It's important to go the bathroom when you need to. "Holding it" can actually stretch your bladder, making it difficult to empty it completely.
But there's such a thing as going too often. (The norm is around seven bathroom trips daily.)
An overactive bladder contracts abnormally, triggering the urge to urinate too often. This can lead to urge incontinence, which occurs when you suddenly feel a strong urge to urinate but don't make it to the bathroom in time.
The good news is that bladder training can help. Here's how.
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Watch your liquid intake
Drinking 10 to 12 glasses of water a day (80 to 96 ounces) may cause you to go every hour or two, which is too often, says Harvey Winkler, MD, cochief of urogynecology and director of female pelvic medicine and reconstructive surgery at North Shore–Long Island Jewish Health System in Great Neck, N.Y. "The normal bladder wants to empty out at about 8 ounces."
Cheryl Iglesia, MD, section director of female pelvic medicine and reconstructive surgery at Washington Hospital Center, in D.C., tells patients to drink when thirsty, but limit the total to 70 ounces of liquid a day. Avoid caffeine and alcohol because of their diuretic effects.
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Log your bathroom trips
The first step in bladder training is to keep a voiding diary. (You can print and fill out this voiding diary form).
For two or three days, make a note of every time you urinate as well as what you drink. This information will give you a baseline as you work on reducing trips.
As you go through the bladder training process, a voiding diary helps you gauge your progress and keeps you motivated.
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Time your bathroom trips
Based on the information from your voiding diary, come up with a comfortable interval between bathroom trips. Then set an interval timer or stopwatch and keep to this schedule during your waking hours.
This is known as "timed voiding." If the time is up and you don't have to go, empty your bladder anyhow. You should also empty your bladder when you wake up in the morning. At night, only go if you wake up and feel the urge.
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Increase the time between trips
Once you're comfortable with your voiding schedule, extend the amount of time between bathroom trips by 15 minutes. For example, if you're urinating every hour and 15 minutes, stretch that out to an hour and a half for a week.
Once you're ready, you can shoot for an hour and 45 minutes. The goal is to get to the point where you're urinating every three hours or so; the specific timing is up to you.
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Wait five minutes
If you feel the urge to go before the scheduled time, see if you can hold off for five minutes.
"What we're trying to do is retrain so the mind is in control of the bladder," explains Thinh Duong, MD, an associate at Southern California Permanente Medical Group, in Los Angeles. Use techniquesincluding Kegel exercises and deep breathingto fight the urge to urinate. If your "mind over bladder" efforts succeed, stick to your schedule; if not, go to the bathroom and then restart your schedule.
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It may take up to three months to reach your bladder training goals, and you may have a few setbacks, but try not to get discouraged.
You should start seeing steady progress by six weeks or so, and some patients see results after only one week, says Dr. Iglesia, who serves on the American College of Obstetricians and Gynecologists' board for patient education.
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Kegel exercises, which involve contracting the muscles around the vagina almost as if you were "lifting" your pelvic floor, can greatly improve your chances of bladder training success.
Have a doctor or nurse examine you while you do a Kegel to make sure you've got it right, says Dr. Iglesia, adding that about half the women in her practice do the exercises incorrectly.
Dr. Iglesia suggests starting with 10 quick contractions, and then another 10 "reps" that you hold for 5 to 10 seconds each. Aim for two to three sets a day.
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Some people have a hard time figuring out how to do Kegel exercises. A technique called biofeedback can help.
It involves placing a device with a sensor inside the body to measure pelvic muscle activity. For women, a small tampon-like device is usually inserted in the vagina; for men, the therapy is done with sensors that fit in the anus.
As you do Kegels, you'll get visual or auditory feedback that will show whether you're contracting the right muscles, and how strong your contractions are.
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While most women can learn to do Kegels, some people have childbirth-related damage to the nerves and muscles that makes it nearly impossible to perform these contractions.
In this case, you can try electrostimulation, which involves stimulating muscles of the pelvic floor and bladder with electric impulses.
Studies have found that electrical stimulation can be as effective as medication at improving incontinence.
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While you can train your bladder on your own, getting support from a professional really helps.
"Just like with any exercise, we slack off," says Dr. Winkler. "It's something that you need that constant support and feedback with."
Your physician can refer you to a continence nurse practitioner or a physical therapist with expertise in bladder training, who can coach you and keep you on track.
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Vaginal weights could help
Vaginal weights could help you ensure you work the right muscles during Kegels, but they are not a silver bullet. Studies have found that weights are no more effective than Kegels alone or electrostimulation. You may have seen devices, usually weighted cones or balls, that promise to strengthen pelvic muscles when placed in the vagina.
"Don't just go order them out of the catalog without asking your doctor," Dr. Iglesia says. "It could be a waste of your money and very discouraging."
If you decide to use weights, which involves inserting balls or cones in the vagina and squeezing the pelvic muscles to hold them in place, do these exercises in the morning; the muscles become tired later in the day.
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