Bladder Retaining 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 Oust 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 (urethyitis), 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). I believe that all patients with any type of urinary urgency or incontinence
should be instructed to perform 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.
The program started when you monitored the amount and the type of fluids you
consumed each day in your Voiding Diary. 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.
Attached is a "Voiding Chart for Bladder Retraining" on which you will chart your
daily progress for the first week. Please make five 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:
- Dark Gray: Scheduled Time. (According to the scheduled time interval)
- Light Gray: Unscheduled Time. (If you cannot suppress the urge)
- White: If you Accidentally wet (incontinence incident). Add a "D" for Damp or
"W" for Wet beside the check mark to indicate the relative amount of
accidental urine loss.
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
Urinate 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 put a check in the Dark Gray
column beside the hour 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 place a check in the Light Gray column as it is unscheduled voiding.
Remember: If you are unable to suppress your urge to urinate and you void at an
Unscheduled time (Light Gray column), you should still 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:
- 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.
- 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:
- Believe that you will be successful.
- Remember to do your Kegel pelvic floor muscle exercises after each voiding.
- Follow the above program directions to the letter.
- Give the program a full six weeks.
- 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:
- Roll up a bath towel and keep it on a chair. Sit on this roll when you
have a strong urge to urinate, or
- Place the rolled towel between your thighs and push it against your perineum
with your hands.
- Tighten and hold your P.C. muscle until the urge passes (Do your Kegels).
- Don't be discouraged by setbacks. Your bladder control may be worse when:
- You are tired.
- You have your mind on many other things.
- You are tense or nervous.
- You are about to start your menstrual period.
- You are outside on cold, rainy, or windy days.
- Drink plain water (add lemon). Avoid alcohol, caffeine drinks, citrus juices.
- Avoid going to the toilet "just in case". Follow your schedule.
- 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.
