The following guest blog comes from urogynecologist, Peter Rosenblatt, MD, creator of a new app for bladder retraining, a proven conservative technique to address overactive bladder. There are hosts of ways that overactive bladder (and related symptoms) can be addressed by many types of healthcare providers and we’re happy for all efforts to make that easier! Add this tool to the all important and ever-growing toolbox!
Multidimensional + multidisciplinary lessens ‘multi’ trips to the bathroom.
Chances are, you’ve probably heard of pelvic muscle exercises that are recommended for women that suffer from urinary incontinence. These can include “Kegel” or squeezing exercises, as well as exercises for better pelvic muscle relaxation and coordination and they are just one of several non-surgical treatments for common conditions, such as stress incontinence (leakage with activities like coughing, sneezing and exercising) or overactive bladder (urinary frequency, urgency, and leakage associated with these sudden urges) that affect literally millions of women in the U.S. Another treatment for these conditions that you may not have heard about is something called “bladder retraining”, which is a simple behavioral modification technique that can be quite effective in managing these conditions, especially when they are combined with other treatments, like the right pelvic muscle exercises.
Bladder retraining is a method where you void (urinate) at specific times during the day, and then slowly increase the time between voiding. That’s the basic idea behind this technique, and it will likely make even more sense as we get into the details below and for those of you who are familiar with “apps” from iTunes, there is a free app that I recently developed with the American Urogynecologic Society (AUGS) that can make this process even easier.
The best way to begin is to keep a diary of your voiding habits for a 24 hour period. Write down on a piece of paper every time you go to the bathroom, both during the day and when you wake up at night to urinate. Also keep track of any episodes of urine leakage, and what you were doing at the time (for example, coughing, sneezing, washing dishes). Click here for a printable voiding diary.
Next, figure out a comfortable average interval based on your diary results – a time between voiding that you think you could manage on a regular basis. Typically, this may be 2 hours, although some women with overactive bladder may need a much shorter interval in the beginning, such as every hour, or even shorter than that. Let’s say the interval you choose is 1 hour. For the next 5 days, during waking hours, make a point of voiding every hour on the hour – and here’s the key to success – go whether you feel you need to urinate or not! In other words, even if you feel you could hold it a little longer…don’t! The idea behind bladder retraining is to “tell” your bladder that you are in charge, and that your bladder is not in charge of you. You’ve heard of “mind over matter”? Well, this is similar…let’s call it “mind over bladder”!
So, when you wake up in the morning, go to the bathroom. Let’s say it’s 7 am. You’ll then void again at 8 am, 9 am, etc. You may need to spread out your drinking over the day, but don’t compromise on your fluid intake – drink what is normal for you on a daily basis. Then, after 5 days, increase the interval by 15 minutes, so now you will be voiding every 1:15. For example, you would void at 7 am, 8:15 am, 9:30 am, 10:45, etc. Again, 5 days later, increase the interval to 1:30 and so on, until you get to a more normal interval. The average person voids between 5-8 times during the day, so that’s somewhere between 2:30 and 3:30 hours between voiding for most people. You may or may not get to an interval of 3:30, but I promise that if you are currently voiding every 45 min, and you can slowly build up to 2:30, this will be an enormous improvement for you. I don’t recommend to my patients that they do any of this bladder retraining at night (ie. after they go to sleep). The general consensus is that if you can take care of this during the day, the night time issues should take care of themselves.
Sure, you may be thinking (and I hear this from my patients all the time), “This sounds fine, but I have a lot of things to do during the day, and I can’t keep staring at my watch, figuring out when I need to urinate the next time.” I agree – you have a lot more important things to think about than your bladder. That’s why I developed an app called the “BladderTrackHer” with the help of the American Urogynecologic Society and a group called The France Foundation. You can download the app for free from the iTunes store.
We developed this app to assist you with bladder retraining and it actually does a lot more than that! It can keep an electronic diary for you of your voiding habits and you can e-mail this diary directly to your doctor, if you choose. It not only reminds you when to void as part of the bladder retraining program, but you can set it up to remind you when to do Kegel or other important pelvic exercises and when to take your bladder medication (if your doctor prescribes such medications). It will also provide helpful tips to improve your overactive bladder condition, such as diet and fluid intake modifications.
Remember – bladder retraining is just one of several non-surgical methods that can be used to effectively manage urinary incontinence and overactive bladder. This is certainly something you could start with before seeing a healthcare provider, but it is not a substitute for seeing a physician or other provider with expertise in bladder and pelvic health. If your symptoms do not improve with pelvic muscle exercises, diet modification and bladder retraining, then make an appointment with your doctor or get a referral to a specialist (either a urogynecologist or a urologist that specializes in urinary incontinence) to make sure there is nothing more serious going on, or to consider medications or other treatments that are often used to treat these conditions. You can also see a pelvic floor physical therapist for additional non-pharmacological and non-surgical care and it can often be helpful to see them in conjunction with a physician specialist.
Finally, there is a lot of great information available through the American Urogynecologic Society (AUGS) on a patient website called OAB (overactive bladder) Central, including a survey, a brief quiz on bladder control, tips on how to make lifestyle changes, and much more.
|Peter L. Rosenblatt, MDDr. Rosenblatt specializes in Female Pelvic Medicine and Reconstructive Surgery, including robotic and minimally invasive surgery for incontinence and prolapse, at Mount Auburn Hospital (Cambridge, MA). He completed his residency at the University of Massachusetts Medical School in Worcester, MA and his fellowship at Women and Infant’s Hospital in Providence, RI. He is an Assistant Clinical Professor at Harvard Medical School. Dr. Rosenblatt is Board Certified in Obstetrics & Gynecology by the American Board of Obstetrics & Gynecology.|