Behavioural therapy: Better manage the urge to urinate with bladder and toilet training

It may surprise you to learn that, you can train your bladder to becoming accustomed to being emptied at certain times. By emptying your bladder at specific times at defined intervals, it can adjust precisely to this rhythm and ‘forgets’ the urge to urinate between these times.

If a doctor recommends bladder training as a therapy for you, you will first document your trips to the toilet in a miction or bladder diary. You will note down how often you go to the toilet, how much urine there is and how many liquids you drink. Notes are also taken about the sorts of situations when any ‘accidents’ occur. The subsequent training aims to get your bladder used to a fixed rhythm. This means that the intervals should be distributed as evenly as possible over the day.

If you manage to stick to the defined times despite the urge to urinate, you will notice that the intervals between the planned visits to the toilet can gradually increase.¹

It may be helpful for you to know that the urge to urinate typically never lasts longer than five minutes.¹ If you can resist for this time, you have won the ‘battle’! And another thing: at the defined times you should always go to the toilet, even if you do not have to go.

You can learn more about How Anxiety Affects Your Bladder and Bowel

 

Electrostimulation and biofeedback

The pelvic floor muscles are initially not easy to train, so biofeedback or electrostimulation can be used to support the training:

Biofeedback helps you to develop greater awareness of bodily functions and learn to control them. Using a small probe you can find out, for example, if you are training the right muscles in the pelvic floor².

Electrostimulation uses vaginal cones available. These small weights shaped like a cone are inserted into the vagina where they are held in place for a few minutes by tensing the pelvic floor³.

Your physiotherapist or GP can provide you with more information about these options.

 

Drug therapy: medications for relief and support

The fact is that there are no medications available that can heal incontinence, for either men or women. However, for mild urge incontinence the symptoms can definitely be eased using medications⁴.

There is a whole range of medications and active ingredients that are available:

In the same way that a urinary tract infection is treated with antibiotics, they can also improve the symptoms of urinary incontinence (e.g. distressing urge to urinate).

Anticholinergics are part of the standard drug therapy for urge incontinence or an overactive bladder. They are used to alleviate the constant urge to urinate and frequent urination⁵.

The active substance duloxetine, originally an antidepressant, is now also used to treat stress incontinence in women. It helps the bladder to withstand more pressure without leaking urine⁶.

Please note that all possible medications may come with side effects. Always discuss how to take the medication and the right dosage with a doctor.

You can find detailed information here about causes of urinary incontinence

 

Surgical therapy: severe forms of incontinence may be operable

If normal conservative treatment methods have been exhausted, surgery may be an option after consulting with your doctor. The following surgical procedures are possible for treating severe incontinence:

• Vaginoplasty⁹


• Prostate surgery


• Sling surgery


• Colposuspension

For cases of uterine prolapse, for example, the pelvic floor muscles are tightened and a vaginoplasty is used to strengthen the perineum.

If the urethra is blocked by the prostate in men, it can be surgically removed. However, the surgery itself also involves the danger of becoming incontinent after the procedure because in some cases the sphincter muscle is damaged.

Surgical options also include sling surgery, which is used to restore the normal anatomy of the pelvic floor or the bladder, and colposuspension¹⁰, which is used to ensure that the urethra does not drop down too far.

For all surgical methods, the same applies: the appropriate and most promising therapy for you can only be identified in a confidential consultation with your doctor. Every surgery has risks and should be considered very carefully.

Read more about Incontinence after prostate surgery

Treatment of the causative disease: there are many reasons for incontinence

There are many causes of bladder weakness and accordingly there are many forms and treatment options. Incontinence is not a disease in and of itself but is instead a symptom: for example, of a disease of the nervous system, a benign or malignant enlargement of the prostate or a metabolic disorder¹¹.

For many causes such as uterine prolapse and enlargement of the prostate or even bladder stones and urinary tract infections, the chances of complete healing of the bladder weakness are good.

 

 

Herbal therapy: help from nature

In consultation with your doctor, natural household remedies from the ‘herbal pharmacy’ can also be worth using to treat mild urinary incontinence – particularly because side effects are more or less ruled out. Drinking herbal teas can support the well being of those affected. Cranberry juice is also found to be beneficial by many of those affected by bladder weakness. The calming and relaxing effect of herbal agents can help to harmonise bladder activity¹². Drinking herbal teas can support well-being. Cranberry juice is also found to be beneficial by many of those affected by bladder weakness.

 

Lifestyle: a healthy bladder thanks to a healthy lifestyle

There are certain risk factors that encourage or aggravate incontinence. You have control over many of them. This means that you can prevent incontinence or relieve your symptoms.

A healthy diet is the foundation for this. It should be high in fibre (wholegrain bread, for example, or legumes) and include 5 portions of different sorts of fruit and vegetables every day. This also includes a regular and adequate intake of fluids. Many of those affected with bladder weakness think: ‘The less I drink, the less often I’ll need to go to the toilet.’ This is not quite the case. Drinking fluids generally supports kidney function. Drinking less fluids concentrates the urine which can then possibly further irritates the bladder.¹³ Ideally, drink still and lightly carbonated water and mild herbal teas and eat fruit. It is also important to know here that there are drinks that act as diuretics. Therefore, it is best to avoid coffee, caffeinated tea or alcoholic drinks.

Excess weight as a risk factor

Another major risk factor for incontinence is being overweight. This is because abdominal fat stresses the pelvic floor and the bladder.

If you can reduce your weight, you have a better chance of getting your bladder weakness under control. To safely lose weight and to relieve the symptoms of incontinence, exercise and sport are a great help. A balanced training program should include strength training to improve the muscle system, endurance training to strengthen the cardiovascular system as well as balance exercises and stretches to increase overall mobility. Many types of sport such as swimming, cycling, yoga or Pilates also naturally strengthen the pelvic floor.

For mild incontinence, a healthy lifestyle alone can certainly alleviate symptoms.

 

 

Be confident: there is the right treatment for you

Bladder weakness does not have to negatively impact your everyday life. By taking the right steps – and the options, as you can see, are many – you can lead a carefree life. A trusted doctor can help you to put together the perfect package for you.