule that works well for you, keep doing it.
• If you wake up during the night and have to urinate, do it. Apply your schedule to waking hours only.

Kegel exercises

These tighten and strengthen pelvic muscles, which can help you control the flow of urine. (If doing these exercises causes pain, stop doing them and talk with your doctor.) To do Kegel exercises:

• Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
• Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.

These methods are often successful in reducing or stopping urinary incontinence.

No risks are associated with these treatments.

Behavioral methods may be used to treat:

• Urge incontinence (using bladder training).
• Stress and urge incontinence (using pelvic muscle exercises).