Bladder Retraining After Long Catheterization
May 30, 2013 by Ken Theriot
A couple of weeks ago my urologist told me I didnt need to wear the leg bag with my catheter anymore if I didnt want to. I wrote about this in my article I Havent Really Need This Leg Bag! At first I felt a bit like I wish Id known this 3 months ago! But as it turns out, I couldnt have gone bag-less any earlier because I was being prepped for my antegrade-retrograde urethrogram , during which time my bladder and urethra had to be resting for 3 months. This apparently makes for a much more accurate picture of the stricture length and location.
But now that they have done the urethrogram and pinpointed the details of the stricture , I can go bag-less every day. However, even after a couple of weeks I still have to go every hour.
So Ive been wondering if I should be holding it for longer, trying to push through the discomfort of the urge to pee for longer and longer, in order to retrain my bladder to hold onto the pee for the normal 4 hours. My hunch appears to have been right, according to the below article. Basically, you have to inform your bladder that YOU are the boss, not IT. As it turns out, thats not entirely true. Im bending to my bladders willeventually. But I was able to get up to 90 minutes a few times yesterday. So maybe its working.
Anyway, here is the article I refer to:
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Avoid High Impact Exercise: It Can Make Leakage Worse
If youre looking at losing weight or exercising to help your urinary incontinence, be aware that high impact exercise can actually make things worse by putting pressure on the pelvic floor muscles. Even sit-ups may prove problematic. So skip the aerobics classes and trade in your running shoes for some yoga or pilates. This will help you build core strength, stretch your body, and get a good workout without taking a toll on your pelvic floor muscles. Plus, as we saw, yoga has some asanas that are actually beneficial for the pelvic region.16
References
Improve Bladder Control Regain Your Continence Sooner After A Robotic Prostatectomy
Kegel exercise strengthens the group of muscles called the pelvic floor muscles These muscles contract and relax around the bladder and the bladder opening at your command. When these muscles are weak, urine leakage may result. You can exercise these muscles just like any other muscle in your body, and building them up may help reduce your symptoms. It is important that you perform these exercises correctly and consistently to gain maximum benefit after prostate cancer surgery.
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Pelvic Floor Ball Squeeze
Sit up straight in a sturdy chair with your head lifted and your chin parallel to the ground, shoulders in line with your hips. Place an exercise ball between your thighs. Squeeze the ball and hold for 10 seconds. Repeat 10 times. For a challenge, sit up without leaning back against the chair, Andrews says. This will help strengthen the inner thighs and the abdominal muscles, which intertwine with those pelvic floor muscles and can contribute to better bladder control, Howe says.
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Living With Urinary Incontinence
Urinary incontinence does, unfortunately, become a long-term problem for some women. Here are some tips on living with it:
- Use incontinence pads, which are made for urine leakage, rather than sanitary pads.
- Take a change of underwear or set of clothes when you go out.
- Know where toilets are located so you can find them quickly .
- Cross your legs when sneezing or laughing.
- Modify your exercise routine to avoid high impact exercises such as jumping.
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Do The Right Exercises
High-impact exercise and sit-ups put pressure on your pelvic floor muscles and can increase leaks.
To strengthen your pelvic floor to relieve symptoms, replace high-impact exercise, such as jogging and aerobics, with strengthening exercise, such as pilates.
Pilates strengthens your core muscles, which is beneficial for stress incontinence.
Can Nerve Stimulation Help Overactive Bladder
Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control.
Nerve stimulation is a reversible treatment. Healthcare providers only recommend it if other treatments dont work.
There are several types of nerve stimulation treatments. These include:
Sacral nerve stimulation
Sacral nerve stimulation is a therapy that electrically stimulates the nerves that control your bladder.
A healthcare provider will implant a small device called a neurotransmitter under the skin near your upper buttock area. The neurotransmitter sends mild electrical impulses through a wire near your sacral nerve. Your sacral nerve is a nerve in your lower back. The impulses help you control your bladder.
Sacral nerve stimulation can reduce the number of times you have to use the bathroom or the number of times you accidentally leak pee. Its overall very effective. Its also an outpatient procedure, so you can go home afterward.
Percutaneous tibial nerve stimulation
Percutaneous tibial stimulation sends small nerve impulses to a nerve branch near your ankle. It helps stimulate bladder control.
