Once you have gained acceptable control of your bladder problem , you must exercise regularly to maintain your muscle strength and control. This is usually between 30-80 pelvic floor exercises through the day . If you stop exercising you may regress to your prior level of control. Use your pelvic floor muscles subconsciously and habitually throughout the day. Here's a review of important ways to keep the gains you've made.
1. Always remember to tighten your pelvic floor muscles during physical stress, i.e.
Endurance Contraction- Keeping your holding power
STARTING THE PROGRAM
Discuss your current toilet habits with your therapist. A bladder diary is usually completed before retraining is started. Keeping records along the way is also important. Use the daily urinary log to track your progress.
SUPPLIES YOU WILL NEED
A daily urinary log and pencil to mark the time of urinating and any urinary leakage accidents. A clock or a timer may help you stay on the scheduled program.
Going to the toilet at the assigned time is important to do, even if you do not feel the need to urinate. The important part of the retraining is that YOU practice telling your bladder when to empty and when to hold. The amount you urinate is not important. It is important to relax and not strain while voiding.
1. It is important to urinate when you first get up in the morning. If you have a hard time making it to the toilet once you get up, use any one of the urge control techniques described above before you get out of bed. Once the urge has decreased, get out of bed using good body mechanics and walk slowly to the toilet. DO NOT RUSH! Empty your bladder as completely as you can, never push or strain, and on your urinary log record in the "amount urinated" box (no measurement is required) beside the hour that you used the toilet. Now set your time for ______ minutes/hours. The schedule for the day always begins with your first urination.
2. When the time sounds, go to the toilet EVEN IF YOU DO NOT FEEL THE NEED TO URINATE! If you urinate, check the box "amount urinated" (only measure if your health care provider has asked you to). If you experience any leakage, record it and the amount (small, medium, large) in the accident column. Immediately reset your timer or watch for _______ minutes/hours. Continue this all day until you go to bed. The retraining does not continue at bedtime. Follow this schedule until your next visit.
KEEPING A DIARY
* Record each of your scheduled urinations on the urinary log sheet. Also record if you had any accident. If you miss urinating at the scheduled time, leave the log blank.
* If you interrupt your retraining by urinating before the scheduled time, record the time you urinated and attempt to urinate at the scheduled time so that you are back on the schedule.
* If you miss one or more schedule urinations, get back on the schedule as soon as you remember.
* Your records will be reviewed during your appointment, so bring them with you.
PROGRESSING THE PROGRAM
You and your therapist will assess the correct amount of time for you at each follow-up visit. You will change the time between urination by ______ minute/hour intervals. This means you will be urinating every _____ minutes/hour. It is easy to compare your continence logs from week to week to see the progress you're making. The goal is to go between 3-4 hours between urinating.
DEALING WITH PROBLEMS AND SETBACKS
If all of the above techniques fail and you still have an overwhelming urge to go, you may use the toilet. If this occurs, record in the amount urinated column as well as in the "activity with leakage and was urge present" column the hour that this urge and voiding occurred.
Whenever you leak urine, check in the "amount of leakage" box with small, medium, or large corresponding to the hour this occurs. Do not be discouraged if this happens, it is normal. Your bladder problems did not happen overnight and won't be cured overnight. This may take several weeks.
The urge feeling needs to be suppressed on a consistent basis, be patient and stick with the program. Before you begin, decide what type of strategy will work for you and use it faithfully.
Some additional ways to calm or suppress your urge to urinate include:
* Pressure to the perineal area - place your hand or a rolled up towel against your body and apply firm pressure. Or, alternatively, sit on a rolled up towel placed on a firm chair.
* Usually the urge wave will pass in a few minutes.
* Mental distraction including visualization of your favorite vacation spot, counting backwards, deep breathing or positive self-thoughts, for example, "I can control my bladder".
* Performing pelvic floor exercises.
Setbacks are not uncommon if you: have been ill with a cold or flu, are tired, cannot completely concentrate on the program, feel nervous or tense, are sensitive to cold weather or the sound of running water, or are about to start your menstrual period.
Some Medications can cause a change in urinary function. It is important to know all of the medications you are taking, whether prescribed by a physician or purchased over the counter drugs. It is also a good idea to keep track of any changes in your urinary habits once you begin to take a new medication. Your Daily Voiding Diary will help you keep track of this information. Here are some bladder side effects from common medications:
MEDICATION BLADDER SIDE EFFECTS
Weak flow of urine
Constipation is defined as the difficult passage and infrequent (fewer than three) bowel movements per week. It may be the result of several different factors including:
This recipes is commonly suggested to promote regular bowel function by increasing dietary fiber. You may experience a bloated feeling and have gas when adding fiber to your to your diet but this should pass within a few weeks. It is important to avoid regular use of laxatives and enemas as they decrease the bowel's function.
A SPECIAL RECIPE FOR BOWEL REGULARITY
1 cup applesauce
1 cup oat bran or unprocessed wheat bran
3/4 cup prune juice
Begin with 1-2 Tbs. each evening mixed with or followed by one 6-8 oz cup of water or juice. This should help to soften and regulate your bowel movements within 2 weeks. If no change occurs, slowly increase serving to 3-4 Tbs. You should plan on making this a part of your daily routine for the rest of your lifetime.
This may be stored in your refrigerator or your freezer. One to two tablespoon servings may be frozen in sectioned ice cube trays or in foam plastic eggs cartons and thawed as needed.
Sabina Weaver, MSPT-ATC-L