Bladder Retraining for OAB

Jessica McKinney, PT Health Guide
  • The function of our bladder is something we generally take for granted, but this important organ can betray us in some pretty disruptive ways.  Overactive bladder (OAB) syndrome is a prime example.  It is classified by the sudden and extreme urge to void, often accompanied by increased frequency of urination and may or may not involve loss of urine (incontinence).  In many cases, it develops slowly and insidiously.  While successful treatment often incorporates more than one intervention, one low-cost and low-risk intervention can be started independently: bladder retraining. 

     

    Generally speaking, bladder retraining involves three primary elements, each of which is multifactorial in its own right: patient education, scheduled voiding, and positive reinforcement.

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    Patient education

     

    This includes information about bladder control and continence, including anatomy and normal function, as well as fluid intake, urge response and urge suppression strategies (the latter of which are particularly needed when one is working on increasing the amount of time between voids).

     

    Seek out a physician from the American Urogynecologic Society Provider Directory or a physical therapist at www.apta.org; Select “Find a PT”, then search for specialty, i.e. “Women’s Health” or other specialists in your area who has expertise in bladder and pelvic health and can provide this education. 

     

    Scheduled voiding

     

    This involves the use of a timetable to track the time and approximate amount of one’s voids. It can also track degree of urge to void, any leakage, as well as food and beverage intake.  This timetable is known as a bladder diary when used to collect a few days’ worth of information on an individual’s bladder habits, and the findings of this diary are used to set the ‘schedule’.

     

    How to track it?

    • There’s an app for that!  Check out the free BladderTrakHer app.
    • Paper is always an option, too!  See this sample form from the Voices for PFD website, which is downloadable and printable.

     

    If you are planning to discuss your bladder health with a provider for the first time, it can be helpful to fill out a few days’ worth of bladder diary beforehand.  Sharing this information with them can help guide treatment recommendations.

     

    Once the diary is completed, the aim is to start with the most typical voiding interval (i.e. the time between voids) and increase in 15-30 minute intervals until one is voiding every three to four hours during the day and zero to one time per night.  The increases are applied uniformly throughout one’s waking hours and are not adjusted upwards again until the present interval is reliably achieved.

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    For example, if your bladder diary reveals voiding intervals of 1.5 to two hours during the day then…

    • Bladder retraining begins by increasing the timeframe between all voids to two hours, starting with the time of the first void upon waking for the day.  When two hours is achieved all day, the interval can be adjusted up to every two hours and 15 minutes, or every 2.5 hours, based upon one’s ability. 
    • Each incremental increase may take one to a few weeks to achieve.

     

    Positive reinforcement

     

    Because the brain and the bladder are powerfully connected, encouragement and regular engagement with a health care professional (in your community or accessible remotely) is a valuable component of successful bladder retraining.  They help to identify barriers to progress, provide help addressing bladder urge triggers, and continually help one understand the process and stay the course.

     

    The bottom line

     

    Bladder retraining is recommended primarily for those who are physically and cognitively able, as well as motivated.  Note that last word…it will take some stick-to-it-iveness to be successful in bladder retraining. But given its low risk, low cost, and potential quality-of-life improvement, you may decide it is right for you. 

     

    Best of luck in education and timed voiding (Consider that your first dose of positive reinforcement)!

     

    References:

    1. Henscher, Ulla (2006), “Storage and Emptying Disorders of the Bladder,”, in The Pelvic Floor, Beate Carriere and Cynthia Markel Feldt, eds.  New York, Theime, 364-68.
    2. Lukacz, E. S., Sampselle, C., Gray, M., Macdiarmid, S., Rosenberg, M., Ellsworth, P., & Palmer, M. H. (2011). A healthy bladder: a consensus statement. International Journal of Clinical Practice, 65(10), 1026–36. doi:10.1111/j.1742-1241.2011.02763.x
    3. Majumdar, A., Hassan, I., Saleh, S., & Toozs-Hobson, P. (2010). Inpatient bladder retraining: Is it beneficial on its own? International Urogynecology Journal and Pelvic Floor Dysfunction21(6), 657-663.
    4. Cardozo, L. (2011). Systematic review of overactive bladder therapy in females. Canadian Urological Association Journal.
Published On: July 22, 2014