Monday, January 30, 2023

Bladder Retraining For Urge Incontinence

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What Else Can Be Done

“Urgency and Urge Incontinence – Bladder Overactivity” with Dr. Melanie Crites-Bachert (360phi.com)

For many people with IC, changes in diet can also help control symptoms. To learn more, check out the information about IC and food sensitivities. There are also over-the-counter products and prescription medicines that may help control symptoms of urinary urgency and frequency .

Revised Tuesday, May 26th, 2015

Why Retrain The Bladder

Whenever you experience pain or urgency in the bladder, the normal impulse is to urinate to stop the symptom. This establishes a pattern of frequent voiding, which can be difficult to reverse, even after your pain is controlled. To retrain your bladder, you will follow a series of simple steps to achieve longer and longer periods between urinations. Increasing bladder capacity is the objective, meaning that you will be able to hold more urine in your bladder and will not need to go as often.

What Is A Typical Program

Often, programs begin with a four-week period of holding your urine for a set amount of time that is somewhat longer than your average voiding interval. For example, if you tend to void every 30 minutes, at your 30-minute mark, wait to void for 15 more minutes. Although the goal is to try to wait for the specified amount of time, even if you have the urge to void, go ahead and void if you have pain or discomfort before the time is up. On the other hand, if you feel the urge to urinate diminish after you wait, then try to keep waiting to stay on schedule.

Usually, after one month of training, you will increase your wait time, and after another month, you will increase it again. Although you will be trying to meet your voiding interval most of the time, it is okay if intervals are occasionally longer or shorter. Also, you dont need to practice this technique throughout the night. The progress that you make during the day will help you to achieve a better voiding pattern around the clock.

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What Is Bladder Training

Bladder training is a way of learning to manage urinary incontinence. It helps you change your urination habits. Its generally used for stress incontinence or urge incontinence. Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles. This could be when you cough, laugh, lift something, or exercise. Urge incontinence is when the need to urinate comes on so fast that you cant get to a toilet in time. Bladder training can also be used for a combination of the 2 types .

Bladder training can help by:

  • Lengthening the amount of time between bathroom trips.
  • Increasing the amount of urine your bladder can hold.
  • Improving your control over the urge to urinate.

Behavioral Intervention: Bladder Training

Bladder Retraining

Bladder training is a behavioral intervention developed originally for urge incontinence. In its earliest form, known as bladder drill, it was an intensive intervention often conducted in an inpatient setting. Patients were placed on a strict voiding schedule for 7 to 10 days to lengthen the interval between voids and to establish a normal voiding interval. Cure rates in women ranged from 82% to 86% . Bladder training is a modification that is conducted more gradually in the outpatient setting.

The premise of bladder training is that the habit of frequent urination can lead to reduced bladder capacity and detrusor overactivity, which, in turn, causes urge incontinence. The goal of the intervention is to break this cycle by encouraging patients to resist the sensation of urgency and postpone urination. Using consistent voiding schedules, the patient voids at predetermined intervals and, over time, gradually increases the voiding interval, which is believed to increase capacity and decrease overactivity, resulting in improved bladder control.

Cynthia E. Neville, in, 2020

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How To Do Pelvic Floor Exercises

First, you need to locate your pelvic floor muscles, which you can do by trying to stop your flow of urine mid-stream. Exercises should be performed at first by sitting on a chair with your feet flat on the floor, and your elbows rested on your knees.

Two types of exercises, called slow contraction and fast contraction, should be performed to give your pelvic floor a full workout. Always do the slow contraction exercises first and then the fast contraction exercises.

To practice slow contraction exercises:

  • Draw up your muscles surrounding your anus as if you are trying to stop yourself passing gas. However, do not squeeze your buttock muscles.
  • Also, draw up the muscles around your urethra as if you are trying to stop urine flow.
  • Hold this position for as long as you can. You may only be able to hold this contraction for a couple of seconds at first, but the goal is to hold for a count of 10 seconds.
  • Slowly relax and let go for 10 seconds.
  • Gradually increase the time you hold the contraction and repeat until your muscles begin to feel tired.

To practice fast contraction exercises:

  • Draw up the muscles surrounding your anus and urethra as before.
  • Hold the contraction for 1 second and then let go and relax.
  • Repeat the contractions up to 10 times or until your muscles tire.

Try to come up with an exercise plan that includes 10 slow contractions and three sets of 10 fast contractions twice per day.

