Bladder training

An overactive or weak bladder can, to some extent, be “trained”: although bladder function is generally influenced by the involuntary nervous system, voluntary nerves also control it. Bladder training can help some people who have an overactive or weak bladder to regain at least some control over their bladder. Ideally, they then no longer have to rush to the bathroom because of an increased urge to urinate, or no longer leak before getting there.

The bladder muscle can be trained to stretch more so that the bladder is able to hold more urine. Bladder training also includes various behavioral treatment approaches and a particular drinking and voiding schedule (bathroom visit schedule).

You can read more about the different treatments for overactive bladder (urge incontinence) here.

First step: Keep a diary

The basis of bladder training is keeping a diary. You can keep one for two to four days, writing down

• how often you go to the bathroom,
• how much urine comes out, and
• how much you drink throughout the day.

It is also important to record information about any medications you take and about situations in which you accidentally leak urine. These notes can be helpful when talking to your doctor and might provide important clues about the cause of the problem.

Voiding schedule: Regularity matters

• Regular rhythm: It is important to go to the toilet at regular intervals so that your bladder gets used to a certain frequency. A voiding (bathroom visit) schedule can be helpful here. Bladder training programs often recommend that, once you have emptied your bladder first thing in the morning and perhaps again after breakfast, you try to keep the intervals between bathroom visits as regular as possible.
• Avoid going to the bathroom “just in case”: If you go to the toilet too frequently “just in case”, you might end up getting stressed or leaking urine. This could make overactive bladder symptoms worse, because the bladder is then “trained” to send a signal that you need to urinate as soon as there is only a little bit of urine in it. Talk to your doctor if you have any questions.
• Do not go to the bathroom straight away: Even if you have a very strong urge to go to the bathroom, it usually only lasts a few minutes and then dies down again. You can practice not emptying your bladder as soon as you feel the need to go. Going to the bathroom calmly and at a slow pace rather than rushing to get there can help too.
• Increase the intervals between emptying your bladder: You can try to wait longer between trips to the bathroom, but do so at a slow pace and without any stress. A voiding schedule can be helpful here too. You can use it to remember, for example, that you want to try to wait 5 minutes before emptying your bladder in the first few days, and then keep this up for about half a week. You can then lengthen that “waiting period” to 10, 15 and finally 20 minutes.

It takes a lot of effort to stick to the training at night. Positive results are more easily achieved during the day. After some time, the training can then be done at night as well.

Distraction techniques

If you are trying not to go to the bathroom as soon as you feel the urge, and want to wait longer between emptying your bladder, several techniques might help to distract you:

• Whenever you feel like you have to “go”, you could try to relax and distract yourself with positive thoughts. For example, you could tell yourself: “I will go to the bathroom in 5 minutes, and think about something else until then”.
• It can also be helpful to sit on a chair and bend your hips to lean the upper part of your body forward until the strong urge passes. Leaning forward changes the pressure in your abdomen and the position of your urethra, so you have less of an urge to urinate. When you are in public, you could do this more subtly by pretending to tie your shoelaces, for instance.
• You could also sit upright and tense your pelvic floor muscles, pulling up and in.

Drinking schedule: Drinking frequently and enough

A lot of people who have a weak bladder drink too little because they are afraid that they will not make it to the bathroom in time. But regularity not only helps when emptying your bladder, it is also important when filling your bladder. Because of this, bladder training usually includes both a voiding schedule and a drinking schedule, in which you record when and how much you drink. Many people find it helpful to use a timer that makes a sound to remind them to stick to the schedule.

• Drinking enough is important for another reason: If your urine is too concentrated, the substances in it might irritate the lining of your bladder after a while. This can make the symptoms worse.
• You can try to drink one to two glasses of still water before every meal and drink juices between meals, as well as small amounts of coffee and black tea.
• In order to try to get the best night’s sleep possible, it can help to drink less or stop drinking about two hours before going to sleep.
• Coffee, black tea, green tea and alcoholic drinks are diuretics. This means they increase the production of urine. Other kinds of tea have this effect too, such as kidney and bladder teas or stinging nettle tea. It can help to avoid these drinks just before going to sleep.
• It can also be helpful to avoid diuretic drinks before taking part in social activities that involve being out and about a lot.

Do not let setbacks discourage you

• Keep up your diary. That is the only way to record positive results and gives you an overview of possible setbacks.
• It is also good to know that setbacks are completely normal, particularly during times when you are feeling exhausted or stressed.
• Setbacks can be caused by other things too, like common colds, urinary tract infections or wet, windy weather.

Bladder training is not always a suitable treatment for weak bladder. It is a good idea to talk to your doctor about whether this might be a good approach for you.

If you are interested in pelvic floor exercises, click here. You will find information about what you can do to strengthen your pelvic floor muscles in everyday life here.


Author: Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care) Last update of this website: 05/11/2012