Percutaneous tibial nerve stimulation is an outpatient procedure. Many people need 12 weekly sessions and then monthly maintenance sessions afterward.
Botulinum toxin injections
Botox® is the most well-known botulinum toxin brand. A healthcare provider injects Botox into your bladder wall using a cystoscope.
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Should I Drink Less Water Or Other Fluids If I Have Urinary Incontinence
No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health.
Women need 91 ounces of fluids a day from food and drinks.11 Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.
After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.12
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Tips To Keep Your Bladder Healthy
People rarely talk about bladder health, but everyone is affected by it. Located in the lower abdomen, the bladder is a hollow organ, much like a balloon, that stores urine. Urine contains waste and extra fluid left over after the body takes what it needs from what we eat and drink. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.
As people get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less flexible bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.
While you cant control everything that affects your bladder, here are 15 steps you can take to keep it as healthy as possible:
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Control Your Pelvic Floor Muscles
It may take some practice to learn to control your pelvic floor muscles. When doing the exercises, relax your body as much as possible and concentrate on your pelvic floor muscles. To avoid using your stomach muscles, rest your hand lightly on your belly as you squeeze your pelvic floor muscles. Be sure that you do not feel any movement of your stomach. Do not hold your breath.
To test whether you are tightening the wrong muscles, squeeze your pelvic floor muscles while sitting in front of a mirror. If you see that your body is moving up and down slightly, you are also using your buttocks or thigh muscles. When done properly, no one should be able to tell that you are squeezing your pelvic floor muscles – except for you.
What Causes Bladder Leaks
There are two main types of urinary incontinence:
Stress incontinence
If you have this type, activities that raise the pressure inside your abdomen cause urine to leak through the ring of muscle in your bladder that normally holds it in. Coughing, sneezing, jumping and lifting heavy objects could lead to a leak.
Going through childbirth, smoking or being overweight can raise the risk of stress incontinence for women, Wright says. Stress incontinence in men is rare, and when it arises, its often due to prostate cancer treatment, such as radiation or surgery.
Urge incontinence
With this type, your brain, spinal cord and bladder dont work together properly to allow you to hold and release urine at the right time. Your bladder may suddenly empty itself without warning. Or you may feel like you need to urinate frequently, a problem called overactive bladder.
Some diseases that affect the nervous system, such as multiple sclerosis or stroke, can cause this kind of incontinence, says Wright. In men, an enlarged prostate may be the culprit. But in many cases, doctors dont know what causes urge incontinence.
It is possible to have both types of incontinence at the same time.
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The Squeeze & Release
The squeeze and release is your secret weapon when it comes to getting your pelvic muscles to respond quickly. This can be very helpful for stopping leaks in a pinch!
To squeeze and release:
Walk Regularly To Avoid Retaining Fluids
Some people, like those who are sedentary or have heart disease, may develop fluid buildup in their legs during the day. At night, this fluid causes them to need to empty their bladders frequently. If you have fluid retention in your legs that’s causing an active bladder overnight, try walking around more throughout the day. If you can’t walk, flex your calf muscles and raise your legs to waist level.
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Exercises Your Leaky Bladder Wants You To Do
There are exercises for your butt, your legs, your arms, your spare tire, even your ever-texting achy thumbs. So considering the bladder itself is a muscleand it’s surrounded by other musclesit makes sense that you can whip that puppy into shape, too.
Of course, unless you already have the occasional leakage due to aging, genetics, or childbirth, you might not focus much exercise attention on your bladder. But strengthening those down-there muscles can stop so-called stress incontinence in its tracks, says Candace Howe, MD, a board-certified ob-gyn in private practice in Newport Beach, California. “Who wants to undergo surgery?” Howe says. “I’m a surgeon, and I tell my patients I wouldn’t want to! If we can fix incontinence with exercise, that’s preferable.”
When Suzanne Andrews, host of Functional Fitness, was experiencing urinary incontinence after the birth of her son, her doctor told her to consider surgery. As an occupational therapy clinician, Suzanne was seeing patients with the same symptoms and realized her exercise background could help. She created the 30 Day Bladder Fix, a pelvic floor strengthening DVD that combines seated and lying-down exercises to help control incontinence. “I remember the day I realized I didn’t have it anymore,” Andrews says. “I sneezed and nothing came out!”
