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Tips to Retrain Your Bladder

So we ended last month's column talking about getting control over your bladder and improving its ability to hold larger (or normal!) amounts of urine. As we continue to discuss disciplining your bladder keep the following tips in mind:

1. Even with a well-disciplined bladder you will need to pee at some point.  This is normal and healthy and good. What goes in must come out—in fairly similar proportions which means if you drink an entire liter of fluid in one sitting don't expect to be able to go eight hours before emptying your bladder!
2. The goal is NOT to pee "as little as possible." The goal is function—to have your bladder hold your urine long enough that you can participate in life! It is normal to pee up to 7 to 10 times per day (depending on how much you drink) and if you are over 60 to get up at least once at night.
3. You may have to make some changes in how you do things. If you keep doing what you've always done expect what has always happened. Doing Kegels and working on mind-over-matter works but you have to actually do it!

KEEPING A BLADDER DIARY
Last month we also talked about keeping a bladder diary. We do this for two reasons. First is to find out what things are irritating your bladder and cut down cut out or dilute them. Second is to calculate roughly how much you are taking in versus putting out.

Normal bladder volume capacity varies from 300-600 mL (about 1 to 2.5 cups) depending on whom you talk to...and who you are! A diary can help you answer the question “Do I really need to pee right now?” 

TIPS TO HELP YOU REGAIN BLADDER CONTROL
If you have had only ½ cup of water in the past four hours and been to the bathroom five times the answer is probably “no!" If the answer is “no” but your bladder is still telling you that you really really need to go right now here are some things that can help:

• Sit down. Putting some pressure on your pelvic floor can help to squelch the urge to go. Once the really strong urge has passed and you can proceed calmly to the toilet do so. Often I'll have patients keep a chair by their front door or bathroom door so they can sit down and get control over their bladder. 
• Distract yourself. Count backwards. Sing the national anthem. Do a Sudoku on your phone.  Do something to get you mind off of thinking “Aaaaggghhhh! I need to pee!!!!” 
• Do Kegels. This helps to reduce bladder muscle contractions.

BABY STEPS
It takes several weeks to retrain the habits you've been developing over the course of your lifetime. The journey of 1000 steps starts with the first step right?  Likewise dry pants start with just one Kegel followed by another and then another. (You're doing them right now aren't you? Don't worry no one else can tell. Good job!)

Stephanie Drew is a physical therapist with Howard Head Sports Medicine in Edwards who specializes in women's health pelvic floor rehabilitation and orthopaedics. She can be reached at stephanie.drew@vvmc.com.