Bladder Retraining Techniques

The Purpose of Bladder and Bowel Urges:

  1. A very effective warning system designed to warn the whole person that there is a need to urinate or a potential need to urinate (or defacate).
  2. It is uncomfortable so that we will be motivated to do something about the threat.
  3. The sensation or warning is increased if the threat has caused embarrassment or potential embarrassment.

The Urinary System

  1. Urge is a complex electrical chemical response. It involves our Autonomic Nervous System, including our parasympathetic and sympathetic systems.
  2. The system is made up of:
  • Cells or neurons
  • Nerves-like electrical wires
  • Chemicals that influence the communication of the message

Synapses-the gaps between cells and neuronsThe bladder detects urge and sends an urge message, which is an electrical impulse along the specialized nerves to the spinal cord. At the spinal cord thee is a gating mechanism that sorts out the electrical impulses. The impulses can:
leave the spinal cord quickly OR
be delayed in leaving the spinal cord OR
be cancelled
What happens at the spinal cord depends on the chemical balance. The electrical messages are NOT urge messages yet.
GABA, Endorphins and Serotonin are chemicals which try to STOP the transfer of the urge message.
Glutamate and Substance P are chemicals which increase the transfer of the urge message.
THe Brain has to make a sensible story of the information from the body. Many parts of the brain are involved:
The memory centre: What happened last time I got a strong urge?
The learning centre: I don’t want this to happen again
The emotional centre: That was embarrassing or potentially embarrassing
The thought centre: If I empty my bladder more frequencly that won’t happen again
The autonomic and immune systems: sense of general well-being
The movement centre: How quickly can I get to the bathroom
The sensory centre: tight tissues causing irritation of the bladder or nerves
If any part of the brain thinks the person is in danger of losing control, it communicates this to the spinal cord through chemicals. This excites the spinal cord.
Possible threats of danger:
Stress
Anger, depression
Fear
Negative thoughts and attitudes
Memories of previous episodes of loss of bladder and bowel control
If the brain does not perceive a threat, it communicates this to the spinal cord through chemicals. This calms the spinal cord.
When the spinal cord gets excited enough, it finally sends the urge message to the brain where it is registered as URGENCY
NO PERCEIVED THREAT=NO URGENCY, just urge which can be ignored or dealt with as appropriate (i.e. if it is not convenient you can push the urge off for a period of time)
Increased threat = URGENCY!! You must go NOW!!!
The brain decides how much urgency you feel, not your bladder!
Our response to the urge can retrigger the urge message. For example, if we give into every urge, our bladder gets used to holding less urine. We start going just in case, and we get anxious and nervous about leaking. These things than become triggers to restart or continue the whole urgency mechanism.

The Intensity of the Urgency Does NOT Indicate how Full Our Bladder Is!

The goal of treatment with urge incontinence: Down regulate the nervous sytem

Breathing:
Breathing calms down the nervous system
Breathing is a higher priority than danger (urgency)
Breathing influences homeostasis (balance of the body’s systems)
Breathing influences fight-flight response
Issues in the Tissues:
Trigger points (tightness) in the pelvic floor and abdomen can cause false messages to be sent to the brain contributing to the sense of urgency (practicing YOGA or other activities to downregulate the nervous system can be very helpful)
Weakness in the pelvic floor can also trigger an urgency response since the pelvic floor cannot be recruited adequately to contract, which suppresses the urge to go to the bathroom
You must strengthen your pelvic floor it if is weak (see Kegels for Women or Kegels for Men or learn to relax the pelvic floor if it is tight (see Reverse Kegels))
Timed Voiding:
Stop going to the bathroom just in case; this often involves going to the bathroom just before you leave the house or work in case you have to go when you are out; it is better to listen to your bladder and go when it is full even if that means finding a toilet while you are away from home
Fill out a Bladder Diary for 2-3 days to get a picture of how often you go to the bathroom. Calculate the average length of time between voiding. This is your base time. Start by adding 15 minutes to your base time, and set a goal to wait to go to the bathroom to void for this set amount of time.
If you get the urge to go before this time is up, do the following activities:
STOP and stand still if the urge is strong
START By doing 1-2 minutes of slow deep breathing, in through your nose and out through your mouth
COUNT backwards by 7’s from 100 to distract yourself while you are breathing
Do your Kegels or Reverse Kegels depending if your pelvic floor is weak or tight for 2-3 minutes
WALK to the bathroom (don’t hurry) when the urge is under control
When you can successfully wait for the base time plus 15 minutes between voiding for several days, add another 15 minutes to your delayed time, and practice again
This takes practice and patience, but is well worth it
Normal voiding frequency during the day is every 2-3 hours or 5-7X/day
**Get some help from a Pelvic Floor Physiotherapist (Find a Physiotherapist near you) if you cannot normalize your Urgency and Urge Incontinence

**Most patients with urge incontinence can quite easily wean themselves off of their over-active bladder medication