Consider Using A Pelvic Floor Training Device
If you just dont have access to a physical therapist right now, you can also consider trying a Kegel exercise trainer to help ensure youre targeting the right muscles. These devices are available online, so they may be easier to access than a pelvic floor PT, depending on any geographic and financial constraints you have. Some of them even provide feedback to help you improve.
A 2020 review of research that explored the effectiveness of app-based pelvic floor exercises and app-and-pelvic floor trainer combos found that using these tools helped improve urge incontinence control and helped people adhere to their exercise routines.2
A device is really handy if youre just starting out, Dr. Sutherland says, but she encourages people to ultimately work toward learning how to target these muscles without one.
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What Can Happen If You Do A Kegel Incorrectly
Women often incorrectly contract their buttocks or gluteal muscles, or inner thighs, and basically squeeze their thighs together. Many strain and increase their abdominal pressure. Thats not good for two reasons. One, its ineffective. And two, straining results in the opposite effect. Chronic straining is a risk factor for developing and worsening problems like pelvic organ prolapse or stress incontinence.
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Exercising Your Pelvic Floor Muscles
Once you master the art of contracting your pelvic floor muscles correctly, try holding the inward squeeze for longer before relaxing. If you feel comfortable doing this, repeat it up to 10 times. This can be done three times a day. Make sure you continue to breathe normally while you squeeze in.
You can do the exercise lying down, sitting or standing with your legs apart, but make sure your thighs, bottom and tummy muscles are relaxed.
It can be difficult to remember to do your pelvic floor exercises. Linking the exercises to a regular activity such as meal times or brushing your teeth is a good way to incorporate them into your daily routine.
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Supta Baddha Konasana Or Reclining Bound Angle Pose
This yoga pose focuses on your groin and pelvic region and works your inner thighs as well as hips, giving it a complete stretch. With stronger inner thighs, you can stabilize your pelvic floor better. Because you boost flexibility, you can sense and use your pelvic floor muscles much more deeply than before.13 Follow these steps to perform this asana14:
- Lie down on your back, knees bent, and feet together.
- Breathe in relaxing the pelvic floor. Feel your hip and abdominal muscle relax. Allow your knees to drop open at the sides of your body.
- Breathe out as you bring your knees back to the start position, pulling your abdominal muscle in and lifting your pelvic floor. Accentuate that contraction of your muscles at the tail end of your exhalation.
Urinate Completely To Avoid Urinary Tract Infections
Women are especially prone to urinary tract infections, which can also involve the bladder. One way to reduce your risk is to make sure that you urinate completely, says Gopal Badlani, MD, of the Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina, and a specialist in bladder issues. If you tighten your muscles to stop urinating too soon, the urine that didn’t quite escape will head back to your bladder, which can bring bacteria into your system.
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What Steps Can I Take At Home To Treat Urinary Incontinence
Your doctor or nurse may suggest some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:
You can also buy pads or protective underwear while you take other steps to treat urinary incontinence. These are sold in many stores that also sell feminine hygiene products like tampons and pads.
How Often Should I Exercise
Do your exercises often enough to make them a habit but at a minimum of 30 repetitions twice a day. Pelvic floor muscle support usually improves within 6 weeks after starting the exercises. Strengthening your pelvic floor is one step you can take to control your bladder. While incontinence and frequent sudden urges to go may be embarrassing to talk about, your health care provider can offer other treatment options that may provide further relief.
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Add To Your Daily Routine
Do your pelvic exercises at least three times a day. Every day, try to do the exercises in three positions: lying down, sitting, and standing. Using all three positions makes the muscles strongest. Keep a daily journal or exercise log to record each time you do the exercises.
Heres a sample daily exercise schedule.
- Do a set of exercises in the morning, while making breakfast.
- Fit in another set in the afternoon, while sitting at your desk or driving.
- End with a third set in the evening, while lying in bed.
Be patient. Dont give up. Its just 5 minutes, three times a day. Like any exercise routine, it can take a little time to build up muscle strength and conditioning. You may not feel your bladder control improve until after 3 to 6 weeks.
Dont overdo it. Keep doing the exercises, but dont increase how many you do. Overdoing the exercises can lead to straining when you urinate or move your bowels.
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