Bladder training (drill)

Bladder training, also known as bladder drill, is a programme to re-train the bladder to become less overactive.
An overactive bladder does not tolerate small amounts of urine. As a result, patients go to the toilet frequently, may rush and even leak on their way, to pass small volumes of urine.
Bladder training is about restoring normal sensation in the bladder, so that patients gradually go to the toilet less frequently and pass larger volumes.

Bladder training (drill) is part of a conservative approach to overactive bladder and painful bladder syndrome, alongside fluid advice and medication.

Overactive bladder is a condition characterised by a frequent and/or urgent need to pass urine with or without urge incontinence (that is, leakage on the way to the toilet).

Painful bladder syndrome is a condition characterised by pain before going to pass urine, usually in association with some or all overactive bladder symptoms.Special leaflets are available for both conditions.

To start bladder training (drill) you should believe you can regain control of your bladder. Your aim is to go to the toilet to pass urine when you want to, rather than when you get the urge to go.
The urge can be suppressed and you must aim to get this to work. A bladder muscle contraction is like a spasm that will pass. You need to learn how to hold until this spasm passes and there are some techniques to distract your mind.

When you get the urge to go to the toilet, sit down, tighten your pelvic floor muscles as firm as you can. Try to distract your mind, for example by counting down from 50 or 100, reciting the alphabet, finishing a job, reading to the end of the page or waiting for the next break on television.
Some try holding on to something, like a rolled up towel on a chair, sitting on the edge of a bath, hopping from one foot to another, crossing their legs or standing on tiptoes. More likely than not, the urge will have passed before you finish these distractions.

Some patients may get the urge when doing particular activities, like before going out, getting out of the car, putting the key in the door, returning home, undressing in the toilet or running the tap.
It is important to break the link between these events and getting the urge. You can do this by mind concentration, trying to squeeze your pelvic floor muscles, holding on and taking more time to get out of the car or get back into the house.

Use a bladder diary (frequency volume chart) to monitor your progress. Set yourself a realistic target to increase the interval before going to the toilet to pass urine. For example, if you go to the toilet every hour, aim to go every hour and quarter for the first week.
Push the duration up gradually till you can reach 3 or 4 hours. This can take time. Be prepared for setbacks and restarts, which are not uncommon. You are likely to be referred to a specialist physiotherapist for this training. The specialist physiotherapist will be following you up during this training. You may also have a follow up appointment with the doctor in clinic to check your progress.

You should not think about failure for a start. Be positive and determine in your mind that you are going to succeed. Be reassured that there are other measures that can be tried if bladder training (drill) does not work, but for now focus on trying to get your bladder under control. There are special leaflets for the next steps and you can ask the doctor or the nurse to provide them.