Bladder retraining and physiotherapy for overactive bladder (OAB)

Bladder retraining and pelvic floor physiotherapy for overactive bladder is effective in many patients in helping to control OAB symptoms without any side effects. These techniques do, however, require a motivated and patient person who is willing to put in time and effort in order to change their bladder habits.

It is very useful to enlist the assistance of a specialist continence physiotherapist or continence nurse specialist to learn these techniques. Pelvic floor physiotherapy in particular is very difficult to learn from written instruction alone.

Bladder retraining involves gradually extending the time between visits to the toilet by using techniques including:

• Urge suppression strategies e.g. with a sudden urge to pass urine
  • Stop and be still. If possible, sit down.
  • Perform several quick pelvic floor muscle contractions (e.g. 5). This has an effect on inhibiting the messages sent to the nerves in the bladder and can be repeated if needed.
  • Try and relax the rest of the body and breathe deeply and slowly.
  • Use mental distraction techniques to take the mind off the urge e.g. counting or spelling words backwards
  • Wait until the urge fades and then go to the toilet without rushing.
• Gradually increasing the time between toilet visits “by the clock” e.g. by 1-2 minutes initially and gradually increasing this over a period of weeks to months.
  • This is NOT the same as “holding on as long as you can”.
  • Use the urge suppression strategies and as an increased sense of bladder control is gained, it is possible to postpone going to the toilet for a minute (to begin with) after the urge fades.
  • The key is to gradually increase the time between the initial urge and going to the toilet aiming to have an interval between passing urine of 3 to 4 hours.
  • This is a slow and gradual process that takes time to master over several months.
• Avoid going to the toilet “just in case” e.g. just before leaving the house after having already urinated just before this and knowing that the bladder is relatively empty.

• Strengthening the pelvic floor muscles with pelvic floor exercises (PFE) or physiotherapy is very useful in treating both urge incontinence as well as stress incontinence.
• Exercising the pelvic floor muscles strengthens them and improves bladder control. It is crucial that the correct muscles are identified and strengthened. These are the same muscles that are used to stop the passage of wind or stop the flow of urine midstream (although this is NOT recommended to be done regularly- only as a technique to ensure that the correct muscles are being contracted). Many people have difficulty identifying their pelvic floor muscles as they are not visible externally. This is where a session with a pelvic floor or continence physiotherapist can improve the pelvic floor contraction technique and develop an individualised programme.
• Two different types of exercises that strengthen the different types of muscle fibres in the pelvic floor (fast muscle contraction versus slow muscle contraction fibres) are taught.
• These exercises can also be used at the time of an urgent need to urinate as an urge suppression strategy (see above).
• It usually takes about 6 to 8 weeks of performing regular pelvic floor physiotherapy with bladder retraining to see an improvement in symptoms with fewer leakage episodes and less urgency and frequency of urination. While some people may see improvements within even a couple of weeks, it can take 3 months or more to improve bladder control.