Bladder Training FAQs
What is bladder training?
If you’re having trouble with constant strong urges and overactive bladder, you would benefit from trying to ‘retrain’ your bladder to function properly. It is referred to as bladder training, but really, it is retraining your brain to communicate properly with the bladder. It is a strategy used to normalise the response from the brain to signals sent from the bladder to indicate its fullness.
Why would I need to do bladder training?
Due to many factors, someone can go on to develop overactive bladder. It is a condition characterised by vastly increased frequency of urination (8+ times per day), frequent, strong urges to urinate (sometimes even when there is little urine to void). Check out our FAQs on OAB here for more information on this condition.
What is the process of bladder training?
In essence, bladder retraining is a process by which we normalise the signals and response form the bladder and by the brain so that the mismatch between the fullness of the bladder and the perceived fullness is resolved. Firstly, it is good to develop an understanding of how the bladder and brain work together, how this mismatch can be present.
How do the brain and bladder work together to regulate voiding?
The bladder wall consists of a smooth muscular structure called the detrusor muscle. As this muscle stretches, information is sent to the brain which reflects the level of stretch of the bladder and thus the level of fluid contained within it. As the brain responds to this information, it relaxes the internal urethral sphincter and creates sensations of needing to void the bladder contents with contractions of the detrusor muscle. These sensations will urge an individual to find a bathroom to urinate, once in an appropriate place, the external sphincter can relax, the detrusor muscle will contact and the contents of the bladder will be excreted.
How do I go about the bladder training process?
Developing an understanding of the connection between the brain and bladder is important as this underpins the whole concept of bladder retraining. The bladder is composed of smooth muscle tissue (the detrusor muscle), which stretches when the bladder fills and contracts when the brain signals to this muscle to contract. Under normal operation, the bladder will only signal to the brain that you need to void urine when it is sufficiently full. In the case of overactive bladder, this signal will occur much earlier than normal, when the bladder isn’t necessarily full, and sometimes when the bladder has very little fluid stored in it. Being able to recognise when the bladder has a significant or insignificant amount of fluid stored is integral to being able to rehabilitate this properly to help relieve some anxiety when you are getting strong urges.
Keeping a bladder diary
A bladder diary is a tool we use to assess your urinary habits throughout a 48 hour period. This can be quite involved and frustrating to complete as it requires you to measure your fluid intake and output. However, it provides a wealth of valuable information from which we can make changes to your voiding and fluid intake patterns. These changes are the cornerstone of bladder retraining as from here fluid intake can be increased or decreased depending on your measured intake. It could also be the case that fluid intake is poorly timed, for example, shortly before bed, which would lead to urges or incontinence in bed and poor sleep which will have consequential effects. It will also provide information of how often you are going to the bathroom to void only small volumes of urine.
Spacing out voiding
In order to retrain the bladder, urges must be resisted! So, when you get an urge to pee, use your pelvic floor muscles to hold in your urine until the urge disappears. This should happen relatively quickly. If the urge comes back within a short time frame and with increased intensity, it is advised to urinate then. Usually if there is little urine stored in the bladder, the urge dissipates relatively well and doesn’t return for some time. The main strategy here is to space voiding out so that your brain re-gains the ability to recognise when the bladder is full or only partially full and create those sensations of fullness and detrusor contractions when the bladder is sufficiently full to warrant voiding. This approach will be individualised and will depend on the frequency of your urges and how well you can tolerate the discomfort of your urges. For example, the strategy might involve spacing out voiding every two hours and resisting urges to go to the bathroom in between those voiding times. Over time, this interval is increased to two and a half hours, then three hours until your voiding habits return to normal.
Pelvic floor strengthening
Pelvic floor muscle training is also beneficial in bladder retraining as it can help build confidence with resisting urges. Stronger pelvic floor muscles will help limit urge incontinence as well but improving your ability to create pressure on the urethra sufficiently to stop unwanted urinary flow. Learn more about the pelvic floor on our FAQ page here.
Improving your general health
t is helpful to educate yourself around the impacts of general health and other systems. Bladder sensitivity often is better when the individual is healthier as a whole. So it never hurts to go for that walk or run and to try to improve your general health as well.
Have a healthy gut
Constipation can perpetuate overactive bladder symptoms and be a contributor to incontinence. Who would have thought your bowel movements would have such a profound impact on your bladder? Being blocked up (especially if it’s severe) can impact the bladder by putting pressure on the bladder walls, effectively decreasing its volume, and decreasing its tolerance to stretch (more readily signalling fullness). Constant straining over the toilet can also weaken the pelvic floor muscles, which play an important role in continence and restricting the passage of urine with strong urges with OAB.
What are some challenges I might face with bladder retraining?
Bladder retraining can be very uncomfortable. Resisting urges will be frequent and you might feel like you are going to leak or actually leak from time to time. It can be challenging to recognise when your bladder is actually full versus when it is mostly empty and you are getting a false urge. As you become more aware of what the sensations should feel like, it should reduce some of the anxiety around bladder retraining and make the experience a bit easier. This comes with time and practice.
How can we help at Sycamore Health?
We have two men’s health physiotherapists who can help guide you through this process. We will work with you to understand your frustrations with overactive bladder and gain insight into your goals. This will help us work with you to devise a plan to overcome your OAB symptoms and guide you through the challenging bladder retraining journey.