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Bladder Training

What is a normal bladder habit?

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 200-500 millilitres) and to pass urine 4-6 times during the day and sometimes overnight.

As we get older our bladder capacity may get a little smaller, so that we need to pass urine a little more frequently (6-8 times per 24 hours, including once or twice overnight).

When is a bladder training program used?

Bladder training is a treatment for people who suffer from an urgent need to pass small amounts of urine more frequently than normal, and who at times may also have incontinence (urine leakage) associated with urgency.

This happens if the bladder is very sensitive and overactive with little or no time between the urge to go to the toilet and the bladder emptying.

These symptoms may be due to conditions such as stroke, an enlarged prostate gland. Parkinson's Disease or simply the outcome of a long history of poor bladder habits. For many people though, no obvious reason can be found.

Practical advice and support throughout the program is helpful, and for some people, essential for the best possible outcome. (Refer to the back of this leaflet for further information on continence resources and services available).

What is bladder training?

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

The program teaches people to hold on longer between visits to the toilet. When the bladder is sensitive or overactive, learning to "hold on" can be difficult initially, but for many it becomes easier with practice.

The bladder training program

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 by using the following as an example.

The first step

Start by filling the bladder chart for 2-4 days (including overnight).

Each time you pass urine:

• Write down the time you pass urine and the amount you pass.
• Write down any episodes of accidental loss of urine.

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 overnight with a strong urge to go 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 program at night.

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, do not run.
• Avoid going to the toilet "just in case".
• Drink 6-8 cups of fluid over the day unless told otherwise by the doctor.
• Minimise intake of fluids which may irritate the bladder, for example, coffee, cola, alcohol.
• Maintain good bowel habits by keeping your bowels regular and avoiding constipation as this can increase bladder sensitivity.
• Do your pelvic floor exercises - this gives you confidence to hold on (see Continence Foundation of Australia "Pelvic Floor Exercises" brochure for men & women).

Will there be setbacks?

Do not 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 may seem worse again. These may occur:

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

If this does happen, do not be discouraged. Think positively and keep trying.

What if the bladder training doesn't work?

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 continence advisor or physiotherapist who will design an individual program especially suited to you.

Remember

You are not alone. Incontinence can be cured, treated or more effectively managed.

Where can help be found?

There are many health professionals qualified to assist you with bladder control problems. You may seek assistance from your doctor who may offer treatment directly or refer you to a specialist, or to a qualified continence advisor. You may also seek help and obtain information directly from the following sources:

• National Helpline 1800 330 066
• Continence services and clinics.
• Continence Nurse Advisors.
• Local Community Health Centres.
• Local Doctors.
• Domiciliary Nursing Services.
• Independent Living Centres.
• Continence Foundation of Australia.
• Australian Physiotherapy Association in your state (see telephone book)