Incontinence and Bladder Training
It can be quite difficult to initially accept that you may be having problems with continence, but it important that you begin early treatment before the symptoms deteriorate making the condition worse, if you do nothing, nothing will improve.
Certain drinks have been linked to irritating the bladder and these include drinks with caffeine in, coffee, tea, acidic fruit juices, chocolate, citrus fruit and tomatoes. These are not known to affect everyone it is a process of elimination of which might be a trigger factor for you.
Urinary incontinence is a situation where urine leaks out from the bladder and you have limited or no control over when or how often this occurs. It is usually caused by an overactive bladder or by the sphincter (the circular band of muscle) which usually relaxes to allow urine to pass which has become weakened. This can be due to a number of different reasons and those should be investigated.
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- Urinary tract infection
- Vaginal infection
- Neurological disorders i.e. Parkinson’s or Multiple Sclerosis
- Men may have an enlarged prostate gland ( an “o” shape gland which goes around the urethra) which may prevent complete emptying
- Bladder stones can cause problems
- Inherited defects of the urinary tract system causing problems
- Bladder prolapse ( the bladder can hang down through the muscle layers and protrude into the vagina)
- Interstitial cystitis (IC), also referred to as “painful bladder syndrome,”
Frequency: Means the need to empty your bladder many times during the day as well as at night.
Urgency: The immediate need to urinate sometimes accompanied by pain, spasm and heaviness. You may feel the need to go to the toilet and are unable to get there in time causing leakage.
Overflow Incontinence: This is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord. It can cause constant dribbling of urine even after visiting the toilet.
Stress incontinence: Urine leaks out when pressure is exerted on the muscle group i.e. when laughing, lifting heavy objects, coughing or sneezing.
Bladder Habit Diary:
When you have taken the first step and have spoken to your GP they may suggest a referral to a Consultant Urologist (specialists in the study and treatment of disorders of the urinary tract) and you may also be referred to a continence advisor these will be either nurses or physiotherapists who have undertaken further extensive training in the treatment and understanding of incontinence. They will be very receptive to your continence needs and will treat you with sensitivity and understanding.
It is a good idea while you are waiting for your appointment to keep a bladder habit diary, for an average week period, which means you keep a record of:
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- How often you are visiting the toilet – both date and time.
- You can also keep a record of how much urine your bladder is able to hold by emptying your bladder into a 500ml jug ( this must be kept solely for this purpose and washed out thoroughly after each measurement) after disposing of the urine down the toilet
- You need to record of if you were able to get to the toilet in time or if there was leakage
- You can keep an additional note if you had any leakage after sneezing, laughing or when lifting heavy objects.
- Keep a record of how much fluid you have been drinking – cups of tea, water and other drinks volume i.e. a mug of tea = 250ml
Questions to might like to ask about your treatment:
When you go to see the consultant and you discuss your treatment, make sure you write down any questions you would like to ask to take with you. As often when you are in the consulting room you forget to ask something you had been meaning to ask. If you do not understand the answer ask them to repeat it and explain it further or to write it down. If you need to undergo investigations like a cystoscopy, urodynamics or urinalysis please click here for further information.
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- What will the treatment involve?
- Do I have different options of treatment?
- What will be the benefits of the treatment?
- When will I start to feel the benefits of the treatment?
- Are there any risks with the treatment?
- Do you have a leaflet I can take away and read?
People who have problems with either urgency, stress incontinence or frequency may decide to embark upon a regime where the bladder is retrained in a combination of pelvic floor exercises also known as Kegel exercises (these are the muscle groups around the bladder and urethra which may become weakened over time causing leakage) and also to lengthen the period of time between trips to the toilet to empty the bladder. A physiotherapist or continence advisor will be able to help you learn some very simple exercises which can really enhance your life. Your doctor or continence advisor may ask you to keep a diary of your bladder habits to assess the level of help which will be required.
There are three types of Bladder Training:
- Pelvic floor exercises: Kegel exercises
- Delayed Urination: This is learning to increase the length of time before emptying the bladder; starting off with a delay time of five minutes and working up to only emptying the bladder every three to four hours.
