What is a normal bladder habit?

The volume of urine passed each time by a normal adult will vary from around 250 - 400ml. This is the same as about 2 cupfuls. Most people with normal bladder habits can hold on for 3 - 4 hours between visits to the toilet. Most younger adults can also go right through the night without the need to pass urine.

With ageing, the bladder capacity may get smaller, so the frequency of passing urine may increase, both by day and night.

What is bladder training?

Bladder training is a treatment for people who suffer from an urgent need to pass small amounts of urine more frequently than normal (ie, more than 3 - 4 hourly), and may experience leakage with urgency.

Sometimes people with no urgency pass urine frequently to avoid accidents. These people may also benefit from bladder training.

What are the aims of bladder training?

The aim of bladder training is to improve bladder control and increase the amount of urine the bladder can comfortably hold, without urgency or leakage of urine.

The programme teaches people to suppress the urgent desire to pass urine until a socially acceptable time and place is found. With people experiencing urgency or frequency, learning to 'hold on' can initially be difficult but usually becomes easier with practice.

Some helpful hints

• when you have the urgent need to pass urine, you may find it helpful to sit down and try to take your mind off wanting to get to the toilet
• when you do go to the toilet, walk, don't run
• avoid going to the toilet 'just in case'
• minimise the intake of fluids which may irritate the bladder, for example, coffee, tea, cola and alcohol
• maintain a good bowel habit by keeping your bowel regular and avoiding constipation, as this can increase bladder sensitivity
• do your pelvic floor exercises - this gives you confidence to hold on. See everybody titles Pelvic floor Training for Women and Pelvic Floor Training for Men
• pelvic floor muscle exercises not only increase the ability to hold urine in, but also can help control an unruly overactive bladder.

Will there be setbacks?

Don't be concerned with small day to day variations in your bladder pattern - these are normal for everyone. However, any person who starts a bladder training programme may experience setbacks when the symptoms seem worse again. These may occur:

• when you are tired or run down
• during a urinary tract (bladder) infection (see the doctor immediately if you suspect this)
• at times of anxiety or emotional stress
• when the weather is wet, windy or cold
• during times of illness, eg. cold or flu.

If this does happen, do not be discouraged. Think positively and keep trying. It becomes easier with practice. Do keep doing the baldder training and the pelvic floor muscle exercises.

The bladder training programme

A useful way to measure progress is to use a bladder chart or diary. If you haven't been given a chart by your doctor or continence advisor, you can draw one yourself using the following example.

The first step

Start by filling in the bladder chart for 2 - 4 days (including overnight).

• write down the type of fluid you drank, the volume and the time
• write down the time you pass urine and the volume you pass
• write down any accidental loss of urine
• note any bladder sensation proceeding the leakage episode.

Over the following weeks:

• try to gradually increase the time between visits to the toilet
• each time you get the urge to go to the toilet, try to hold on for a few minutes longer
• if you wake up during the night with a strong desire to go to the toilet, it is reasonable to go and empty the bladder right away (unless advised otherwise). As you improve by day, you will gain confidence to practice the programme at night.

What if bladder training doesn't work?

If, after 4 - 6 weeks, the programme has not helped your bladder control problems, seek help. The best results are achieved by working with a health professional who is trained in dealing with bladder problems and who will design an individual programme especially suited to you.

How to seek help

There are health professionals qualified to help you with bladder control problems. You may seek advice from your GP or contact the Freephone Helpline - 0800 750 659.

Original material provided by the New Zealand Continence Association. Edited by everybody, July 2005.