How to Use Bladder Retraining to Treat Urinary Urgency and Incontinence

When you think about peeing, you probably think of your kidneys, bladder, and urethra. But there's another surprising organ that might be involved in your urinary symptoms: your brain. It senses when your bladder is full and sends you those “gotta go” signals. 

Sometimes, your habits can disrupt the brain-bladder reflex loop. If you make “just-in-case” trips to the bathroom before your bladder is full, for example, your brain can get confused. It might start sending stronger “urge” signals that don’t always match up with how full your bladder is. Or it might start sending signals more often, which can lead to problems with urinary urgency and frequency.

That’s where urge suppression and bladder retraining come in. You can retrain your bladder and brain so the signals to empty come at the right time and interfere less with your daily life. 

Read on to learn how to use bladder retraining techniques to reduce your urinary urgency and incontinence symptoms.

What Is Urge Suppression? 

Urge suppression is a technique used to reset mixed-up brain-bladder signals. Here’s how to do do it: The next time you have to pee, rate your urge to go on a scale of 1 (mild) to 3 (urgent) before you go, suggests physical therapist Kandis Daroski, PT, DPT. 

“If your urge is a 3, empty your bladder right away — but count your urine stream in seconds. Ten to 12 seconds indicates your bladder was full enough to need to be emptied.” 

If your urine stream was less than 10 seconds or your urge is a 1 or 2, try the following strategies before you bolt to the bathroom: 

• Stop where you are and stand still or sit down. (Crossing your legs or pushing your knees together helps.) 

• Perform five quick Kegel exercises or hold a Kegel for five seconds (ask your physical therapist for help to perform these correctly). 

• Take three deep diaphragmatic (belly) breaths. 

• Think of something else. Count backward or tell yourself, “This can wait.” 

• Perform five heel raises or walk to the bathroom on your tiptoes. (Contracting the muscles in your feet and calves will help contract your pelvic floor.) 

• When the urge to urinate has decreased, calmly and slowly walk to the bathroom (as long as it’s been at least two hours since your last bathroom trip). 

• If it’s been less than two hours, try to delay your bathroom break. Even if you can only delay it a few minutes at first, that’s okay. Slowly increasing the time between bathroom trips gradually retrains your bladder to reduce urinary urgency for future episodes. 

If you find that you often have an urge to pee more than every two hours, try bladder retraining. 

What Is Bladder Retraining?

Just like you train your muscles at the gym, you can train the muscles that control your bladder. This can help delay emptying your bladder when you get the urge to urinate. Bladder retraining is  meant for people who pee more frequently than “normal.” It’s normal to pee about seven times per day, with about two to four hours in between trips. 

If you’re not sure how often you go, keep a bladder diary for a few days. 

Here’s how bladder retraining works: 

1. Set a goal. Determine your average bathroom interval — how long you can go between bathroom visits. Add 15 minutes to determine your new goal. (If you currently pee every hour, aim to go every hour and 15 minutes.)

2. Make a bathroom schedule. Start with when you first wake up and designate subsequent bathroom trips based on your interval calculated in step 1. 

3. Practice urge suppression as needed. When you feel the urge to pee before your scheduled trip, use the above urge suppression process. If this stops the urge enough to hold off until your next trip, great. If not, try waiting five minutes before you calmly go to the bathroom. (Try a relaxation exercise to help manage urges.)

4. Monitor your bathroom breaks. If you constantly have to break your schedule, create a new schedule with a shorter interval. 

5. Make slight changes. Each week or so, increase your interval until you reach three to four hours between bathroom visits. 

It should take about six to 12 weeks to retrain your bladder. As you go through bladder retraining, remember that setbacks are common. Many issues can influence how challenging this is on any given day. Try not to let obstacles discourage you. Keep practicing these techniques and before you know it, you’ll have more “good” than “bad” bladder days.

Physical Therapy for Urinary Urgency and Frequency

When problems with your pelvic floor muscles are causing urinary problems, pelvic floor physical therapy (PT) can help. To help ease urinary urgency and frequency, pelvic floor physical therapists can recommend a variety of exercises to help both strengthen and relax your pelvic floor muscles. 

It’s important to remember that pelvic floor exercises are not just Kegel exercises, and in some cases, they may make urinary problems worse. A PT can help determine the best exercises for you. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

More Ways to Treat Urinary Urgency and Frequency

Based on the cause and severity of your symptoms, your provider may prescribe medications, or recommend biofeedback therapy, injections, nerve stimulation, or surgery as part of your bladder function treatment plan. There are also strategies and lifestyle habits that can help improve your bladder function and manage urges and frequent urination, such as:

•  Practice mindfulness (including deep breathing exercises or meditation). It can help calm your nervous system, which may decrease feelings of urgency.

•  Limit bladder irritants. If certain foods or drinks increase your symptoms, consider either cutting them from your diet, or reducing your intake.

• Avoid tight-fitting clothing, which can add unnecessary pressure to your pelvic floor muscles and increase urgency.

Learn More About Hinge Health for Pelvic Symptom Relief

If pelvic symptoms are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

References

1. How To Retrain Your Bladder To Control Leaks. National Association For Continence. (n.d.). https://www.nafc.org/bladder-retraining

2. Bladder training. (September 22, 2021). UCSF Health. https://www.ucsfhealth.org/education/bladder-training