BLADDER RETRAINING

Bladder retraining is done to gradually increase your bladder capacity and decrease the frequency of urination. Using this regimen of retraining, patients can see improvement rates of 44%to 90%. The main goals of bladder retraining are to expand the amount of time between voids and to help control the urge to urinate.

The bladder is the reservoir for urine in between voiding. When the bladder senses that it is full a message is sent to the brain to stimulate the urge to urinate. After an extended period of time with frequent urination the bladder capacity sensors or volume gauge is set at a very low volume. This gauge needs to be reset to tolerate a higher volume.

In addition, concentrated urine is "irritating" to your bladder and makes you feel like you need to urinate at lower volumes than dilute urine. Certain dietary factors can also be irritating to your bladder and make you feel like you need to pass urine frequently. In order to encourage your bladder to hold larger volumes, the urine going into your bladder should be dilute and as "non-irritating" as possible.

When you first start drinking more water, you may find that the frequent urination seems worse until your bladder starts to gradually enlarge.

The best way to monitor your progress is to keep a bladder diary 1 or 2 days per week. Keep track of how much urine you pass and how often you pass it. You will see the volumes of urine that you pass gradually increase. We have forms to help you keep track of this.

HOW TO START:

Eliminate bladder irritants such as:

• Coffee (even decaffeinated)
• Tea
• Carbonation
• Alcohol
• Chocolate
• Tomatoes
• Acidic fruits and juices (cranberry, orange, grapefruits, lemon, apple)

Drink at least 1 quart of water per day, gradually increasing to 2 quarts of water per day.

When you get the urge to go, try to hold it for 5 extra minutes before going to the bathroom. Each day or two, add 5 minutes to the length of time you hold the urine after you have the urge.

The goal is to hold 300cc-400cc in your bladder and urinate every 2-4 hours during the day. Once you have your bladder capacity at a larger volume, you can gradually decrease your fluid intake to decrease the frequency of urination. Half of your fluid intake should always be water. You should see improvement of your bladder capacity within 2-3 months.

Pelvic floor muscle exercises can help you focus on the muscles which control urination and decrease the incidence of stress incontinence as well as urge incontinence. A separate sheet on performance of these exercises (also known as Kegel Exercises) will be given to you.

Stress Strategy- is a technique of patients consciously contracting the pelvic floor muscles every time you perform and activity that normally results in leakage. It takes practice to develop the habit of using these pelvic muscles before and during physical activities, but with time and practice, it becomes automatic.

Kegel Exercises control not only stress urinary incontinence but can help control urge incontinence as well. Voluntary contraction of the pelvic muscles should be done whenever you experience an urge to urinate. In addition, when the urge to urinate hits, you should not rush to the bathroom! Rushing to the bathroom is counter productive because it increases abdominal pressure and exposes patients to visual cues that can trigger incontinence. Instead, when you get an urge to urinate, do your Kegel exercises and stay away from the bathroom. Pause, sit down if possible, relax the entire body and contract the pelvic floor muscles repeatedly to diminish urgency and prevent urine loss. Only after the urge to void subsides should you proceed to the bathroom at a normal pace.

If you have trouble localizing and contracting the pelvic muscles, a number of aids are available. Some patients benefit from weighted vaginal cones, which can be inserted and used to localize and strengthen the proper pelvic muscles. Other patients benefit from Biofeedback, which is a computerized program that can localize and strengthen these muscles after repeated outpatient visits. Ask your doctor about any or all of these procedures, if necessary.