10 Healthy Tips to Help Improve Bladder Control

1. Use the toilet regularly. Make toilet facilities convenient – this may mean a bedside commode, bedpan, or urinal placed within reach.
2. Wear clothes that are easy to remove when it is time to use the toilet.
3. Train your bladder. Use a clock to schedule times to toilet. Every hour, then every 1 – ½ hours, etc., until you achieve a satisfactory schedule. Avoid frequent trips to the toilet “just in case.”
4. Remain at the toilet until you feel your bladder is empty. Do not rush. If you feel there is still some urine in the bladder move around, or stand up if you were sitting, sit back down and lean forward slightly over the knees.
5. Empty your bladder before you start on a trip of an hour or more. Do not try to wait until you get home or until it’s more convenient.
6. Learn to squeeze before you sneeze – and before you cough, laugh, get out of a chair, or pick up something heavy.
7. Establish regular bowel habits. Constipation affects bladder control.
8. Consider avoiding foods that are known to affect the bladder, such as tomatoes, chocolate, spicy foods, and beverages, including alcohol, and those containing caffeine. These make the bladder more irritable and therefore increase the chance of incontinence.
9. Watch your weight. Obesity makes bladder control more difficult. Ask your regular doctor about a sensible diet if you are overweight.
10. Stop smoking. Smoking has been listed as a risk factor for bladder cancer, and it is irritating to the bladder. Also, a smoker’s cough may cause bladder leakage.

This diary is a very important part of your urologic evaluation.

It will provide information that may relate to your symptoms and will therefore be useful in making a diagnosis. Please continue with your normal daily habits, so that we may have a representation of your normal daily intake of liquids and voiding patterns.

Carry this diary and a measuring device with you for a 48-hour period.

Measure all urinary output and write the amount in the appropriate space provided below.

Place a mark in the “leakage” column if you experience leakage. Note the type of activity you were engaged in when the leakage occurred (e.g. Sneeze, cough, climbing stairs, sleeping) and quantify the amount of leakage (e.g. few drops, soaked pad).

Write the amount and type of fluid intake and the appropriate column. Try to be as accurate as possible. Example: 8 ounce cup of milk, 12 ounce beer, 6 ounce coffee, etc.

In the beginning check yourself frequently by looking in the mirror or by placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh, or buttock’s muscle move. If there is movement, continue to experiment until you have isolated just the muscles of the pelvic floor. Your bladder control should begin to improve in 3-6 weeks. If you keep a record of urine leakage each day, you should begin to notice fewer marks in the bladder leakage column.

For example: During week 1 do 5 quick contractions, 10 slow contractions to a count of 3, and 5 quick contractions.

Make pelvic floor exercises a part of your daily routine; whether you are doing pelvic muscle exercises to improve or maintain bladder control, you must do them regularly on a lifetime basis. Use daily routines such as watching TV, reading, stopping at traffic lights, and waiting in the grocery store checkout lines as cues to perform a few exercises.

Kegel or pelvic floor muscle exercises are to help strengthen weak muscles around the bladder. When these muscles are weak, urine can leak from the bladder. These exercises called Kegels (kay-gull) are named after Dr. Arnold Kegel, who developed them to strengthen the pelvic floor muscles. There is a sling of muscles extending from the inside of the pubic bone to the anus and surrounds the vagina in women, and the  urethra and rectum in men and women. This group of muscles help indirectly control the contractions of the bladder muscle and directly compress the  urethra. These muscles contract and relax under your command to control the opening and closing of your urethral sphincters, or the muscles that give you urinary control. Through regular exercise, you may be able to build up their strength and endurance to gain better bladder control.

What is the Pelvic Floor?

The Pelvic Floor is a “hammock” of muscles that supports the internal abdominal and pelvic organs. These muscles run in different directions and are different sizes. The job of these muscles is to support, lift and control the muscles that close the urethra (the tube that urine passes through).

How do I exercise these muscles?

You exercise these muscles by squeezing and relaxing them. This takes effort and practice.

How do I find the right muscles?

• In order to make sure that you are exercising the right muscles, try starting and stopping your urine stream. This exercise will help you find the correct muscles. Do not tighten your buttock or thigh muscles when doing these exercises. Relax your stomach muscles as much as possible.
• When you are standing and squeeze your pelvic floor muscles, you should see your penis move slightly.

Don’t continue Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can lead to incomplete emptying of the bladder and increase the risk of a urinary tract infection.

How do I exercise these muscles?

• Begin by squeezing the muscles for a count of four (4), then relax for a count of four (4). At first, you can only squeeze the muscles for 1-2 seconds, but as your muscles get stronger, you will be able to hold to the count of four (4).
• Work up to repeating these exercises for five (5) minutes twice a day.
• Remember to relax between each squeeze and just let the muscles go loose. Do not push down.

Where do I do these exercises?

When you first start doing the exercises, you will need to set aside time when you can do them without being interrupted. After you have done them for a while, you can practice these exercises anytime and anywhere.

Always squeeze your pelvic floor muscles when you:

• Sit up from lying down
• Stand from a sitting position
• Lift something heavy

You can practice squeezing these muscles when you are watching TV, standing in line, or driving a car. Since these muscles are inside your body, people do not know you are doing exercises. It usually takes 6-12 weeks to see results. Do these exercises regularly.

Are there precautions?

• Some people exercise more than they should, hoping that they will regain bladder control quicker. If you exercise too much or too soon, your bladder control may get worse for a while. Start slowly and increase the amount of exercise slowly. Follow the guidelines that your health care team has given you.
• Be sure to breathe during the exercises. Holding your breath may put extra pressure on your pelvic muscles.

• Do you rush to the bathroom for fear of losing urine?

• Do you ever dribble urine on your way to the bathroom?

The feeling of urgency to get to the bathroom is most likely caused by bladder spasms. Rushing to the bathroom during spasms or urge causes your bladder to bounce. This causes more bladder spasms. Learning urge suppression may help you control and/or eliminate these spasms so that you can stop the feeling of urgency and walk to the bathroom calmly.

To stop the feeling of urgency to urinate:

1. Remain in the same position in which you began having the feeling to urinate. If you are sitting, remain seated.
2. Tighten your rectum, then let go a little, tighten again and let go a little. Keep doing this until the urge feeling has passed (about 15-30 seconds). By tightening and letting go of your rectum, you stimulate a nerve in the pelvic muscles which cause the bladder to relax. This stops the strong feeling to urinate.
3. Tell yourself that you are in control of your bladder-not the other way around.
4. Once the urge is over, take a deep breath and relax. Then walk to the bathroom calmly.

What is bladder retraining?

Bladder retraining involves changes in the “way” you urinate.

• Scheduled (timed) voiding
• Double voiding
• Delayed voiding

Utilizing the above components helps patients empty their bladder prior to having an urge incontinence episode, completely empty the bladder, and helps you hold more urine before you get the signal to urinate.

How do you accomplish bladder retraining?

Bladder retraining involves training yourself to delay voiding when you feel an urge to urinate. It starts with building strength through Kegel exercises. You begin with 5 minute delays by performing an urge suppression. This will turn off your bladder’s signal to empty and allow your bladder to hold more urine. You will gradually work your way up to urinating every three to four hours.

How does a physical therapist help with bladder retraining?

A physical therapist (PT) can help you better identify the muscles you use in Kegel exercises. They have tools such as biofeedback that help you gauge the strength of your contractions. PT helps maximize your pelvic floor strengthening.