Training your bladder

Treatment choices for urinary incontinence range from lifestyle changes to surgery. Your treatment will depend on the underlying problems causing the incontinence. But keep in mind that no treatment works perfectly, and you may have to try more than one approach before you find the one that best suits your needs. Treatments may be different for men and women. Because there are a variety of options, your preferences are important in developing a plan.

For example, a woman may be a candidate for either injections of bulking agents or a sling procedure. If she is in her 40s and likes to do kickboxing for exercise, she may not be dry enough with the injections and may choose sling surgery. A woman with similar exam and test results but a less active lifestyle might get along fine with injections.

It's also important to know that less invasive treatments, such as biofeedback or pelvic floor exercises, are a good first step and can be helpful, but may not be as effective as some surgical procedures. You and your physician need to decide which is most appropriate for you. Check with your health plan to find out which therapies are covered. Treatment for urinary incontinence is an area of active research, and new approaches are under development.

Bladder training

You might be teaching your bladder some bad habits—habits that can gradually result in incontinence or frequent bathroom breaks. For example, if you routinely urinate before your bladder is full, it learns to signal the need to go when less volume is present. That can set up a vicious cycle, as you respond to the new urges and teach your bladder to cry "run" when less and less urine is present.

Luckily, old bladders can learn new tricks. Bladder training, a program of urinating on schedule, enables you to gradually increase the amount of urine you can comfortably hold. Bladder training is a mainstay of treatment for urinary frequency and overactive bladder in both women and men, alone or in conjunction with medications or other techniques. It can also help prevent or lessen symptoms of overactive bladder that may emerge after surgery for stress incontinence. You can try it on your own or with the guidance and support of a health professional. Because bladder training is low-cost and low-risk, your clinician may encourage you to try it first, even before specific diagnostic tests are performed.

Step-by-step bladder-training technique

• Keep track. For a day or two, keep track of the times you urinate or leak urine during the day.
• Calculate. On average, how many hours do you wait between urinations during the day?
• Choose an interval. Based on your typical interval between urinations, select a starting interval for training that is 15 minutes longer. If your typical interval is one hour, make your starting interval one hour and 15 minutes.
• Hold back. When you start training, empty your bladder first thing in the morning and not again until the interval you've set. If the time arrives before you feel the urge, go anyway. If the urge hits first, remind yourself that your bladder isn't really full, and use whatever techniques you can to delay going. Try the pelvic floor exercises sometimes called Kegels, or simply try to wait another five minutes before walking slowly to the bathroom.
• Increase your interval. Once you are comfortable with your set interval, increase it by 15 minutes. Over several weeks or months, you may find you are able to wait much longer and that you experience far fewer feelings of urgency or episodes of urge incontinence.