Bladder control training for urinary incontinence
control training for urinary incontinence
(This article was first printed in the August,
2004 issue of the Harvard Women’s Health
Watch. For more information or to order, please
go to http://health.harvard.edu/women.)
You may be able to teach
your bladder to behave itself.
Urinary incontinence — the
involuntary loss of urine — can happen
to anyone, but it occurs more often in women.
One of the major causes is pelvic floor or sphincter
muscle damage sustained during childbirth. Another
possible contributor is the drop in estrogen
levels at menopause, which can lead to changes
in muscles that support the bladder and in the
lining of the bladder and urethra. Other causes
include aging, diseases such as diabetes, medications,
and nerve damage.
Many women accommodate minor
or temporary urinary incontinence by wearing
pads. But all too often, urinary control problems
take over a woman’s life. She may start
to organize her activities around access to a
bathroom or give up important pursuits, such
as exercise, social events, and travel. If this
is happening to you, you should know that in
most cases, nonsurgical treatment can cure or
markedly reduce urinary incontinence. One strategy
that’s often successful is bladder control
In bladder control training,
a physician will first try to identify the cause
of the incontinence. She or he will perform a
physical exam, take a medical history, ask about
any medications or supplements you take, and
discuss your lifestyle and activities. You may
also be asked to keep a 48-hour voiding diary — a
record of your fluid intake, the times you urinate,
and any leaking episodes.
Medical devices, medications,
and surgical procedures have been developed to
treat urinary incontinence. Depending upon the
type and seriousness of the problem, one or more
may be right for you. But many clinicians start
by recommending a trial of bladder control training.
This includes learning to urinate on a schedule
(timed voiding), pelvic muscle exercises (Kegels),
and sometimes biofeedback. Your clinician may
also suggest taking a medication and limiting
fluids to no more than 6–8 cups per day
from all sources while you’re learning
to control your bladder.
Bladder control training can
be especially helpful with urge incontinence — the
sudden and overwhelming need to urinate, sometimes
accompanied by involuntary loss of urine on the
way to the bathroom. During urge incontinence,
the muscle surrounding the bladder contracts
too soon, telling your brain that you must go,
even when your bladder isn’t full. Urinating
every time you get the urge only worsens the
problem; it teaches the bladder to hold smaller
and smaller amounts of urine. Bladder control
training helps increase bladder capacity.
Learn to “go” on
The mainstay of bladder control
training is timed voiding, which means that you
urinate at a set time, not when your bladder
tells you to. Here’s what to do:
Determine your pattern. For
a day or two, keep track of the times you urinate
or leak urine during the day. If you filled out
a voiding diary at your clinician’s request,
you already have this information.
Choose an interval. Figure
out how long you typically wait between urinations
during the day. Based on that average interval,
choose a starting time that’s 15 minutes
longer. For example, if you usually go every
hour, your starting interval will be 1 hour,
Go by the clock. On
the day you start, empty your bladder first thing
in the morning and not again until after the
interval you’ve set. If that time arrives
before you feel the urge, go anyway. Remember,
you’re training your bladder to keep a
schedule. If the urge hits first, do everything
you can to hold off going. This can be difficult
at first, but usually improves with practice.
If the urge is great, try to distract yourself.
Practice Kegels (described below), cross your
legs, stand still, or breathe slowly in and out
for counts of four. Remind yourself that your
bladder isn’t really full. If you can’t
wait the full 15 minutes, try to manage another
5 minutes before walking slowly to the bathroom.
Increase your interval. Once
you’re comfortable with your initial interval
and aren’t having any leakage — this
may take anywhere from a few days to a few weeks
to accomplish — increase the time by another
15 minutes. Continue repeating this process and
increasing your time by 15-minute increments.
After several weeks or months, you may find that
you’re able to wait for 3–4 hours
between trips to the bathroom and that the feelings
of urgency and episodes of incontinence have
No training at night. Get
up in the night whenever you need to urinate.
Your day training should eventually begin to
influence your entire voiding pattern, so that
you get up less frequently at night.
relies on a complex process involving
the brain, nerves, and muscles. When
the bladder is full, nerves send the
brain a message that it’s time
to urinate. Normally, the ringlike
sphincter muscle surrounding the urethra
(the tube that carries urine from the
bladder and out of the body) helps
hold the urine back until you reach
the bathroom. Once you’re there,
the brain signals the sphincter to
relax (to let the urine out) and tells
the muscle surrounding the bladder
(the detrusor muscle) to squeeze the
If any step in this
process goes wrong, incontinence can
result. For example, if muscles in
the pelvic area are too weak to support
the bladder and other nearby organs,
urine may leak out when you exercise,
laugh, cough, sneeze, or otherwise
put pressure on the bladder. This is
called stress incontinence. Urge incontinence
is thought to result from an overactive
detrusor muscle that causes the bladder
to go into spasm. It’s exacerbated
by poor tone in the urethra. Postmenopausal
women often have both types — so-called
Learn to Kegel
Pelvic floor muscles are the
muscles you use to hold back urination and thus
are important to urinary continence. Contracting
them also signals the detrusor muscle to relax,
which allows the bladder to better hold the urine.
You can strengthen and condition these muscles
with pelvic floor exercises, also known as Kegels
(named for Arnold Kegel, the physician who first
To perform Kegels, you first
need to find your pelvic floor muscles. Pretend
you’re trying to avoid passing gas while
simultaneously tightening your vagina around
a tampon. You should feel the contraction more
in the back than the front. Don’t contract
the muscles of your stomach, leg, or buttocks.
Once you’ve loca ted the pelvic floor muscles,
you need to repeatedly contract and relax them.
Practice both short and long contractions and
Short contractions, sometimes
called flicks, are quick squeezes and releases.
Mastering long contractions will take more practice.
Start by holding each contraction for 3–5
seconds, resting for the same number of seconds
between contractions. Build up to 10-second contractions
with 10 seconds of rest between contractions.
Try to do 30–40 long Kegels every day,
divided into groups of 10 contractions each.
You may want to do 10 before getting out of bed
in the morning, 10 standing after lunch, 10 in
the evening while sitting, and another 10 before
going to sleep.
Women who have very weak pelvic
muscles may benefit from biofeedback using a
device that can help monitor progress in learning
and doing Kegels. Patches placed over the muscles
are connected to a video screen that displays
the strength of the muscle contractions.
Better Bladder and
Bowel Control, a Special Health Report
from Harvard Medical School, is available
Harvard Health Publications
P.O. Box 421073
Palm Coast, FL 32142-1073
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