- Planned Urination: This is where you decide you will empty your bladder at a certain time perhaps half hourly initially whether you need to go or not, and then this time span is increased so you will go on the hour and then increased again until you find a comfortable time which works with your life style.
The aims of the bladder training include:
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- Increasing the pelvic floor muscles effectiveness.
- Improving the amount of urine that can be held by the bladder
- Lengthening the time between visits to the toilet
- Reducing the urge to empty your bladder
- Improving the quality of life for the person affected
You may only have one aspect which is causing you problems with your continence and the program agreed with the team will concentrate on your specific needs.
Pelvic Floor exercises also known as Kegel exercises
These are exercises are aimed at reinforcing the supporting muscles of your pelvic area; they are the ones which control bladder continence. Increasing the effectiveness of these muscles means that you will have far better control of your bladder The exercises take only five minutes to do three times a day. You will notice an improvement gradually over time this can take between three to twelve weeks. Do not be disheartened if you feel you are not achieving rapid improvement it took sometime for the muscles to relax and it will take a while for them to get back in shape.
Where are your pelvic floor muscles?
The pelvic area includes your hip bones, and is supported by a series of muscle layers which attach to the sides and front and back of the pelvis. They referred to as the triangle and hammock and bear the main load of weight of the internal organs in the pelvis. This means that they help you control your bowels and emptying your bladder.
To identify which muscles you need to use can be a bit tricky the main aim is to use the right ones and not use muscles in your legs or stomach. You need to be relaxed so don’t hold your breath when you do these exercises and find a quiet area where you won’t be disturbed. If you have problems with locating these muscles your continence advisor will be able to assist you with specialist electrical stimulation device which will help.
Finding the right muscles:
To find the right muscles try to imagine you are desperate to go and empty your bladder and you have to stop yourself if you can feel yourself tensing the muscles, those are the right ones. If you find that difficult when you next do need to empty your bladder start passing urine and then try to stop mid flow even if you are not able to achieve this at this stage you will be able to feel the muscles try and those are the correct muscles. Women will feel a pulling sensation in the vagina and men will feel the penis move.
The other muscles you need to locate are the ones around the anus, if you imagine you are going to pass wind and need to stop it those are the muscles which you are looking for. You will feel a pulling sensation as you draw in those muscles.
The procedure you need to practice is simply to pull those muscles in for the slow count of three and then relax for the slow count of three and repeat it ten times. Initially it is best to do this lying down as it will be easier to not have your full body weight bearing down. After you feel there is improvement, move on to a sitting position and again when you feel there is improvement in the muscles move on to doing the exercises standing up. Each time you move on with the exercises you will be adding more of your body weight to the muscle group and they will be increasing in strength. It is important to not over do the exercises, doing them regularly three times a day is of far greater benefit.
Doing these exercises three times a day might seem like a big commitment but you can build it into your lifestyle. If you make it a habit it won’t seem so difficult for instance try doing them:
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- When you are cooking or waiting for the microwave to go ping
- When you’re brushing you teeth after breakfast
- Whilst talking on the telephone
- When you’re sitting at the desk on the computer
- Standing at the bus stop or in a queue
- Sitting in a traffic jam in the car
By keeping your bladder habit diary again after six weeks for another week you should see an improvement in your continence problem.
In the event that the exercises do not work surgical intervention may be necessary the options that will be available will be discussed fully with you with the Urologist, including the risks and the benefits of the different treatments available.
Help lines and Organisations:
307 Hatton Square
16 Baldwins Gardens
London ECIN 7RJ
Helpline Phone: 0845 345 0165
Monday to Friday, 9:30am to1:00 pm
Tel: 0870 770 3246
Fax: 0870 770 3249
Email - firstname.lastname@example.org
ERIC (Education and Resources for Improving
34 Old School House,
Telephone: 0117 9603060
Helpline 0845 370 8008 (10.00am-4.00pm, Mon-Fri)
Facsimile: 0117 9600401
Association for Continence Advice
c/o Fitwise Management Ltd
Tel: 01506 811077
Fax: 01506 811477
Royal College of Nursing Continence Care Forum
Royal College of Nursing
20 Cavendish Square
Tel: 020 7409 333
Images with Kind Permission from 3B Scientific