Our bladders love routines. They seem to look for patterns in everything and their main concern in life is not overfilling. When all is healthy, our routine-seeking, protective bladders are wonderful. However, sometimes things can go haywire and our bladders send signals of needing to pee far too frequently. We can end up in the bathroom on back to back trips with little to no pee coming as a result. Because our bladders absolutely love routine, breaking a bad routine can be tricky. To make things even trickier, peeing too frequently can actually make the bladder walls stiffer and less able to stretch to hold pee overtime. To combat this less-than-ideal bladder pattern, we have to guide our bladders through a bit of a bladder bootcamp. In our pelvic health world we call this a “Bladder Retraining and Urge Suppression Program”.
Keep in mind, there’s a reason we call this a program and not a fix. For one, we have to make sure we are already making headway on addressing the factors that led your bladder to get into a bad pattern in the first place. Is your pelvic floor too tight? Is your bladder well supported? Are you using your core muscles appropriately with activity? Work with your pelvic health provider to make sure you are not neglecting any of these bigger factors before trying to push through this program.
Secondly, this takes time even in the simplest of cases. It probably took awhile for your bladder to get into a bad pattern and it will probably take awhile to relearn the correct pattern. Your bladder needs time to learn how to stretch, what different signals mean, and how to partner effectively with the pelvic floor muscles.
Bladder Diaries: The First Step
- The first step is to assess your current bladder schedule. If you’ve already completed a bladder diary with your provider recently, great! If not, spend a few days tracking when and how much you drink and when you go to the bathroom.
- Your pelvic health provider can give you more targeted guidance, but generally it’s a good idea to set your target schedule for about 15 minutes longer than it currently is. If you are going every hour, see if you can go every hour and 15 minutes between trips to the bathroom.
- You can push it a bit further than 15 minutes out, but don’t torture yourself! If you can’t think of anything other than the need to pee and the urge suppression techniques listed below aren’t working, go ahead and go to the bathroom.
The Retraining Program
- Now that you have your schedule goal, it is time to practice sticking with this new schedule.
- Each morning when you wake up, go to the bathroom and completely empty your bladder. Your peeing schedule will begin and end when you wake up and go to bed.
- If you feel you need to pee before the scheduled time, use the urge suppression techniques listed below.
- If you need to pee strong enough that it’s getting hard to focus on anything else despite trying all the urge suppression techniques, go to the bathroom!
- If you do not have to pee at a scheduled time, you can wait until you have an urge but do not go longer than 3-4 hours without peeing.
- If you have to interrupt the schedule, get back on schedule at the assigned time for the next trip to the bathroom.
- If you can easily complete the voiding schedule for 3-5 days. Then add an additional 15 minutes to your voiding schedule.
- The goal is to work up to a bladder schedule of peeing every 2-3 hours.
Urge Suppression Techniques.
- These are the steps to practice to help the bladder quiet down when the sudden sense of urgency strikes.
- Stop what you are doing. If you can, sit down. If not, stand still.
- Try and keep your body relaxed and resist the urge to tighten your knees together.
- Perform some quick pelvic floor contractions (6 quick kegels).
- Distract yourself: counting backwards, deep breathing, reading or performing another task.
- Reassess your sense of urgency. If the urgency is gone and it’s not time to go to the bathroom, wait until your scheduled time comes. If you still feel like you need to go or if it is time for you to go, walk, do NOT rush, to the bathroom.
- Many times the sense of urgency will spike again when you go to open the bathroom door or go to get undressed when sitting next to the toilet. If this is the case, repeat the relaxing and quick kegel steps from above until the strong urgency becomes quieter.
Other important tips:
- It is important NOT to restrict the amount of fluid you drink during the day. This will make things worse in the long run.
- Do not go to the bathroom “just in case”.
- Sit completely on the toilet while voiding. No hovering!
- Do not strain or try and push while peeing.
- Practice the KNACK
- Squeezing the pelvic floor before you cough, laugh, sneeze, or lift to decrease any pee leaking
- “squeeze before you sneeze”