Bladder Retraining Drill

Aka: Bladder Retraining Drill, Bladder Training

1. See Also
   1. Incontinence
   2. Low Pressure Urethra (Type 3)
   3. Overflow Incontinence
   4. Urge Incontinence
   5. Stress Incontinence
   6. Functional Incontinence
   7. Medication Causes of Incontinence
   8. Three Incontinence Questions
   9. Enuresis
2. Indication
   1. Urge Incontinence (without cognitive Impairment)
3. Mechanism
   1. Retrain pelvic mechanisms and CNS to inhibit urge Sensation between voids
4. Technique
   1. Baseline voiding interval obtained
   2. Ask patient to void every 30-60 minutes
      1. Patient voids regardless of voiding Sensation
   3. Suppress urge to void before scheduled time
      1. Remain stationary at time or urge Sensation
      2. Concentrate on decreasing urge Sensation
         1. Rapid successive pelvic floor Muscle Contractions
         2. Distraction with other activities (e.g. math problems, crossword, soduko)
         3. Relaxation Techniques (e.g. breathing Exercises)
      3. After controlling urge Sensation walk slowly to bathroom to void
         1. Gradually extend intervals between voids to at least 30-60 minutes
         2. Longterm goal to extend voiding intervals to 3-4 hours without Incontinence
5. Monitoring
   1. Keep voiding and Incontinence diary
   2. Follow-up in clinic weekly
6. Goals
   1. Increase voiding interval by 30 minutes per week
   2. Ultimately increase voiding interval to 2.5-3 hours
7. Reference
   1. Fanti (1991) JAMA 265:609-13 [PubMed]
   2. Hersh (2013) Am Fam Physician 87(9): 634-40 [PubMed]
   3. Khan (2004) Clin Geriatr Med 20(3): 499-509 [PubMed]