Bladder training

The aim of bladder training is to improve bladder control and increase the amount of urine the bladder can comfortably hold, without urgency or leakage.

A chart or diary is used to record fluid intake and urinary output. The aim is to gradually increase the amount of time you can wait before emptying your bladder. If no improvement is seen after 4–6 weeks, an individualised programme from a health professional is advised.

What is a normal bladder habit?

The volume of urine passed each time by a normal adult will vary from around 250–400ml. This is the same as about two cupfuls. Most people with normal bladder habits can hold on for 3–4 hours between visits to the toilet. Most younger adults can also go right through the night without the need to pass urine.

With ageing, the bladder capacity may get smaller, so the frequency of passing urine may increase, both by day and night.

Also see: Overactive bladder

Who can benefit from bladder training?

Bladder training should be of benefit for people who suffer from an urgent need to pass small amounts of urine more frequently than normal (ie, more than 3–4 hourly), and may experience leakage with urgency. Sometimes people with no urgency pass urine frequently to avoid accidents. These people may also benefit from bladder training.

The programme teaches people to suppress the urgent desire to pass urine until a socially acceptable time and place is found. With people experiencing urgency or frequency, learning to 'hold on' can initially be difficult but usually becomes easier with practice.

Some helpful hints

  • When you have the urgent need to pass urine, you may find it helpful to sit down and try to take your mind off wanting to get to the toilet.
  • When you do go to the toilet, walk, don't run.
  • Avoid going to the toilet 'just in case'.
  • Minimise the intake of fluids which may irritate the bladder, for example, coffee, tea, cola and alcohol (but keep up a good fluid intake each day).
  • Maintain a good bowel habit by keeping your bowel regular and avoiding constipation, as this can increase bladder sensitivity.
  • Do your pelvic floor exercises – this gives you confidence to hold on. Also see: Pelvic floor training for women and Pelvic floor training for men.
  • Pelvic floor muscle exercises not only increase the ability to hold urine in, but also can help control an unruly, overactive bladder.

Will there be setbacks?

Don't be concerned with small day to day variations in your bladder pattern – these are normal for everyone. However, any person who starts a bladder training programme may experience setbacks when the symptoms seem worse again. These may occur:

  • when you are tired or run down
  • during a urinary tract (bladder) infection (see the doctor immediately if you suspect this)
  • at times of anxiety or emotional stress
  • when the weather is wet, windy or cold
  • during times of illness, eg. cold or flu.

If this does happen, do not be discouraged. Think positively and keep trying. It becomes easier with practice. Do keep doing the bladder training and the pelvic floor muscle exercises.

The bladder training programme

A useful way to measure progress is to use a bladder chart or diary. If you haven't been given a chart by your doctor or continence advisor, you can draw one yourself using the following example.

The first step

Start by filling in the bladder chart for 2–4 days (including overnight). Write down:

  • the type of fluid you drank, the volume and the time
  • the time you pass urine and the volume you pass
  • any accidental loss of urine
  • any bladder sensation proceeding the leakage episode.

Sample bladder chart

Time Fluid intake: type/amount Urine passe: amount Leakage
7am   200ml Damp
9am coffee/ 200ml    
9.30am   70ml Damp
10am tea/ 250ml    
11.45am   160ml  

Over the following weeks

Try to gradually increase the time between visits to the toilet. Each time you get the urge to go to the toilet, try to hold on for a few minutes longer.

If you wake up during the night with a strong desire to go to the toilet, it is reasonable to go and empty the bladder right away (unless advised otherwise). As you improve by day, you will gain confidence to practice the programme at night.

What if bladder training doesn't work?

If, after 4–6 weeks, the programme has not helped your bladder control problems, seek help. The best results are achieved by working with a health professional who is trained in dealing with bladder problems and who will design an individual programme especially suited to you.

Support

There are health professionals qualified to help you with bladder control problems. You may seek advice and support from your GP or contact the New Zealand Continence Association.