The following tips may help you to increase your success with bladder training:

A Bladder Training Program

We recommend working with a continence nurse specialist or men’s women’s and pelvic health physotherapist to design a bladder training program to suit your individual needs. Bladder training programs may take up to three months, with weekly or fortnighly appointments to monitor your progress and measure your improvement.

At the start of a bladder training program, you will be asked to keep a bladder diary. Every time you pass urine, you record the date, time and how much urine you pass. You will also need to record the amount of fluid that you consume each day. This will need to be done for a few days to see how much your bladder holds and how often you need to empty it. You should also include comments about leaking or other symptoms such as burning or pain.

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Do Regular Kegel Exercises

Once you find your pelvic floor muscles, you can complete regular Kegel exercises to strengthen them. Simply contract your pelvic floor muscles, hold them for five to ten seconds, and relax them. The Urology Care Foundation suggests that you complete at least two sessions of Kegel exercises per day. Up to 30 contractions per session.

How Bladder Training Can Help

Overactive Bladder Symptoms Retraining and Treatment

After going through bladder training, you should be able to:

  • Go longer periods of time between bathroom visits
  • Hold more liquid in your bladder
  • Have more control over the urge to go

Although you probably want to see results right away, be patient. Bladder retraining can take six to 12 weeks to be successful.

If you’ve been trying bladder training for several weeks and it still isn’t working, check back in with your doctor. You might need to try other approaches, like medication or surgery.

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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 infection
  • 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.

Pelvic Floor Muscle Training

Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.

A GP may refer you to a specialist to start a programme of pelvic floor muscle training.

The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.

If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.

Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.

Find out more about pelvic floor exercises.

Also Check: Chronic Bladder Infection In Men

How Does Bladder Retraining Work

Bladder retraining helps you to begin to hold more urine for longer periods of time. It is possible to train your bladder to do this by gradually increasing the time between each visit to the toilet.

This method sounds simple, however bladder retraining takes time and determination and will not work overnight. To have a chance of successful bladder retraining you must try and ignore the feeling that you need to go to the toilet for as long as possible.

If you can learn to ignore the feeling that you need to go straight away your bladder will begin to relax and will become less irritable. It is possible for you to be in control of your bladder and not the other way round.

Epidemiology And Causes Of Urinary Incontinence

ON THE SPOT: Overactive bladder versus urge incontinence ...

Urinary incontinence is a common problem. The prevalence in women is reported variably to be from around 9% to 72%. One of the largest studies found an overall prevalence of 25% of communitydwelling women, age 20 years or over, reporting some form of urinary leakage . In men the prevalence is lower with reports ranging from 3% to 11% . The causes or risk factors are still uncertain and appear to differ between women and men. In women, urinary incontinence has been associated with increasing age, childbirth, obesity, presence of lower urinary tract symptoms and decreased mobility . In men associated risk factors are increasing age, lower urinary tract symptoms such as cystitis or bladder outlet obstruction, decreased mobility, and radical prostatectomy .

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Limit Caffeine And Alcohol

Caffeine and alcohol have a diuretic effect on your body. That means they increase the amount of urine you produce. If youre having trouble controlling your bladder, consuming caffeinated beverages may be contributing to the problem.

To help manage your symptoms, consider limiting caffeine and alcohol, or avoiding them altogether. Coffee, tea, soda, chocolate, and certain medications are common sources of caffeine.

Data Collection And Analysis

Two reviewers assessed trial quality and independently extracted data. Five primary outcomes were prespecified: participant’s perception of cure of urinary incontinence participant’s perception of improvement of urinary incontinence number of incontinent episodes number of micturitions and quality of life. Adverse events were also noted. Three comparisons were made: bladder training compared to no bladder training bladder training compared to other treatments and combining bladder training with another treatment compared to that other treatment alone.

Also Check: How Long Does It Take To Cure A Bladder Infection

Treatment Of Urgency Urinary Incontinence

Initial conservative treatment of UUI includes behavioral modifications and lifestyle changes, such as reducing fluid input by 25% as long as the patient is drinking more than 1L/day , stopping smoking, reducing weight, and avoiding caffeinated and fizzy drinks that may irritate the bladder .The patient is also taught bladder training and pelvic floor muscle training to supplement the fluid manipulation. These treatments must be attempted for at least 6 weeks to obtain benefit, and they should ideally be tried for 3 months.

