In my practice, which specializes in Overactive Bladder treatment, I find most patients assume that our focus is on OAB medications. Other patients may see me because they haven’t had a satisfactory response to medications and are seeking advanced therapies such as botulinum toxin (Botox) or sacral neuromodulation or percutaneous tibial neuromodulation. While these are all very important and extremely valuable treatments for OAB, it is too easy to skip over similarly important treatments that should be tried even earlier. These first-line or Behavioral Therapies can be very powerful tools to control your bladder and may even be as effective as medications for many people. These changes can be made without a single trip to the pharmacy or visit to the doctor’s office. In fact, because behavioral changes are so important, the current American Urological Association guidelines on OAB urge providers to offer these as the initial treatment for OAB. For those people who may eventually require medications or more advanced therapy, multiple studies confirm that those treatments are made more effective if combined with behavioral treatments.  

Behavioral treatments for OAB include fluid reduction, diet changes, weight loss, and pelvic floor exercises. When we say bladder training, I imagine most people think we are talking about pelvic floor exercises. But, in reality, bladder training (BT) is about gradually changing the way that your bladder and brain interact in deciding when to urinate. I outline here some steps towards training your bladder.

1. Educate Yourself: Begin by educating yourself on the basics of bladder training. This can be done through blogs or websites or videos that discuss bladder training.  

2. Keep a Voiding Diary: A voiding diary is a record, usually kept for a few days, of every time that you urinate. Many diaries include space for fluid intake and the amount that you urinate as well. By completing a diary, you can start to get an idea of how much time you can typically wait between trips to the bathroom. You will probably notice that you are rushing to the bathroom or even having urgency incontinence, which is typical of overactive bladder. Many people with OAB urinate so frequently that they almost always put off going to the bathroom as long as they can stand it, which may not be very long.

3. Avoid Urgency: The first step in bladder training is to find the amount of time between trips to the bathroom that does not result in urgency or incontinence. My usual recommendation to my patients is that they subtract about 15-30 minutes from the average time recorded in their diary.

4. Urinate on a Schedule: Once you have that shorter time that doesn’t cause urgency or incontinence, use that to set a urination schedule. By that, I mean that you should urinate that often while awake whether you have an urge to go or not. For instance, if your diary showed you were urinating every 2 hours with urgency most of the time, you might set the shorter interval to 90 minutes. You would then try to urinate every 90 minutes whether you felt an urge or not. In fact, the goal is for most of your trips to the bathroom to be without that uncomfortable urge you’ve been so used to.

5. Gradually Decrease the Interval: You may notice that I have just asked for you to trade one problem, urgent urination, for another, frequent urination. But, be patient!! About every 1-2 weeks, begin to increase the interval by 15-30 minutes. If you notice the urgency or incontinence returning, back off a little and increase more slowly. Your goal is to slowly decrease the number of times that you urinate per day without finding yourself rushing to the bathroom or experiencing incontinence. Your goal may be to increase the amount to time between trips to the bathroom to 3-4 hours, but increase gradually and don’t rush yourself there.

6. Get Help if Needed: There are numerous other behavioral changes that you can add to bladder training to make it more successful, including moderating fluid intake, avoiding irritating foods and beverages or practicing pelvic floor exercises. However, some people have such severe symptoms that bladder training can be difficult or impossible, at first. I have met patients in my clinic who urinate every 30 minutes with urgency. What are they supposed to do? I’m not going to ask them to begin urinating on a schedule of every 15 minutes!!! Instead, patients with these severe symptoms often benefit from starting an OAB medication at the same time that they are adding behavioral therapies. If medications can decrease the frequency and urgency to urinate, changes like bladder training can be even more effective.

How effective is bladder training? Trials comparing it to the most common medications used to treat OAB show that it is as effective as medications with fewer side effects. Perhaps more encouraging, other therapies, including medications, are more effective if you add bladder training. So, not only can behavioral therapies be used to treat OAB on their own, but they should be continued even if you move on to other therapies. While your local gym may be closed right now, that doesn’t mean you have to skip training altogether. Just spend some time training your bladder instead!