Reducing Urgency | Overactive Bladder | Behavioral Therapy for Urinary Incontinence | Stress Incontinence | Suggestions for Improving Bladder Habits | Dietary Suggestions For Improving Bowel Habits | Pelvic Muscle Excercises For Women | Resources For Patients With Urinary Incontinence
When you feel the urge to empty your bladder
First: STOP and stand very still. Sit down if possible. Staying as still as you can will help control the urge.
Second: TIGHTEN your pelvic muscles 3 to 5 times. Take a deep breath and as you let it out, allow your body to let go and RELAX. Think of something other than the bathroom.
Third: WALK, when the urge has decreased somewhat, to the bathroom at a normal speed.
If the urge happens again on the way to the bathroom, STOP and repeat the above steps.
Do not be discouraged if you do not see results at first. You are learning a new skill. Try practicing these steps at home until you feel comfortable with your new skill.
Bladder Drills and Retraining
- Place patient on a specified voiding schedule and increase intervals to three to four hours between voids
- Studies report about a 60 percent decrease in incontinence episodes
Pelvic Floor Exercises
- Seems to work much better for overactive bladder than stress urinary incontinence
- Voluntary pelvic muscle contraction can inhibit detrusor contraction
- Instead of rushing to toilet which increases abdominal pressure and exposes the patient to visual voiding cues, they are instructed to pause, sit down, and relax and contract pelvic floor muscles to diminish the urgency and inhibit the detrusor contraction
- Efficacy similar whether taught with or without "biofeedback"
- Biofeedback vs. verbal feedback vs. self-administered treatment all have similar outcomes
- As little as weekly 20 minute group sessions yields a 50 percent decrease in incontinence episodes
Pelvic Floor Exercises with Other Treatments
- PFE combined with meds equals better outcomes than either alone
Adherence is crucial. If patients do not continue these exercises, the problems may reoccur.
Extracorporeal Magnetic Enervation (EXMI)
- Stimulates the pelvic floor with magnetic fields
- Studies have shown a benefit though it seems to tail off when treatment is stopped
The Agency for Healthcare Policy and Research of The U.S. Department of Health and Human Services has recommended behavioral treatment as first line therapy for urinary incontinence. Earlier, in 1988, the National Institute of Health Consensus Conference on Urinary Incontinence In Adults recognized behavioral treatment for incontinence as an efficacious treatment and recommended that the least invasive or least dangerous procedure be tried first.
Advantages of Behavioral Treatments
- Absence of side effects
- Patient comfort
- High levels of satisfaction
Review voiding diaries - look for "trigger" behaviors/events
General Conservative Treatments
- Weight loss - decreases of stress incontinence
- Treatment of asthma/reduction of smoking - decreases stress incontinence
- Chronic constipation - exacerbates incontinence
- Reduction in caffeine/alcohol/bladder irritants - decrease incontinence episodes
- Fluid reduction - only recommended if intake is abnormally high
Pelvic Floor Exercise
- Exercise increases muscle strength
- Practice for using the muscles to prevent urine loss when anticipating a stress event
- Both quick and three-second and sustained ten-second contractions
- To facilitate adherence link exercise to other well established behaviors
- Biofeedback - are form of teaching pelvic floor exercise
- Best for women with poor awareness of how to contract pelvic floor muscles
- Thought to promote correct pelvic floor contraction
- Over time increase the weights
- Half of patients withdraw from this therapy
- Unlikely to be superior to standard pelvic floor exercises
- Contraction of muscles directly or via pudendal nerve
- Mixed outcomes data
- Perhaps best for those initially unable to contract pelvic floor
1. Normal voiding is 6-8 times during the day or every 3-4 hours
2. Total fluid intake should be 6-8 glasses or 1-1/2 to 2 liters in a day
Many people who have bladder control problems reduce the amount of liquids they drink in the hopes that they will need to urinate less often. While less liquid through the mouth does result in less liquid in the form of urine, the smaller amount of urine may be more highly concentrated and thus irritating to the bladder. Highly concentrated, dark yellow, strong urine may cause you to go to the bathroom more frequently. It also encourages the growth of bacteria. When bacteria begin to grow, infection sets in and incontinence may be the result. Do not restrict fluids to control incontinence.
