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:
Bladder Training is an important form of behavior therapy that can be effective in treating urinary incontinence. It is a behavioral modification treatment technique that involves placing a patient on a toileting schedule. Incontinence occurs when an individual feels a sudden need to urinate and cannot control the urge to do so and, as a consequence, involuntarily loses urine before making it to the toilet. The goal of this training is to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold.The time interval between urination is gradually increased in order to train the patient to remain continent.
Incontinence often appears in a care setting such as a nursing home. In such cases there is sometimes pressure applied to the patient or their caregiver to allow the use of sanitary garments. In many cases the provision of bladder training can postpone the need for such treatment and should be tried before the use of sanitary garments is permitted.
Incontinence may be controlled through a number of invasive and non-invasive treatment options, including Kegel exercises, biofeedback, bladder training, 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 may be 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.
A complete evaluation to determine the cause of urinary incontinence is critical to proper treatment. A thorough medical history and physical examination should be performed on patients considering bladder training. 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 requires that a fixed voiding schedule be established, whether or not the urge to urinate is present. If urge occurs before the assigned interval, urge suppression techniques (such as relaxation and Kegel exercises) should be used. As success is achieved the interval is lengthened in 15 to 30 minute increments until it is possible to remain comfortable for 3 or 4 hours. This goal can be individualized to suit each person's needs and desires.
Keeping a diary of your bladder activity is very important. This helps your health care provider determine the correct place to start the training and to monitor your progress throughout your program.
Empty your bladder as soon as you get up in the morning. This act starts your retraining schedule.
Go to the bathroom at the specific times you and your health care provider have discussed. Wait the full amount of time before you urinate again AND when it is your scheduled time. Be sure to empty your bladder even if you feel no urge to urinate. Follow the schedule during waking hours ONLY. During the nighttime go to the bathroom only if you awaken and find it necessary.
When the urge to urinate is felt before the next designated time, use "urge suppression" techniques or try relaxation techniques like deep breathing. Focus on relaxing all other muscles. If possible, sit down until the sensation passes. If the urge is suppressed, adhere to the schedule. If you cannot suppress the urge, wait 5 minutes then slowly make your way to the bathroom-then re-establish the schedule. Repeat this process every time an urge is felt. When you have accomplished your initial goal, gradually increase the time between emptying your bladder by 15 minute intervals. Try to increase your interval each week, but you will be the best judge of how quickly you can advance to the next step. Increase the time between each urination until you reach a 3-4 hour voiding interval.
It should take between 6 to 12 weeks to accomplish your ultimate goal. Don't be discouraged by set-backs. You may find you have good days and bad days. As you continue bladder retraining you will start to notice more and more good days, so keep practicing.
You will hasten your success by doing your pelvic muscles exercises faithfully every day. Your diaries will help you see your progress and identify your problem times.
Bladder training may not be successful in all patients with urge incontinence. Patients who demonstrate a strong desire to control their continence and are committed to sticking with a training program tend to have the most success with bladder training.
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 progress made with bladder training.
Biofeedback training monitors temperature and muscle contractions in the vagina to help incontinent patients control their pelvic muscles.
Exercises that tighten and tone the pelvic floor, or perineal, muscles. Also known as Kegel and PC muscle exercises.
Blaivas, Jerry. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York: Plenum, 1998.
King, Barbara and Judy Harke. Coping With Bowel and Bladder Problems. San Diego: Singular Publishing Group, 1994.
Strange, Carolyn J. "Incontinence Can Be Controlled." FDA Consumer 31(July-August 1997): 28-31.
American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800)242-2383. http://www.afud.org/
National Association for Continence. 2650 East Main Street, Spartanburg, SC 29307. (800)252-3337. http://www.nafc.org/
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800)891-5388. http://www.niddk.nih.gov/health/urolog/pubs/kuorg/kuorg.htm/
