Healthy Bladder Habits & Bladder Retraining

Healthy Bladder Habits

Normal Voiding Frequency

Normal frequency (how many times you urinate) during waking hours for adults is 5-8 times (around every 3-4 hours). During sleeping hours, waking once to urinate can be normal for people under the age of 65. As a person ages, the bladder capacity becomes a little less. Seniors may find that they need to get up twice at night. In a young, healthy individual a strong urge to urinate will occur at a bladder volume of 300-600 mL.

Amount of Fluid Intake

The amount of fluid you drink depends upon your weight, activity, diet, environmental temperature and other factors including certain medical conditions. The “right” amount is different for everyone. The 8 8-ounce glasses of water a day is a myth. Still, do not severely reduce your intake to avoid going to the bathroom or leaking. The goal is pale yellow urine without a strong odour.

What to Drink

Water is best. Avoid bladder irritants such as caffeine (in regular and decaf coffee, black tea, dark sodas and chocolate), alcohol, acidic fruits and vegetables, sugar, artificial sweeteners, spicy foods, among others. A list is contained in the section “Diet and Other Factors Affecting Bladder Health.”

Some other “Do’s”

  • Spread out your fluid intake throughout the day.
  • Restrict your intake at 2-4 hours before bed especially if you have problems getting up at night.
  • Empty your bladder completely. Give it time. You may need to “double void” (i.e., go back to urinate a 2nd time, say, 10 minutes later). There should be no need to push forcefully.
  • Empty before sexual activity.
  • Use dietary or supplemental fibre as constipation can profoundly affect your bladder.
  • Wear clothing that is easy to manage when voiding.
  • Arrange your toileting environment at home so that it is easy for you to access.
  • Give yourself positive reinforcement.

Some “Don’ts”

  • Do not rush to the bathroom with an urge. You will often lose the race!
  • Do not go “just in case” (under most circumstances).
  • Don’t give up on bad days. Bladder retraining typically takes at least several months.

What is Bladder Retraining (Timed Voiding)?

Bladder retraining is a simple form of behavioural therapy designed to reduce problems with frequency (going too often), urgency (needing to pass urine without delay) and urge incontinence (leaking with urgency). It involves voiding by the clock, not by how you feel, gradually increasing the time between voids until a normal interval of 3-4 hours is reached. In this way you reestablish voluntary control over your bladder, reversing your bladder’s control over you. Studies show at least 50% of people experience substantial improvement using this technique. Combined with modifying diet and fluid intake and, in some cases, adding medications, success increases even further.

We all get the gradual desire to void as the bladder fills with urine. Bad bladder habits develop by: emptying at the first sensation of bladder filling, “going just in case,” running to the toilet as soon as the urge comes, and trying to keep the bladder empty so leaking will not occur. This leads to messages from your bladder that it is always full when it is not. Once developed, bad bladder habits can be hard to undo; but with persistence, patience, and a little work it can be accomplished.

The “How To” of Bladder Retraining

Keeping an initial bladder diary is important. This determines the starting interval (and voided volume) and helps to monitor your progress. You will find a printable voiding diary on this site.

  1. Empty your bladder first thing in the morning.
  2. Void throughout the day by the clock, not by how you feel. Start with every _____ hours/minutes. Wait the full amount of time before going to the toilet and empty even if you do not feel the urge. Empty just before bedtime and overnight go only if you awaken cannot easily suppress the urge to void.
  3. If you feel a strong urge before it is time to void, use the following urge suppression techniques:
    – Do not rush to the bathroom.
    – Use distraction: think about anything but the toilet (what you made for dinner last night, what you are doing tonight, count backward by 7s from 100, etc.).Perform 5 quick pelvic floor muscle “squeezes” (Kegels), wait 10 seconds and repeat.
    – Take 3 slow deep breaths, concentrating on the “in and out.”
  4. Once you are comfortable with this interval for around 1 week, increase it by 15-30 minutes.
  5. Gradually increase the time between voiding until it is at 3-4 hours. An interval that permits you carry on with your day-to-day activities is another way to measure a “successful” bladder retraining.
  6. Keep a 24-hour diary 1-2 times a week to measure and document your progress. It is most important to measure the interval between your voids, but also measuring the voided volumes is helpful for some people.
  7. Be patient. It will take at least 6-12 weeks experience improvement. Don’t get discouraged. You will have good and bad days. As you continue, you will notice more good days.
  8. Keep your scheduled clinician visits and bring your diaries. We are here to support you.

Diet and Other Factors Affecting Bladder Health

Types of Food & Drink

Certain foods and drinks may be associated with symptoms of urinary frequency, urgency, incontinence, or bladder pain. Using the list below as a guide, keep a diary to determine if any associations exist between your diet and urinary symptoms. Try eliminating one or more of these foods from your diet for 2 weeks and see if your symptoms improve. Once you are feeling better, consider re-introducing foods back one at a time. If symptoms return, you will be able to identify the irritant.

Potential Bladder Irritants

  • Acidic juices, fruits and vegetables (apple, cranberry, grapefruit, lemon, lime, orange, pineapple, tomato products)
  • Alcohol
  • Artificial sweeteners
  • Caffeine (coffee including decaffeinated, tea, colas, chocolate)
  • Carbonated drinks (contain ascorbic and citric acid)
  • Spicy foods
  • Sugar, honey, corn syrup

Volume of Fluid Intake

A concentrated (darker) urine can be irritating to the bladder. The goal should be pale yellow urine without a strong odour. Although there are no hard and fast rules, some recommend a total fluid intake of 6-8 cups (1500-2000 mL; 1 cup = 8 oz) which includes drinking fluids and fluids in foods such as soups, vegetables, fruits (20% of our daily fluids come from foods). Be aware of losses from sweating or intestinal losses which need to be replaced. Consider spreading fluid intake evenly throughout the day and restricting intake 2-4 hours before bedtime if your bladder tends to wake you up overnight.

Fibre

Eating 25-30 grams of fibre each day plus drinking water prevents constipation. A rectum full of stool and straining to defecate can make it hard for your pelvic floor (which includes both the anal and urinary sphincters) to function optimally. Sources of fibre include bran, grains, whole-wheat products, fresh veggies and fruits.

Smoking

The chemicals in tobacco products are irritating to the bladder and can also increase the risk of bladder cancer. Repetitive coughing from smoking generates such high pressure on the pelvic floor that the muscles and nerves can be damaged over time.

Weight Loss

An increased body weight is associated with increased risk for both stress incontinence and overactive bladder, urge incontinence. Weight loss has been shown to significantly improve these symptoms.

Medications

Prescription, over the counter and herbal or natural products may affect your bladder. Potential medications include diuretics (“water pills”), blood pressure medications, psychiatric medications, cough and cold preparations, B vitamins. Many contain caffeine or other chemicals. Check with your doctor or pharmacist to see if anything you take can affec