Foods and beverages to be avoided
Coffee (even decaffeinated)
Soft drinks with caffeine
Citrus juice & fruits
Tomatoes and tomato-based products
Highly spiced foods
Beverages to be added
Water - add thin slice lemon
Cranberry, Grape, Apple and Cherry juices
Do wear cotton underpants
Avoid nylon underpants and pantyhose
Avoid colored or perfumed toilet tissue and sanitary napkins
Avoid detergent bath additives or feminine hygiene products
Recommendations for improving bowel habits
1. Drinking 6-8 glasses of fluid a day
2. Increasing fiber in one's diet*
Raw vegetables and fruit: apples, prunes, celery
Cereals: bran, shredded wheat, crackling oats
Whole grain breads
3. Increasing exercise: walking daily
4. Milk of Magnesia taken after morning or afternoon meal
5. Adding a bulk-forming agent: karaya, methylcellulose, psyllium
6. Adding fecal softener: colace, glycerine suppository
*When adding fiber to your diet, remember that you may feel bloated and have gas in the beginning. It is also important not to restrict fluids when you are adding fiber.
1 cup applesauce
1 cup oat or wheat bran
1/4 cup prune juice
Cinnamon for taste (optional)
Begin with 2 tablespoons each evening followed by one 6-8 ounce glass of water or juice. After 7 to 10 days, increase this to 3 tablespoons and then at the end of the second to third week, increase to four tablespoons. You should begin to see an improvement in your bowel habits in 2 weeks. When you begin using the Special Recipe, you may notice some increase in gas and you may feel bloated. This should go away in several weeks.
This recipe may be stored in your refrigerator or in the freezer.
Pre-measured servings may be frozen in sectioned ice cube trays or in the nice foam plastic egg cartons and thawed as needed.
What are the pelvic muscles?
Pelvic muscles are the muscles that span the pelvis fiom the pubic bone, in &ont of the body, to the tai1bone, in the back of the body. Pelvic muscles provide support to the urethra, bladder, uterus, vagina and rectum.
What are pelvic muscle exercises?
Pelvic muscle exercises will help you tighten up and strengthen the muscles that surround the opening of the urethra, vagina and rectum. These exercises work only when the right muscles are used and enough repetitions are done. If you have a problem with incontinence, it may take up to three months for you to see an improvement. They can help prevent leakage with activity (stress incontinence) as well as overactive bladder (urge incontinence, urinary urgency and frequency).
How do I find these muscles?
Do not identify the pelvic floor muscles by trying to stop and restart the flow of urine. Instead, notice the muscles you use when you voluntarily pull in on your rectal muscles to retain gas. You can also find these muscles by placing a finger in the vagina and squeezing your vaginal muscles around it, while keeping the other hand over the lower abdomen to make sure you don't squeeze the muscles of your abdominal wall. Do not tighten the abdominal, thigh or buttock muscles when tightening the muscles of the pelvic floor.
How do you exercise the pelvic muscles?
The following is one set of exercises. There are 2 components - a set of short rapid contractions and a set of longer contractions:
Start with 10 "quick flicks":
- Contract and relax the muscles as quickly as possible): 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
- Start slowly. At first, you may only be able to do one or two sets per day.
- Try to build up to four or five sets per day.
- In due time, try to perform five to ten sets per day.
- When your muscles become tired, stop, and try another set an hour or two later.
Once you are comfortable with the "quick flicks" start doing the longer contractions as well:
- Quickly contract the muscles around your vagina inward and outward and hold the contraction hard and firm for 10 seconds: 1...2...3...4...5...6...7...8...9...10...
- Relax for 10 seconds: 1...2...3...4...5...6...7...8...9...10...
- Repeat 2 or 3 times a day.
Ultimately should do at least 5 of the quick flicks and 2 to 3 of the longer held contraction sets per day.
Make pelvic muscle exercices a habit. To remind yourself to do them, combine the exercises with other activities. For instance, do them whenever you stop at a red light, talk on the phone or perform household chores.
Besides regularly doing the exercises one should utilize them at certain times to prevent leakage:
For stress incontinence:
Use pelvic muscle exercises to prevent "accidents".Tighten your pelvis muscles before you sneeze, cough or lift.
For urge incontinence, urinary urgency or frequency and overactive bladder:
Use pelvic muscle exercises when you get the sudden urge to void in order to let the urge subside. Once it has subsided, you can calmly make your way to the bathroom.
Once you find that pelvic muscle exercises have improved your incontinence or other problems, don't stop doing them. You should look at these exercises as a lifetime commitment to maintaining good muscle tone.
These suggestions about the management of incontinence are reproduced here by kind permission of Dr. Howard Goldman, Professor of Urology at the Cleveland Clinic, Glickman Urological Institute, Section of Voiding Dysfunction and Female Urology
Staying Dry: A Practical Guide to Bladder Control
The Incontinence Solution: Answers for Women of All Ages
William Parker et al.
7 Steps to Normal Bladder Control: Simple Practical Types & Techniques for Staying Dry
National Association for Continence.
Phone: 1/800-BLADDER www.nafc.org
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