The bladder acts as a reservoir for storing urine produced by the kidneys. Emptying the bladder is accomplished by contraction of the muscles of the bladder. Normally this does not happen until the time and place is convenient because bladder contractions are under the control of the brain.
Unfortunately in some people this ability to control bladder contractions is faulty, resulting in an overactive bladder which may contract at any time with little or no warning. Uncontrolled bladder contractions are not dangerous but are a common cause of frequent voiding, a feeling of urgency, leakage of urine and sometimes discomfort. Fear of an accidental leak results in emptying the bladder more often than necessary. Consequently the bladder shrinks and this aggravates the already irritable bladder.
The aim of training is to help you regain control of your overactive bladder by suppressing the unwanted contractions and allowing it to fill to its proper capacity. The treatment requires determination and commitment on your part and therefore your own attitude of mind is a most important aspect. It will be helpful to have a measuring jug (500ml size). Keep a chart of the time of voiding, the amount passed and of any leakage. This will show your bladder pattern to start with and the improvement as your exercises take effect. The object of bladder training is gradually to lengthen the intervals between voiding and so improve the capacity of the bladder. You must try very hard to hold onto your water by contracting the pelvic floor muscles when the feeling of urgency first occurs, allowing time for the bladder emptying muscles to relax. When you succeed, the desire to pass water will fade and allow the bladder to continue filling up. As soon as the feeling has gone away try and occupy yourself to divert your attention from your bladder. Gradually the intervals and volumes will increase.
You are aiming for:
To begin with progress may seem small; provided you persevere you should see a great improvement. You will need to continue the treatment for at least three months, and often much longer, by which time you should be regaining control of your bladder and the improvement will be long-lasting.
- Voiding intervals of 3 - 4 hours
- Urine volumes of 300 - 400 mls
- To abolish any leakage.
Pelvic floor muscle exercises
These exercises are designed to strengthen the muscles which close off the bladder outlet and will help you to prevent leakage when a strong or urgent desire to pass water occurs. The pelvic muscles help to support and control your bladder. They cannot be seen but can be identified in the following way:
Once you have worked out how to contract these muscles they should be exercised regularly. It is a good idea to set aside a few minutes at a fixed time each day to practise the exercises as follows: Starting with the front (bladder) muscles and then the back (bowel), tighten both counting to four slowly and then release them. Do this four times and repeat at least four times a day, more often if possible.
- Imagine that you are trying to stop yourself passing urine. By doing this several times you will become aware of the muscles involved and how to contract them. Do not tense any other area of your body such as your legs or abdomen.
- In a similar way imagine you are trying to stop a motion or control diarrhoea by tensing the muscles. Do this several times until certain you can identify the muscles and how to activate them without tensing the legs, buttocks or abdomen.
You will have been asked to keep a (frequency/voiding) chart for a minimum of one week before starting treatment. Whilst on treatment we suggest you fill in the chart once a week on the same day so that you can monitor your progress. Please bring the chart with you when you attend the surgery.
Useful advice on bladder problems can be found here www.continence-foundation.org.uk
This article published on
01 July 2005
Next review date 01/07/2013
Treatment and drugs
Bottoms, willies and other bits