Behavioural modifications
So much of our toilet behaviour is formed through habit.
No-one taught us how to empty the bladder, or evacuate the bowels. This may not have been a problem when we were young, but years of bad habits can cause all sorts of problems.
Common examples:
- going to the toilet just in case can decrease the bladder volume, resulting in more trips to the toilet, worsening the problem
- straining when evacuating the bowels decreases the body’s own ability to ‘expel’ faecal matter, resulting in the need to strain, worsening the problem
Often, examining the way in which we interact with the world, and the toilet, gives us valuable insight into possible places where we can regain lost control.
After all, who is the boss? You? The bladder?? The bottom and the bowel???
Bladder Retraining (Drill)
The bladder can learn bad habits, often over a period of years. This means that the bladder starts to dictate when it should be emptied rather than allowing you to decide when it’s convenient for you.
To regain control of your bladder it is necessary to ‘train’ it:
- Do not empty the bladder ‘just in case’. If you need to go more often than every 2 hours try to wait a little longer, even a few minutes will help. This will help to stretch the bladder a little and encourage it to hold better volumes.
- When the urge to go to the toilet comes over you try to keep calm. Sit down, if possible, and try to hold a pelvic floor contraction (not as hard as you can, but hard enough to prevent leaking) for about 20 seconds, or as long as you are able. The desperate urge should pass. This either allows you to defer going for another minute or 2, or to get to the toilet without leaking on the way. Sometimes the urge passes completely and it may be a half hour before you get it again!
- Do not restrict your fluid intake; the less fluid, the stronger the urine, the more irritable the bladder becomes. Try to drink at least 1.2 litres a day, or 5 glasses. Water is by far the best!
- Some bladders are sensitive to caffeine. Caffeine is found in coffee, tea, cola and, horror of horrors – chocolate!!! Reducing your intake may prevent you going to the toilet so often. Bladders are also sensitive to alcohol.
- If you wake at night to empty your bladder, don’t drink within two hours of going to bed.
Persevere – bladder training usually takes at least 6 weeks before it has a noticeable effect.
Defaecatory technique (Getting things moving)
There is a particular position that simultaneously encourages the bowels to work freely and the pelvic floor to relax. This promotes emptying the bowels without straining.
Straining can damage the muscles of the pelvic floor by stretching and weakening them.
- The knees should be higher than the hips. To achieve this, the feet may need to be supported on a box, or pile of magazines, about 10 – 15 cm high.
- Lean forward, keeping the back straight and letting the abdomen hang loosely.
- Rest the elbows on the knees.
- Relax the pelvic floor.
- ‘Strain’ by allowing the abdomen to swell forwards and the waist to swell sideways.
- DO NOT hold the breath and push.
- Open the mouth and whisper (non-spoken) “Pah-ha-ha” on the breath out.
- Keep breathing until the urge to push comes. Push GENTLY.
- If no success:
Relax, lean back and wait for a few seconds
Resume the above position and try again
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