The Bladder Retraining Program is a self-help process by which patients suffering from conditions that produce urinary urgency and/or frequency can learn to control their urge to urinate in an attempt to improve their symptoms.
The The theory behind the program is that whenever a patient experiences pain or urgency in the bladder, the normal impulse is to urinate in order to stop the symptom. This establishes a pattern of frequent voiding, which, once begun, can be difficult to reverse. The bladder is a muscle, and that muscle wall becomes weakened in the course of frequent urinating. The goal of the Bladder Retraining Program is to use a series of simple steps to achieve longer and longer periods between urinations. Rehabilitation of the weakened bladder muscle is the objective, with increased urinary capacity and reduction of discomfort the expected result.
It is very important to note that in patients whose symptoms are varied and in whom pain is the major feature of the diagnosis, the pain must first be addressed before bladder retraining can be effective. In mild IC cases where urinary urgency is the only symptom, improvement may be evident within several weeks. With more severe urgency and frequency, the retraining process may take longer.
Working with a urologist, a program is established for each patient beginning with a fourweek period of holding the urine for a minimum of a certain number of minutes or hours (based on the individual’s current average voiding schedule). The patient is encouraged to wait a specified period after the first urge is felt before urinating (15 minutes, for example). If pain is felt before the period has elapsed, voiding is encouraged. If after waiting, the patient finds that the need to urinate has diminished, then she/he should wait to urinate until the next urge to void is felt. At the end of one month, the time interval is increased, and at the end of the second month, the interval is increased again. The goal is to have the patient meet the required interval most of the time. It is acceptable if intervals are occasionally longer or shorter, as long as the minimum interval occurs most of the time.
- Many IC patients -- probably due to confusion between IC and "common" cystitis (urinary tract infection) -- have been instructed to drink large quantities of liquids and urinate often. Although an adequate amount of liquid is necessary, excessive intake will lead to significantly increased frequency, and is not recommended.
- While caffeine, carbonated beverages and acidic foods are often mentioned on lists of foods & beverages for IC patients to avoid, in addition, salt (sodium) and salt substitute -- widely used in processed and frozen convenience foods -- can be serious bladder irritants.
Simply instructing the patient to hold the urine will inevitably fail due to a lack of understanding as well as skepticism. The relatively long time period (average 3 months) required for success also contributes to patient dissatisfaction and noncompliance. The Program does prove successful when special attention is paid to the patient, including the employment of a medical social worker to encourage the patient’s belief in the method, as well as an understanding that this is not an “instant cure.” In the absence of a medical social worker, the urologist should provide formal written instructions to explain the program, and should arrange for regular follow-up visits to monitor and encourage the patient’s progress.
- The Interstitial Cystitis Survival Guide, Robert Moldwin, MD, New Harbinger Publications, 2000, pp. 184-6.
- IC: Successful Management by Increasing Urinary Voiding Intervals, CL Parsons, MD, PL Koprowski, MSW, Urology, March 1991
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