Bladder Training and the Overactive Bladder

By Dr. Christine Martirez PT, DPT on 10/10/2023

Overactive bladder is a condition characterized by sudden and frequent urge to urinate, sometimes leading to unintentional leakage. It can be a frustrating and embarrassing condition that impacts your daily activities and quality of life. Symptoms may be managed conservatively with bladder training, which may include dietary changes, timed voiding, and bladder holding techniques.

Symptoms

If you suffer from overactive bladder, you may experience:

• Sudden urges to urinate that is difficult to control

• Urge incontinence, which is uncontrolled leaking associated with urge to urinate

• Frequent urination, more than 8 times in 24 hours

• Waking up more than two times in the night to urinate

How Does the Bladder Work?

Your bladder normally stores urine, which is produced by your kidneys. The amount of urine produced is dependent upon how much you drink, eat, and sweat. Your bladder should normally hold around 400-600 mL of urine. Normal frequency of urination is 7-8 times within the day, and possibly once during the night. The amount of fluid you drink will determine how frequently you will need to urinate. The National Academy of Medicine suggests an adequate daily intake of fluids at 13 cups and 9 cups for adult men and women, respectively. Appropriate fluid amounts will vary based on a number of factors including weight, climate, activity level, and more. 

Your bladder should act like a balloon, filling gradually. When the bladder fills, the detrusor, an involuntary muscle located in the bladder, is relaxed while the urethral sphincter and pelvic floor muscles are contracted. The first sensation can happen from 20-50% fullness of bladder, in which urination is voluntarily inhibited until the appropriate time to urinate. Ideally, the bladder should become more full before emptying, in which this is the normal desire to void. When it is time to urinate, the detrusor contracts, the urethral sphincter and pelvic floor muscles relax, and the bladder will empty. 

Complex nerve messages are sent between the brain, bladder, and pelvic floor muscles. This influences the sensation of bladder filling and allows the muscles to coordinate together to maintain continence. 

Habits Impacting Overactive Bladder

• “Just in case” urination

  • If “just in case” urination becomes habitual, this may train the bladder to feel the desire to empty even if it is not full

• Semi-squatting or not sitting on toilet

  • Your pelvic muscles are active and engaged in a squatting position, which prevents them from fully relaxing during micturition

• Pelvic floor muscle exercises to interrupt voiding

  • Stopping the stream of urine causes an interruption of the bladder from emptying fully and efficiently

• Straining

  • Chronic straining can lead to overstretching and weakening of pelvic floor muscles

• Being dehydrated or not drinking enough fluid

  • Being dehydrated can cause an increase in uric acid of urine, which will in turn irritate the bladder further and cause more frequent desires to void

How Bladder Training Can Help

Bladder training can be used to gradually increase the amount of urine you can comfortably hold if these consistent habits have impacted your urinary urge. Bladder training consists of a program of urinating on schedule, which can assist the bladder in regaining normal desires to void. 

How to perform:

• Calculate, on average, the length of  intervals between urination during the day

• Increase this interval by 5-10 minutes, or at a length as discussed with your healthcare provider

• When beginning training, empty bladder first thing in the morning and wait to go again at your set interval

• If urge arises prior to your set interval, use urge suppression techniques as discussed with healthcare provider

• Once you are comfortable with the current interval, increase this time by 10-15 minutes

• End goal is to achieve urination every 2-4 hours

Things to Consider

Bladder training requires patience and consistency to notice a change over several weeks. Working with a pelvic floor therapist can help identify if you would benefit from bladder training, what intervals are optimal for you, and what urge suppression techniques would best suit you and your pelvic floor. 

Are you someone that suffers from an overactive bladder and/or pelvic floor dysfunction? Call us here at Pelvic Health Center in Madison, NJ and set up an appointment with one of our skilled therapists at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

Works Cited:

• https://www.ucsfhealth.org/education/bladder-training

• https://www.health.harvard.edu/healthbeat/training-your-bladder

• https://www.ouh.nhs.uk/patient-guide/leaflets/files/65610Poveractivebladder.pdf

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