**5.1.2 Bladder retraining**

Bladder training involves patient education and scheduled voiding in which the voiding interval is progressively increased. This method is based upon frequent voluntary voiding which keeps the bladder volume low and training the central nervous system on pelvic floor musculature to inhibit urgency. Utilizing the patient's bladder diary, the initial frequency of timed voiding is based on the smallest time interval between voids. The goals of bladder training are to normalize urinary frequency, to improve control over bladder urgency, to increase bladder capacity, to decrease incontinence episodes, to prolong voiding intervals,

A common sense approach to the treatment of patients with OAB should include counseling patients on dietary and lifestyle modification that may improve their symptoms and quality of life. In general, patients should increase awareness of amounts and types of fluids consumed, especially as it relates to their symptoms. Although not well studied some foods and beverages are believe to increase detrusor activity and symptoms of OAB. The authors recommend that patient's begin to eliminate one food or beverage at a time from the

In one study patients with caffeine intake > 400 mg/day were shown to be 2.4 times more likely to have detrusor overactivity. (Arya, et al., 2000) In addition, limiting fluid intake has been shown to reduce frequency and urgency as well as improve quality of life in patients

Although weight loss is a good lifestyle modification, in general, it has been shown to significantly improve only stress urinary incontinence symptoms, but not OAB symptoms. A large randomized trial of overweight and obese women with urinary incontinence symptoms underwent an intensive 6 month weight loss program compared to a group with a structured education program. (Subak et al., 2009) Mean weight loss was 8 percent (7.8 kg) and 1.6 percent (1.5 kg) in the intervention and control groups, respectively. The authors found that weekly incontinence episodes decreased by 47 percent in the intervention group compared to only 28 percent in the control group. Of note, is that these patients had a

Bladder training involves patient education and scheduled voiding in which the voiding interval is progressively increased. This method is based upon frequent voluntary voiding which keeps the bladder volume low and training the central nervous system on pelvic floor musculature to inhibit urgency. Utilizing the patient's bladder diary, the initial frequency of timed voiding is based on the smallest time interval between voids. The goals of bladder training are to normalize urinary frequency, to improve control over bladder urgency, to increase bladder capacity, to decrease incontinence episodes, to prolong voiding intervals,

significant decrease in stress incontinence, but not urge incontinence episodes.

**5.1.1 Dietary and lifestyle modification** 

Caffeinated (Coffee, Tea)

 Citrus juice and fruits Artificial sweeteners

Tomatoes and tomato-based products

with OAB. (Milne, 2008 and Swithinbank et al., 2005)

following list: Beverages

Foods

Alcoholic

Carbonated

Spicy foods

 Chocolate Corn syrup Sugar Honey

**5.1.2 Bladder retraining** 

and to improve the patient's confidence in bladder control. It is safe and may be beneficial. (Wallace et al., 2004) Bladder training requires compliant and motivated patients and may not be suitable for those with cognitive impairment. It can be time-consuming and is primarily effective during waking hours. (Ouslander et al., 2001)

Patients can be instructed to follow the steps listed below for bladder training :(Modified from DuBeau, 2011):

	- You do not have to get up during the night!
	- Stop, don't run to the bathroom!
	- Stand still or sit down if you can.
	- RELAX. Take a deep breath and let it out slowly.
	- Concentrate on making the urge decrease or even go away, anyway you can.
	- When you feel in control of your bladder, walk slowly to the bathroom, and then go.
	- Then, increase the time between scheduled trips to the toilet by one hour
	- When you can go two days without urine leakage, extend the time between trips again.
	- This may take several weeks.
	- DON'T GET DISCOURAGED! Bladder training takes time and effort, but it is an effective way to get rid of incontinence without medication or surgery

A review in 2009 found that bladder training may be helpful for the treatment of urinary incontinence, but definitive research is needed to support that conclusion. (Wallace et al., 2004) However, there is very little downside to this therapy.
