Posts tagged: voiding diary

This blog is part 3 of an 11 article series of 11 New Year’s resolutions that actually work and WILL improve your pelvic health. Get the full list of all 11 New Year’s resolutions HERE.

Browse any online forum about women’s health, and you will likely come across the subject of women’s urinary incontinence. While other women’s health issues certainly have their own aspects of pain, the women posting in the urinary incontinence forum use some very strong phrases that definitely describe their pain and suffering. See if any of these adjectives resonate with you, especially when you suffer from a urinary leakage accident in public:

• soooo embarrassed
• terribly confused
• hate that ‘wet pants’ look
• humiliated in public … can never return to that store
• everyone was staring … wished I could just disappear
• detest owning 30 pairs of panties and carrying a good supply in public
• feel so alone and isolated

If any of the above phrases ring a bell with you, especially the last one about ‘being alone,’ we know exactly how you feel. We also know, as a urologist and physical therapist specializing in women’s pelvic health, that you are most definitely not alone! We have helped many women with the exact same problem–and same kind of suffering–and helped them get past that humiliating public urine leakage accident.

That’s why we are writing this 11-part series on lifestyle changes that may significantly improve your urinary leakage issues. The key is to be persistent in your approach to relieving your symptoms. You can and should try some or all of the approaches discussed in this series. Some women respond well to one type of lifestyle change, while other women need a combination of multiple approaches before they see results. Finally, seek out a compassionate medical professional for a diagnosis and assistance.

In this article we talk about how to use a bladder diary so you can truly track your symptoms, since you can’t cure your urinary incontinence until you know specifics of your condition, down to the last detail. We then discuss how you can use bladder retraining, based on the information you learned from your bladder diary, as a conservative technique to relieve women’s urinary incontinence symptoms.

Keeping a Bladder Diary
The bladder diary (or voiding diary) is exactly what it sounds like: it is a record of your bladder habits. You may think you know absolutely everything about your condition, but when you start keeping a bladder diary, you may be surprised. Many women fail to notice crucial details of their urinary habits, and are surprised at how often they need to urinate, how many times a day they have strong urges, or the amount of water they drink. Most of these details fall by the wayside when there is a humiliating public leakage accident, or are simply filed under the category of “that happens a lot.” With a bladder diary, you will discover just how much is “a lot.” You will need these details so you can design a bladder retraining program that is customized to your unique condition.

To keep a bladder diary, simply track the following for a minimum of a week:

• when, how much, and what kinds of fluids you drink (all fluids, especially caffeinated fluids)
• when and how many times you urinate during the day
• when and how many times a day you experience strong urges to urinate, whether you urinate or leak urine
• how many times a day you experience leakage and how much you leak
• the triggers that cause you to leak urine or experience strong urges (such as coughing or sneezing, hearing the sound of running water, or lying in bed)

Also record any other health issues you experience, even if you think they are not related to your urinary incontinence. Your doctor will want to know about these, as some may be caused by medications you take for other health conditions, or other lifestyle issues. Once you have at least a week’s worth of data, proceed to the next step: designing your customized bladder retraining program.

Designing Your Custom Bladder Retraining Program
Just as not all women start doing Kegels with the same level of intensity, your bladder retraining program should also be customized to your specific needs. A custom Kegel program is based on a woman’s current level of pelvic floor muscle fitness, including how long she can hold a correct contraction plus how many repetitions she can do. Your custom bladder retraining program will be based on how long your bladder can hold urine before you must urinate or have a leakage accident.

Bladder retraining is most effective if you have urge urinary incontinence (also called overactive bladder or OAB) or mixed urinary incontinence. The goal of this conservative therapy is to learn to delay your urination after you get the urge to urinate. Bladder retraining does work. According to the American Academy of Family Physicians, women who practice this method notice the following improvements:

• increased amount of urine the bladder can hold
• better control over the urge to urinate
• more time (or delay) between bathroom visits

These improvements can definitely help prevent those embarrassing public leakage accidents. What’s even better is that bladder retraining is not a difficult technique to learn or use. Simply use the following steps to start retraining your bladder today.

1. Determine Your Urination Interval
The goal of bladder retraining is to delay your trips to the bathroom to urinate so that you urinate once every two to three hours during the day (this is considered a “normal” voiding interval). If possible, bladder retraining should also help you avoid trips to the bathroom at night so you can experience uninterrupted sleep until morning. In short, bladder retraining gives you control of your bladder by having you urinate on a schedule.

Before you can set a schedule, you need to first determine the current interval between trips to the bathroom to urinate. For most women we recommend setting the interval at one-and-a-half hours. However some women cannot hold their urine for this long in the beginning. To determine your customized interval, look through your bladder diary and calculate the average amount of time between trips to the bathroom. You will use this average interval in the next step.

2. Increase Your Urination Interval with Timed Voiding
Once you have this average, add 5 to 10 minutes to this interval to arrive at your starting interval. For instance, if your bladder diary tells you that your average interval is normally 45 minutes, set your starting interval at 50 or 55 minutes. That means you will attempt to hold your urine and avoid trips to the bathroom for 50 to 55 minutes. Once the interval has ended, go to the bathroom and urinate, whether you need to or not. This process is called timed voiding, and is the basic technique behind bladder retraining. This process trains your bladder to release urine only when you choose, according to your own schedule.

Most women need to set a timer, especially at the beginning, to remind them when the interval has ended. If you feel the urge to urinate before the interval is complete, try one or more of these techniques to delay urination:

• relax and breathe in a deliberate manner
• sit quietly, avoid moving or fidgeting
• visualize a tranquil scene (without water)
• think about another topic to distract your attention
• do a series of Kegels if you know you can do a correct contraction

If you still cannot hold your urine until the interval is over, don’t worry. Run for the bathroom. When you return, reset your timer and start again. Bladder retraining, like any learned technique, takes practice so don’t worry if you can’t make it to the end of the interval the first few times. Once you are able to consistently hold your urine during your chosen interval, stretch the interval by 5 to 10 minutes at a time until you reach the goal of two to three hours.

3. Once in the Bathroom Empty Your Bladder Completely
One of the keys to successful bladder retraining is to empty your bladder completely when you do finally urinate. Some women do not fully empty their bladders when they urinate, and this can interfere with the success of bladder retraining. To ensure that your bladder is completely empty, urinate until you feel your bladder is empty. Wait 10 seconds, and then lean forward. Try to urinate again. You may be surprised by the amount of urine that was still in your bladder. By leaning forward, you change the angle of your pelvic organs, especially the bladder neck, which allows any remaining urine to be released.

Coping with Women’s Urinary Incontinence Requires Patience and Persistence
Patience and persistence are the two “P’s” of success when coping with this humiliating, embarrassing, and downright inconvenient condition. As you commence your bladder retraining program, practice both patience and persistence. Be patient with yourself when you don’t make the interval or continue to suffer from leakage accidents. Retraining takes practice. Be persistent, as well. Stick to your voiding schedule like clockwork. We suggest you stick with your bladder retraining program for at least 40 days.

Continue logging your results in your bladder diary. Your bladder diary will help you notice even minor improvements in bladder control, and these changes should be celebrated! Any increase in bladder control is worth the effort that goes into a bladder retraining program. Also remember that bladder retraining is only one of many conservative therapies for women’s urinary incontinence. If bladder retraining doesn’t relieve your symptoms to your satisfaction, consider trying a combination of therapies (read all about them in this complete guide).

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