Bladder training may help a patient to regain continence by strengthening the brain's control over the lower urinary tract.  Training requires a patient to practice both inhibiting and initiating voiding (urination) on a specific schedule. Initially, the time allotted between episodes of urination is brief.  But, this interval is then gradually increased during training until a patient achieves a voiding pattern that lacks episodes of incontinence or problems controlling urgency.

Instructions:

• Follow the assigned voiding schedule as closely as possible.
  
  
• Begin your schedule every morning after getting out of bed, and end it every evening at bedtime.  No voidings are scheduled during sleeping hours.
  
  
• If you feel the urge to urinate before your scheduled voiding time, make every effort to wait until your assigned time. If you can distract yourself long enough, often the urge to urinate will pass.  Suggested distractions include:
  
  Mental games such as counting backwards from 100 by 7's or working a crossword puzzle.
  
  Thinking about a task that you need to complete, for example, planning the weekly food menus,  balancing the checkbook, writing a letter, or some other activity that requires a great deal of focus.
  
  Concentrating on another body sensation such as deep breathing.  Sit down, take 5 slow deep breaths, and focus on the air flowing in and out of your lungs.
  
  Timing how long you can ignore the feeling of urinary urgency and then trying to double this time when urgency occurs again. For example, if you can initially control your urgency for only 1 minute, aim to control your urgency for 2 minutes the next time, then for 4 minutes the third time, and so on.
  
  
  
• If you must urinate before your scheduled voiding time, resume your schedule and urinate again at the assigned time, even if only a few minutes have passed. For example, if you urinated 15 minutes before your assigned time, urinate again at your assigned time. You should then continue on your voiding schedule trying not to interrupt it again. 
  
  

Important points:

• Follow your voiding schedule as closely as you can. Even if you do not feel the desire to urinate, go to the toilet at the assigned time, and try to empty your bladder. Understand that the amount of urine in your bladder, whether a few drops or a pint, is not important; the important point is your effort to empty the bladder on a strict schedule.
  
  
• Record each of your voidings on a Bladder Training Diary sheet. Use a new Bladder Training Diary page each day.
  
  
• If you miss one or more scheduled voidings, return to the schedule as soon as you remember.
  
  
• Your Bladder Training Diary will be reviewed each week. If you have been able to control your bladder on your assigned schedule, the voiding interval will be increased by 30 minutes.  Your physician will review this diary review and will adjust the voiding schedule each week until you achieve a normal voiding pattern. If you have had difficulty controlling your bladder on this schedule, the time between voidings may remain the same or be shortened. The voiding interval will be changed to meet your needs.
  
  

Remember to: 

•  Follow the assigned voiding schedule.
  
  
•  Urinate on schedule whether or not you feel the need to urinate.
  
  
•  Void every morning after you get up and every evening at bedtime.
  
  
•  Make every effort not to void between scheduled voiding times. 
  
  
•  Use techniques to distract or relax yourself.
  
  
•  Keep a daily Bladder Training Diary.
  
  
•  Bring your Bladder Training Diary to your clinic appointments.
  

Gynecology and Fertility Clinic
Aston Ambulatory Care Building
5303 Harry Hines Blvd., Fifth Floor, Room U5.104
Dallas, Texas 75390-8865
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