The aim is to train the bladder to accept progressively larger and larger volumes of urine, and thus relearn the voluntary central control of detrusor contractions.
A suitable drill is as follows. Get the patient to urinate sufficiently often to keep dry, e.g. by hourly voiding. Having established this interval, gradually increase the interval between voiding, e.g. by 15 minutes every 3 days. This is to deliberately stimulate a detrusor contraction and to practice inhibiting it. The process may be more effective if the periods of holding the urine in are under supervision. Eventually the period between voiding may be returned to normal.
Bladder retraining requires considerable drive and persistence to work. It is most suited for patients with a strong pyschological element to their incontinence. The elderly tend to do less well with this method.
Biofeedback is a variant of bladder training. Physiologic changes are monitored by various instruments and fed back to the patient in an attempt to induce cortical change. The results are similar to those of bladder training but with the disadvantage of increased manpower and equipment costs.
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