Timed Voiding and Fluid Management


Timed voiding (also referred to as bladder retraining/training, bladder drill, bladder discipline, and bladder reeducation) is a behavioral exercise used to establish bladder control in adults. Evidence indicating that bladder training is effective in women with urodynamic urge incontinence with or without associated detrusor overactivity, sensory-urgency without incontinence, and urodynamic stress incontinence, has led to the 1996 Clinical Practice Guideline's recommendation of bladder training as a first-line therapy for urge, stress, and mixed incontinence. Urodynamic studies are not required before initiation of behavioral therapy.

The three components of timed voiding are education regarding continence and incontinence mechanisms; scheduled voiding with systemic delay of voiding by implementing distraction and relaxation techniques; and positive reinforcement provided by a caregiver. The specific goals of bladder training include correcting inappropriate habits of frequent urination, improving control of bladder urgency, extending intervals between voids, increasing bladder capacity, reducing incontinence episodes, and building patient self-confidence in bladder control. There is very little understanding of how bladder retraining works. Several hypotheses exist, including improved cortical suppression of sensory stimuli from an uninhibited bladder, improved cortical inhibition of an overactive detrusor muscle, maintenance of bladder pressures lower than the urethral closure pressure during stress, increasing bladder “reserve” volume, and altered patient behavior to avoid incontinence triggers and to gain awareness of the lower urinary tract.


Urinary Incontinence Detrusor Overactivity Interstitial Cystitis Caffeine Intake Urodynamic Stress Incontinence 
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© Springer-Verlag London Limited 2008

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Urological Institute and Women's Health Center, Section of Urogynecology and Reconstructive Pelvic SurgeryThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of Obstetrics and GynecologyThe Cleveland Clinic FoundationClevelandUSA

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