November 21, 2018
Restroom sign

How to Train Your Bladder

by Wellness Letter  

If you experience a frequent urgency to urinate—perhaps due to having an enlarged prostate if you’re a man, having given birth if you’re a woman, or having an “overactive bladder”—there may be a practical DIY solution to the problem, referred to as bladder training. It may be worth a try before resorting to medication or surgical procedures.

Though evidence of effectiveness from studies is limited, bladder training is commonly done in clinical practice, with patients often reporting success.

Bladder basics

The average bladder can hold about a pint of urine. It’s common to urinate anywhere from five to eight times over a 24-hour period—though the frequency depends on how much food and fluid you consume, as well as your age and metabolism. Psychological factors also influence voiding: While some people bite their nails or eat when stressed, others urinate a lot.

As urine is produced by the kidneys, it gradually fills the bladder, causing it to expand like a balloon and the “detrusor” muscle within the bladder wall to stretch. Meanwhile, the muscles in and around the urethra (the tube through which urine passes out of the body) help dam up the bladder until there is an appropriate time and place to urinate. Pelvic floor muscles situated beneath the bladder also help keep a lid on the urethra.

But as the bladder begins to reach its capacity, signals are sent to the brain that increase the urge to urinate. Urination—which is normally under voluntary control—occurs when the detrusor muscle contracts and the urethral muscles relax.

An “overactive bladder”—a broad term used to describe a range of symptoms, including urinary urgency and sometimes leakage—occurs when the bladder contracts abnormally for various reasons, triggering a sudden and uncontrollable urge to urinate. Weak pelvic floor muscles can contribute to the problem. Many people who have leakage or accidents go to the bathroom when they don’t need to—“just in case”—but this strategy can backfire. If you often go when your bladder is not full, the bladder wall doesn’t get stretched as much, which conditions it to send out the need-to-urinate signal at a reduced volume of urine.

Go, bladder training!

Voiding is a learned behavior. At birth, bladder emptying is simply a spinal cord reflex similar to the knee-jerk reflex. It is not until the central nervous system sufficiently matures that we learn to control this reflex.

The goal of bladder training is to increase the length of time between bathroom visits, increase the amount of urine your bladder can hold, and give you more of a sense of control over your urge to urinate. It involves several strategies, and often a combination is needed to get the best results. Don’t expect immediate improvement, however; it may take several weeks or even a few months. Here are the basics.

  • Keep a “bladder diary.” Keep a journal of your urinary bathroom habits for several days, in which you write down the times you void, both during the day and night (a sample diary can be found here). To get a fuller understanding of the functioning of your bladder, you can also record the level of urgency, whether there was leakage and, if so, what you were doing at the time, along with the type and amount of fluids you consume.
  • Schedule regular trips to the bathroom. Empty your bladder right before going to sleep and as soon as you get up in the morning. Then, using your diary as a guide, follow a voiding schedule for the rest of your waking hours—whether you have the urge to urinate or not—based on the shortest amount of time between your recorded bathroom visits. For example, if the shortest time was one hour, then schedule urination every hour during waking hours. Using a stopwatch, such as on a smartphone, can help keep you on your schedule.
  • Increase the time between voiding. When you have no problems adhering to your schedule for a few days, increase the interval between bathroom trips by 10 or 15 minutes. When you are successful with that, increase the time by another 10 or 15 minutes, and so on, until you are going to the bathroom only every three to four hours, which is considered normal. Alternatively, you can skip the first two steps outlined here and just try to delay urination by 10 minutes or so whenever the urge strikes, incrementally increasing the time until you can wait several hours between voiding.
  • Think “mind over bladder.” If you have a strong urge to urinate before your scheduled time, try not race to the bathroom. Instead, stand or sit still and take slow, deep breaths. Try to distract yourself from the feeling of urgency—count backwards from 100, for example. Or visualize the pressure in your bladder subsiding. If the urge passes, stay on your normal schedule. If it does not, walk slowly to the bathroom.
  • Don’t rush when urinating. You want to be sure to empty your bladder completely. After you think you are done, wait 30 seconds or so to see if any more urine can be expelled. This is called double voiding. At the end, push a little (but don’t strain) to make sure your bladder is fully empty.
  • Watch what you drink. Limit caffeinated beverages and alcohol—these can act as mild diuretics and increase urination. Drink fewer liquids in the hours before bedtime (but don’t reduce your total daily fluid intake). Some people report that certain beverages, such as citrus juice, as well as certain foods may increase symptoms; your bladder journal can help you identify if any are a problem for you.
  • Do pelvic floor (Kegel) exercises. These exercises, which involve “squeezing” your pelvic floor muscles as if you are trying to stop the urine flow (see box), can help when you have a strong urge to go. Just do a few quick contractions. Kegel exercises can also be done regularly every day—with an empty bladder—to help treat certain types of incontinence. However, if you have been diagnosed with pelvic floor spasms, these exercises may make matters worse.

This article first appeared in the UC Berkeley Wellness Letter.

Also see Yoga for a Better Bladder.