Bladder Training

Bladder training involves relearning how to urinate. This method of rehabilitation is usually used for active women with urge incontinence and sensory urge symptoms known as urgency. Many people who have urge incontinence sense that they have to urinate, but their bladder is not full and they do not urinate much when they return to the bathroom frequently. This means that, although their bladder is not full, it is signaling for them to void.

• Bladder training generally consists of self-education, using the bathroom according to a schedule, consciously delaying going to the bathroom, and positive reinforcement. Although bladder training is used primarily for symptoms of urgency and findings of urge incontinence, this program may be used for simple stress incontinence and mixed incontinence. For bladder training to work, you must resist or inhibit the feeling of urgency and wait to go to the bathroom. You must urinate according to a scheduled timetable rather than every time you have the feeling that you need to urinate.
• This plan incorporates dietary changes such as adjusting how much you drink and avoiding dietary stimulants. In addition, there are distraction and relaxation techniques to delay voiding to help expand the urinary bladder. By using these strategies, you can train the bladder to accommodate more stored urine.
• The initial goal is set according to your current voiding habits and is not followed at night. Whatever your voiding pattern is, the first goal for time between trips to the bathroom (voiding interval) may be increased by 15-30 minutes. As the bladder becomes accustomed to this delay in voiding, the interval between voids is increased. The ultimate goal is usually two to three hours between voids, and it may be set further apart if desired.
• Another method of bladder training is to maintain the prearranged schedule and ignore the unscheduled voids. In this method, regardless of whether you make an unscheduled trip to the bathroom, you still have to maintain the prearranged voiding times and go to the bathroom as scheduled. This program must be continued for several months.
• Another method of bladder training uses ultrasound to prove to that your bladder is not full even though you feel the need to urinate. A bladder scanner is a portable ultrasound machine that measures the amount of urine present in your bladder. With this method, you can void when your bladder fills to a certain volume visible on ultrasound rather than you feel the need to go to the bathroom. Each time you feel the need to void, you check your bladder using the scanner to see how much urine is being stored. If your bladder is shown to be empty, then you should ignore that sensation.
• Bladder training has been used primarily to manage symptoms of urgency and the findings of urge incontinence; however, it also may be used for stress and mixed incontinence. With bladder training, the cure rate for mixed incontinence is reported to be 12%, while the improvement rate was 75% after six months.

Anti-Incontinence Products

Anti-incontinence products, such as pads, are not a cure for urinary incontinence; however, using these pads and other devices to contain urine loss and maintain skin integrity are extremely useful in selected cases. Available in both disposable and reusable forms, absorbent products are a temporary way to stay dry until a more permanent solution becomes available.

• Do not use absorbent products instead of treating the underlying cause of incontinence. It is important to work with your doctor to decrease or eliminate urinary incontinence. Also, improper use of absorbent products may lead to skin injury (breakdown) and UTIs.
• Absorbent products used include underpads, pant liners (shields and guards), adult diapers (briefs), a variety of washable pants and disposable pad systems, or combinations of these products. More than 50% of the members of the National Association for Continence (NAFC), a national support group for people with incontinence (800-252-3337), use some form of protective garment to remain dry. In addition, 47% of all elderly men and women use some type of absorbent products.
• Unlike sanitary napkins, these absorbent products are specially designed to trap urine, minimize odor, and keep you dry. There are different types of products with varying degrees of absorbency. These products may absorb 20-300 mL (1-10 ounces), depending on the brand and the absorbent material of the product.
• For occasional minimal urine loss, panty shields (small absorbent inserts) may be used. For light incontinence, guards (close-fitting pads) may be more appropriate. Absorbent guards are attached to the underwear and can be worn under usual clothing. Adult undergarments (full-length pads) are bulkier and more absorbent than guards. They may be held in place by waist straps or snug underwear. Adult briefs are the bulkiest type of protection, they offer the highest level of absorbency, and they are secured in place with self-adhesive tape. Absorbent bed pads also are available to protect the bed sheets and mattresses at night. They are available in different sizes and absorbencies.

Urethral Occlusive Devices

Urethral occlusive devices are different for males and females. Female devices are artificial implements that may be inserted into the urethra or placed over the urethral opening to prevent urine from leaking out. Inserts include the Reliance Urinary Control Insert® and the FemSoft® device, while patches include the CapSure® and Re/Stor® devices. Urethral occlusive devices tend to keep people drier; however, they may be more difficult and expensive to use than pads. Urethral occlusive devices must be removed after several hours or after each voiding. Unlike pads, these devices may be more difficult to change.

Male devices are usually clamps that constrict the penis and decrease the amount of urine leakage. They are usually used in severe incontinence which are resistant to other treatments and are variably effective.