What is Bladder Retraining?
Bladder retraining is a way of training your bladder to retain adequate amounts of urine without experiencing incontinence. By expanding the bladder muscle over time we are promoting both good bladder capacity and strong pelvic floor muscle tone. Bladder retraining can, in some cases, completely resolve incontinence.
Facts About Incontinence
The Continence Foundation of Australia suggests that an average adult should be able to drink up to two litres of water a day and void their bladder (expel urine) approximately six times over a 24-hour period without experiencing any form of incontinence.
For some people with incontinence this may sound impossible, especially where urgency and frequency plague their day-to-day lives. Incontinence is not only a health concern, but it can also lead to increased social isolation, financial strain and, later in life, may lead to the person having to live in a residential aged care facility (RACF).
A study conducted by the Department of Health and Ageing in 2010 found that incontinence was one of the defining factors in permanent high-care admissions, including RACFs. The study also identified that incontinence affected over half of all high-care residents in Australia. The good news is that there is a solution for those suffering from this often embarrassing issue – a solution that involves bladder retraining.
There are several types of incontinence, all of which require a unique management strategy. Bladder retraining is one form of incontinence management and is best used for people who have an overactive bladder (commonly known as urge incontinence). Urge incontinence occurs when the need to go to the toilet is sudden and the person is unable to hold off that urge for any period of time.
Bladder retraining aims at improving the person’s bladder capacity by training their detrusor muscle to hold more urine over time. Bladder retraining also assists with strengthening pelvic floor muscles (the muscles that support the urethra and bladder).
The Detrusor Muscle
To get a better understanding of how bladder retraining works, it is best to look at the bladder as the muscle that it is.
As identified in the diagram above, the bladder is a thick, muscular reservoir supported by the surrounding organs and pelvic floor muscles. When urine is detected around the trigone area, the bladder sends a signal to the brain indicating the need to void. A continent person is able to hold off this urge until convenient or appropriate. However, in urge-incontinent people, the pelvic floor is weak and the bladder capacity is diminished. The person has reduced capacity to retain the bladder’s contents once the need to void is present.
The Nurse’s Role
Nurses play an important role in bladder retraining. There are many tools available to health professionals that they can use to assist their clients with bladder retraining.
Tools and Strategies for Bladder Retraining
Used to determine bladder capacity, frequency, intake/output, and identify bladder irritants such as tea, coffee, soft drinks, sports drinks, etc.
Helps to eliminate recurring reminders to empty the bladder.
PFMEs (Pelvic Floor Muscle Exercises)
Recurrent exercises aimed at strengthening the pelvic floor, in turn increasing your client’s ability to hold off the flow of urine until appropriate.
Direct pressure on peri area
Using one’s hand or crossing the legs to manually block the flow of urine.
Diet and exercise regime
Assists with reducing bladder irritants in both food and drink and encourages healthy eating.
Maintaining regular bowel motions to avoid straining or constipation as this may stretch/weaken the pelvic floor muscles. A compacted bowel also reduces the amount of room left for the bladder to expand, causing decreased bladder capacity.
Helps reduce pressure directly on the bladder.
Ensure that any recurrent coughs or sneezes are managed, as these symptoms place increased pressure on our intra-abdominal muscles, resulting in large amounts of pressure being applied to the bladder.
A review of current medication may be in order, especially if someone is taking diuretics or antispasmodics. Medication management could include changing dosage, or reviewing the time taken for ceasing or starting certain medications.
The most important thing to remember for yourself and your patients is that incontinence is not a normal part of the ageing process, nor is it something one should simply put up with. Incontinence affects a large and diverse number of people and there is help available. Urge incontinence in particular can be managed, and in many cases, cured by bladder retraining.
Education and awareness are essential in identifying and resolving incontinence.
- Undertake Video Learning Activities (VLAs) on urinary incontinence
- Attend the Advanced Aged Care Nursing Skills seminar
- Improve your clinical nursing skills in aged care
- Revise your knowledge of dementia care
- Anon. 2014, Promoting Bladder and Bowel Health, viewed 9 December 2016, http://www.continence.org.au/…ence.pdf
- Department of Health and Ageing 2010, Bladder and Bowel 2010, Good Bladder Habits for Everyone, Australian Government, viewed 9 December 2016, http://www.bladderbowel.gov.au
- The Department of Health 2003, Incidence of incontinence as a factor in admission to aged care homes: executive summary, Australian Government, viewed 9 December 2016, http://www.health.gov.au