Bladder training

Overview of bladder training

A recent statistics of the Indian Express has shown that nearly 60.4% of India’s total population does not have access to toilets.  This is interfering with the hygiene habits of the less affluent section of the Indian population, which in turn is giving rise to numerous urinary problems in both men and women.

Coming to the global statistics, the epidemiological findings by the National Kidney Foundation show that nearly 20% of women having a history of urinary tract infection are likely to develop a recurrent infection in future. Many of these patients grow acute kidney malfunctions in future. A recent survey conducted by the American Urological Association reveals that about 12% men and 7% women normally suffer from kidney stones worldwide.

All the above situations may result from or give rise to bladder incontinence and urinary problems. This necessitates “bladder training”, a self-therapy to alter the body’s excretory mechanism and minimize the incontinence problems.

What is bladder training?

Bladder training is a therapy for urinary incontinence where the bladder activity is regulated through a series of processes. The aim of this self-help program is to improve the containing capacity of the urinary bladder. It can effectively help improve symptoms like excess urinary urge, bedwetting and nocturia (frequent passing of urine at night).

The training encompasses a strict pattern of urine passing. At the beginning of the program, the interval between two consecutive bathroom visits is maintained as 2 hours. After a few sessions the duration of the intervals is increased. The program is made in such a way that the increase in the duration of the interval becomes directly proportional to the increase in bladder control. To make the program more effective, the person undergoing the training is made to drink large quantities of fluids, which the bladder is compelled to store for a certain period of time.

What are the problems solved by bladder training?

Bladder training helps resolve the following difficulties faced on a regular basis by the incontinence patients-

• Urinary frequency: Under normal circumstances a person is not supposed to pass urine more than 4-6 times a day. Under certain medical conditions like Diabetes, the patients tend to urinate around 9-10 times or more in a day. The training is particularly helpful for them.
• Nocturia: Nocturia is the act of passing urine at night. For people under 65, one bathroom visit at night is considered normal and for people above 65, one or two visits are allowable. If the frequency in either case becomes higher, bladder trainings become necessary.
• Urgency: Some people fail to control urinary urge even under normal conditions. The urge often intensifies due to the fear of leakage. A trained bladder becomes capable of pacifying urgency.
• Urge incontinence: Bladder storage capacity in these people is completely nil and they are often found to urinate at inappropriate places and times. These people often are not aware of the passage of urine and have the habit of bedwetting.

What are the main objectives of bladder training?

Bladder trainings are mainly directed towards improving the retention capacity of the urinary bladder. This also helps prevent accidental leakage of urine. The main objectives of these programmes are as follows-

• Increase the length of time between two successive bathroom visits
• Increase the quantity of urine the bladder can store for a length of time without any discomfort
• Discharging urine strictly according to the schedule even in the absence of an urge
• Minimise or completely eliminate urinary incontinence
• Independent management of bladder, that is management in the absence of any training

What is the commonly followed bladder training schedule?

The bladder training schedule is planned as recommended by the doctor. It will be discussed in this section according to the weeks of training-

• From the very first week, the patients should maintain a Bladder Diary, which will keep an account of the number of bathroom visits and accidental leaks in a day. In this week, the patients are trained on the Bladder Urge Control procedure to retain and void as per the set schedule.
• In the following weeks, the length of the intervals is increased by 15-30 minutes. For the younger people, bathroom visits after 3-6 hours and for the elderly people, visits after 2-3 hours is permissible.
• If the bladder control does not improve even after a week’s training, the patients are advised to undergo the same training under the same schedule for another week. The schedules are altered only after the incontinence problems are resolved to some extent.

How does the Bladder Urge Control procedure work?

Now that you know about how to start the training, it is necessary to have a detailed knowledge of the Bladder Urge Control technique, which is fundamental to the concept of urge minimization. Follow a few simple steps-

• To prevent overstimulation of the bladder, sit quietly or stand still at one place
• Relax your mind and take slow, deep breaths
• Perform repeated contractions if the pelvic floor muscles. This enables the closure of the urethra and pacification of the bladder.
• Use self-suggestion and mental imagery to suppress a strong urge. Convince yourself that your bladder is capable of holding the urine until and unless you voluntarily want to go to the bathroom and urinate.
• Use distraction techniques to divert your mind from the urge.
• When the urge completely subsides, avoid using the toilet until the next voiding time set as per the schedule.

Throughout the entire procedure, you need to continuously apply the bladder defer tactics in order to suppress the urge and increase the capacity.

References