If patients are unable to tolerate antimuscarinics or the antimuscarinics have failed to control symptoms, then patients can be prescribedmirabegron, which is a 3-agonist lipophilic medication that is metabolized in liver, and more than 50% is excreted in the urine. It has been licensed for the treatment of OAB in several countries, including the United States, the United Kingdom and other European countries, and Japan. Mirabegron showed proven efficacy and superiority to tolterodine in terms of urinary incontinence episodes and frequency .

Jacques Corcos, … Dania Gambini, in, 2015

What Are Normal Bladder Habits

“Urgency and Urge Incontinence – Bladder Overactivity” with Dr. Melanie Crites-Bachert (360phi.com)

A healthy bladder can hold one and a half to two cups of urine during the day and about four cups at night. It is normal to pass urine five or six times a day if you drink between 6-8 glasses of fluid. It is usual to empty your bladder when you get out of bed in the morning, three times during the day, and before you go to bed at night. As we age this pattern may change, as older people tend to make more urine at night.

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Do Kegel Exercises Help People With Ic

Some bladder retraining programs recommend practicing Kegel exercises as part of bladder retraining. Kegel exercises are very frequently used to treat incontinence but can actually make IC symptoms worse. This is because Kegel exercises are designed to tighten the pelvic floor muscles. But people with IC often have pelvic floor dysfunction , and their pelvic muscles are too tight. For these patients, Kegels can cause further muscle tension and muscle spasms. There are, however, other exercises and stretches that you can do to ease muscle tension and reduce spasms. Ask your healthcare provider for a referral to a physical therapist who treats people with IC and pelvic floor dysfuction.

Bladder Training For Urinary Incontinence In Adults

Urinary incontinence is the inability to control the leakage of urine and is a common and distressing problem. Urge incontinence is leakage of urine when a person is unable to control the strong desire to pass urine . Stress incontinence is the leakage of urine when a person coughs or undertakes physical exertion. Bladder training encourages people to extend the time between voiding so that continence might be regained. This can take months to achieve but may help people who are physically and mentally able to use this method. The review of trials did not find enough rigorous evidence and concluded that more research is needed. The limited evidence available suggests that bladder training may be helpful in treating urinary incontinence but this is not definite.

The limited evidence available suggests that bladder training may be helpful for the treatment of urinary incontinence, but this conclusion can only be tentative as the trials were of variable quality and of small size with wide confidence intervals around the point estimates of effect. There was also not enough evidence to determine whether bladder training was useful as a supplement to another therapy. Definitive research has yet to be conducted.

Urinary incontinence is a common and distressing problem. Bladder training aims to increase the interval between voids and is widely used for the treatment of urinary incontinence.

To assess the effects of bladder training for the treatment of urinary incontinence.

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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 , 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.

This Problem Has Been Solved

Pin on Women

A nurse is reinforcing teaching about bladder retraining with aclient who has urinary incontinence. Which of the followinginstruct nurse include?

Try to suppress the urge to urinate until the scheduledtime.

Drink carbonated beverages to help with urinary retention

Awaken every 2 hr during the night to urinate.

Restrict fluid intake to no more than 1 L during wakinghours.

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When Should You See A Doctor

For many people, urge incontinence is merely an inconvenience that doesnt require a doctors visit.

However, if you have a serious case of urge incontinence, you should seek treatment right away. Your symptoms could be signaling:

  • bladder infection
  • an obstruction
  • stones in the bladder or kidney

Some symptoms to watch out for alongside your urge incontinence are pain in the pelvic region, burning or pain with urination, or symptoms that continue for several days.

In addition, if urge incontinence impedes your daily activities, you may want to visit your doctor to discuss treatment options or other ways to manage your condition.

To diagnose incontinence and develop a treatment plan, your healthcare provider will ask you about your medical history and history of incontinence. They will likely perform a physical exam, including a pelvic exam, and take a urine sample.

Your healthcare provider may also perform additional tests if necessary, including:

  • Urodynamic studies. These studies are used to evaluate how your bladder and urethra are functioning.
  • Cystometrogram.This test establishes your bladder size and whether your bladder is functioning properly.
  • Uroflowmetry.This test determines how much urine you release and how quickly its released.
  • Stress testing. Your healthcare provider will ask you to perform activities that cause your incontinence symptoms.
  • How Long Does It Take To Work

    If urinary urgency and frequency are your only symptoms, you may see improvement in a few weeks. If you have more severe urgency and frequency, bladder retraining may take longer. On average, it takes about three months to retrain the bladder. By using this technique, you can take more control of your urinary urgency and frequency symptoms.

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