Bladder Training

Definition

Bladder training is a behavioral modification treatment technique for urinary incontinence that involves placing a patient on a toileting schedule. The time interval between urination is gradually increased in order to train the patient to remain continent.

Purpose

Bladder training is used to treat urinary urge incontinence. Urge incontinence occurs when an individual feels a sudden need to urinate and cannot control the urge to do so and, as a consequence, involuntarily loses urine before making it to the toilet.

Precautions

Incontinence may be controlled through a number of invasive and non-invasive treatment options, including Kegel exercises, biofeedback, bladder training, medication, insertable incontinence devices, and surgery. Each patient should undergo a full diagnostic work-up to determine the type and cause of the incontinence in order to determine the best course of treatment.

Description

Bladder training may be prescribed and implemented by a general physician, urologist, or urogynecologist. A urination schedule is created for the patient. The schedule typically starts out with fairly short intervals between bathroom breaks (e.g., an hour). As soon as the patient is able to consistently remain continent for several days at a certain toileting time interval, the time span is increased. Bladder training continues until the patient regularly achieves continence at a time interval he/she feels comfortable with.

Preparation

A complete evaluation to determine the cause of urinary incontinence is critical to proper treatment. A thorough medical history and physical examination should be performed on patients considering bladder training. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis. It may include a series of exams called urodynamic testing that measure bladder pressure and capacity and the urinary flow. The patient may also be asked to keep a diary of their urination output and frequency and episodes of incontinence over a period of several days or a week.

Risks

Bladder training may not be successful in all patients with urge incontinence. Patients who demonstrate a strong desire to control their continence and are committed to sticking with a training program tend to have the most success with bladder training.

Normal results

Patients who undergo successful bladder training gain complete or improved control over their urination. In some cases, additional alternate treatment such as biofeedback or pelvic muscle exercises may be recommended to supplement the progress made with bladder training.

Resources

ORGANIZATIONS

American Foundation for Urologic Disease. 1128 North Charles St., Baltimore, MD 21201. (800) 242-2383. 〈http://www.afud.org〉.

National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337. 〈http://www.nafc.org〉.

KEY TERMS

Biofeedback— Biofeedback training monitors temperature and muscle contractions in the vagina to help incontinent patients control their pelvic muscles.

Pelvic muscle exercises— Exercises that tighten and tone the pelvic floor, or perineal, muscles. Also known as Kegel and PC muscle exercises.