Bladder Retraining Program for Urinary Urgency and Urge Incontinence

Urinary urgency is the feeling of the urgent need to urinate. Women who experience urgency usually know where the nearest bathroom is located…just in case). When the urge strikes they will rush to the bathroom to urinate and usually relieve the uncomfortable urge sensation. If they fail to get there in time, the accidental loss of urine may occur and is called urge incontinence. The amount of urine loss can vary with the intensity of the urge, the volume of urine in the bladder, and the strength of the pelvic floor tissues. Urgency and urge incontinence are often associated with frequent urination (called frequency) and getting up at night to urinate (called nocturia). Women who regularly experience urinary urgency and frequency (with or without nocturia) have what is called urinary urgency syndrome, and they may or may not experience incontinence.

The causes of urinary urgency syndrome can be both physical and non-physical. Physical causes are usually temporary such as infection of the bladder (cystitis) and/or urethra, and are corrected with treatment of the infection. There are other physical causes such as chronic inflammation of the bladder, polyps or tumors, and even taking certain medications. When no physical cause can be found, the cause is usually a result of a progressively learned habit. Correction of the non-physical ("learned") urinary urgency syndrome, with or without urge incontinence, may include treatment with medications, a bladder retraining program, and pelvic floor muscle exercises (Kegel exercises). All patients with any type of urinary urgency or incontinence should be performing daily Kegel pelvic floor exercises. (This instruction program will be given to you separately.)

Bladder Retraining is referred to as a Timed Voiding Program. When followed consistently you will have significantly improved control over your urgency symptoms, including any urge incontinence. In essence, you can be in control of your bladder, rather than your bladder habitually controlling your life.

A normal fluid intake is between 1500-2000 cc's (50-70 oz.) per day, which should produce 1200-1500 cc's (40-50 oz.) of urine output. The normal bladder capacity before you feel any sensation of urge is about 300 cc's (10 oz.). Normal voiding volumes are 210-300 cc's (7-10 oz.) with the first morning voiding usually being the largest at 400-500 cc's. Your Voiding Diary record will have indicated if any modification is required in the volume or type of fluids you drink.

Your goal with the Timed Voiding Program is to increase your bladder's capacity and prolong the time interval between voidings up to a minimum of three or more hours. The initial time interval between voidings will be determined by the frequency of urination as recorded in your Voiding Diary.

You may obtain a "Bladder Health Diary" from our office. Please chart your progress as directed by your physician or nurse practitioner. Please make additional blank copies of the Voiding Chart to insure you have a total of six weekly charts. The Chart is a daily record of your Scheduled (predetermined voiding interval), Unscheduled (unable to suppress the urge without accidental wetting), and Accidental (incontinence) voiding episodes. Follow the instructions on the Chart.

• Fill in the following: Your Name, Week Beginning Date, and Voiding Interval (Hrs.) on each weekly sheet.
• Fill in the time for any of the three types of voiding (scheduled, unscheduled, or accidental) and place a check mark in one of the following three columns:

Keep your Chart nearby along with a pencil and a clock or timer. Most importantly, you need to maintain the determination to stay with this six week program.

WEEK ONE

Urinaate when you first get up in the morning and indicate the time. If you have a difficult time making it to the toilet, squeeze the pelvic floor muscles (Kegel exercise) before you get out of bed and count slowly to FIVE. Get out of bed slowly and walk slowly to the toilet. Empty your bladder as completely as you can and note the time that you void. Then set your clock or timer for the predetermined interval. When the timer sounds, go to the toilet even if you do not feel the need to empty your bladder. Fill in your Chart and reset your timer for the next interval. Repeat this sequence throughout the entire day until you go to bed. If you get up at night to urinate, indicate the time and note it as an unscheduled voiding.

Remember: If you are unable to suppress your urge to urinate and you void at an unscheduled time, you should still try to urinate at the Scheduled time, even if it is only a few minutes later!

Learning to Control the Urge to Urinate: When you feel the urge to urinate before the timer clock sounds, try to distract yourself with the following:

1. Think about a very complex task. i.e., balancing your checkbook; naming the streets on the way to an enjoyable place; remembering all the words to a favorite song or hymn; listing the birthdates of ten family members or friends; etc.
2. Think about something especially fun or happy. i.e., vacationing on an exotic South Sea island; lying in a hammock in the shade near a beautiful flower garden; sitting on a hillside watching the sunset over the ocean; etc.

The feeling that you need to void should pass and you may be able to wait until the timed interval has elapsed. If you cannot wait, go ahead and urinate, indicate the time and put a check in the Light Gray column. When you are able to consistently urinate according to the scheduled time you are ready to progress and increase your time interval.

WEEK TWO

If you reached your goal during Week One of voiding only at the predetermined (Scheduled) timed intervals, then you will increase the time interval by 15 to 30 minutes during Week Two.

If you still have an uncomfortable urgency or accidental voiding when you first get up, then increase your slow count to TEN before getting up and walk slowly to the toilet. Repeat the Timed Interval voiding routine throughout the day as you did in Week One. Once you have had a few days of consistently voiding at the increased predetermined scheduled times, you are ready to progress again.

Remember: When you feel the urge to urinate before the timer has sounded, practice the distraction or relaxation techniques described previously to suppress the urge. If you become too uncomfortable with the urge sensation, use the toilet. Do not be discouraged when this happens, it is normal. After all, this is why you are retraining your bladder function.

WEEKS THREE thru SIX

In each of these weeks you will increase the time intervals between scheduled voidings by 15 to 30 minutes each week. If you started at one hour intervals, you can be voiding every three hours by the end of week six. Compare your charts from week to week to see your progress. Remember: Your goal is to be back in control of your bladder function!

TIPS for SUCCESS:

1. Believe that you will be successful.
2. Remember to do your Kegel pelvic floor muscle exercises after each voiding.
3. Follow the above program directions to the letter.
4. Give the program a full six weeks.
5. If you find that thinking about complex tasks or relaxing fantasies does not make the urge sensation go away, try one of these following techniques:
a. Roll up a bath towel and keep it on a chair. Sit on this roll when you have a strong urge to urinate, or
b. Place the rolled towel between your thighs and push it against your perineum with your hands.
c. Tighten and hold your P.C. muscle until the urge passes (Do your Kegels).

6. Don't be discouraged by setbacks. Your bladder control may be worse when:
a. You are tired.
b. You have your mind on many other things.
c. You are tense or nervous.
d. You are about to start your menstrual period.
e. You are outside on cold, rainy, or windy days.

7. Drink plain water (add lemon). Avoid alcohol, caffeine drinks, and citrus juices.
8. Avoid going to the toilet "just in case". Follow your schedule.
9. Avoid constipation by using fiber or bulk stool softeners.

Keep your appointment scheduled for approximately six weeks after you begin your bladder retraining program. Call our office, if you have any questions regarding your progress. Good Luck.