Whenever a neurologic problem causes damage to the brain one of the most likely consequences is for the patient is to lose bladder or bowel control. This is known as incontinence.
It is normal for an adult with a reasonable fluid intake to pass one to two cups full of urine each time the bladder is emptied (between 250 - 400 mls) during the day and maybe once at night. This may increase slightly with age.
As we get older our bladder capacity may get a little smaller, so that we need to pass urine a little more often, including once or twice at night.
Incontinence may be controlled through a number of invasive and non-invasive treatment options, including bladder training, Kegel exercises, biofeedback, medication, insertable incontinence devices, and surgery. Each patient should undergo a full diagnostic work-up to determine the type and cause of the incontinence in order to determine the best course of treatment.
Bladder training is a behavioral modification treatment technique for urinary incontinence that involves placing a patient on a toileting schedule. The time interval between urination is gradually increased in order to train the patient to remain continent.
Often a patient who is becoming incontinent and may be headed toward having to wear special incontinence garments or a catherter may improve or delay the need by beginning and staying on a bladder training routine. Thus, bladder training should be tried in most cases before the patient is assigned incontinence garments.
Bladder training may be suggested by the patient or their caregiver and is prescribed and implemented by a general physician, urologist, or urogynecologist. A urination schedule is created for the patient. The schedule typically starts out with fairly short intervals between bathroom breaks (e.g., an hour). As soon as the patient is able to consistently remain continent for several days at a certain toileting time interval, the time span is increased. Bladder training continues until the patient regularly achieves continence at a time interval he/she feels comfortable with.
Before a patient begins a bladder training program they need a complete evaluation to determine the cause of their urinary incontinence. The evaluation should include a thorough medical history and physical examination. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis. It may include a series of exams called urodynamic testing that measure bladder pressure and capacity and the urinary flow. The patient may also be asked to keep a diary of their urination output and frequency and episodes of incontinence over a period of several days or a week.
Bladder training may not always be successful. It largely depends on how much desire the patient has to be able to control their continence and to the the patient's commitment to sticking with the program. If, after 4 - 6 weeks, the program 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.
Patients who undergo successful bladder training gain complete or improved control over their urination. In some cases, additional alternate treatment such as biofeedback or pelvic muscle exercises may be recommended to supplement the bladder training program.
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 program may experience set backs when the symptoms seem worse again. These may occur: