Which type of urinary incontinence is managed with timed voiding and double voiding

Timed Voiding is used to treat the symptom of urinary urgency – a sudden compelling desire to pass urine that is difficult to postpone. Urgency may be associated with a fear of leakage of urine or with actual leakage of urine.

Usually the urge is all of a sudden with little prior warning that you need to pass urine. Your bladder has become unreliable at indicating how full it is and when you are likely to next need to pass urine.

The urge comes on without your control. Timed Voiding and Bladder Training are about teaching you to regain voluntary control over your bladder. At least to begin, don’t try doing it overnight, just do it during the day.

Timed Voiding starts by going to the toilet before you get the urge, on the clock, even if you don’t feel like you need to pass urine. What time intervals you choose to start is determined by looking at your bladder diary and seeing how often you usually get the urge.  This approach is used for people who can't defer without incontience.  For those who can hold on they may not need to use time voiding and can go straight to bladder retraining where they try to gradually extend the time interval they can hold on for.

For example if you usually get the urge or leak with urge every 1 1/4 hours then you start by going every hour. Once you are dry on this regime you gradually increase the time interval between going to the toilet, day by day. Generally you stay at a time interval until you have mastered it before moving on so you may spend a few days at one level. You need to be pretty strict about the timing. As you increase the time interval, usually by 15 to 30 minutes each day, you need to try to hold on in between. You are aiming to be able to hold on for 3 – 4 hours eventually.

If you get an urge to pass urine you may be able to stop it by doing a pelvic floor contraction. This is why a pelvic floor exercise program in combination with bladder training is essential. You may also be able to take your mind off it by doing something else. For example if you get the urge when you walk in you front door, rather than rushing to the toilet try collecting the mail, and then with time even opening it first. Once the urge goes you can then slowly make your way to the toilet, rather than running.

Other measures include reducing things in the diet that may irritate the bladder such as caffeine found in coffee, tea, chocolate, cola drinks, and alcohol. Also avoid constipation.

Medications to treat the urge may be used with this programme.

Don’t worry about set backs. It takes at least 4-6 weeks to see results. Keep trying and think positively.

Version: V3, July 2017

Experts at UT Southwestern Medical Center have specialized training and expertise in caring for women with urinary incontinence. Our teams use the most advanced evaluation and treatment methods to provide compassionate care to relieve symptoms and treat underlying conditions.

Research-Backed Care for Female Urinary Incontinence

Urinary incontinence, also known as involuntary urination or leaky bladder, is a lack of bladder control resulting in the unexpected leakage of urine. It occurs more often in women than in men, with potential factors such as pregnancy, childbirth, and menopause playing a role.

While urinary incontinence might not be considered a disease, it can be associated with other conditions such as diabetes, multiple sclerosis, or stroke. Incontinence can greatly affect quality of life and often goes untreated for years. 

At UT Southwestern, our physicians offer the most effective and advanced therapies to treat women with all types of urinary incontinence. Our physicians were the first in North Texas to offer botulinum toxin (Botox®) injections for neurogenic bladder dysfunction. In addition, our physicians offer unique treatments such as neuromodulation for patients who have not had success with other therapies.

Types of Urinary Incontinence

There are different types of urinary incontinence, each with different symptoms. The five main types are:

• Stress incontinence: Urine leakage occurs when efforts such as coughing, sneezing, laughing, or exercising put pressure on the bladder.
• Urge incontinence: Often associated with overactive bladder, this type involves a sudden, intense need to urinate, and urine leaks before the person can get to a toilet.
• Overflow incontinence: When the bladder does not completely empty during urination, it can become too full, leading to frequent urine leakage.
• Functional incontinence: Problems such as a physical disability, mental impairment, or other barrier can prevent a person from reaching the toilet in time.
• Mixed incontinence: People can have more than one type of urinary incontinence, called mixed.

Causes of Urinary Incontinence

Sometimes, the causes of incontinence are unknown. Some known causes include:

• Blockage in the urinary tract, such as bladder stones
• Certain foods or drinks that act as diuretics, increasing urine production, such as caffeine, alcohol, spicy foods, or citrus fruits
• Certain occupations, such as those that involve heavy lifting or exertion
• Dementia or other mental health issues that make it difficult to notice the urge to urinate
• Diuretic medications such as heart or blood pressure medications, muscle relaxants, or certain sedatives
• Diabetes
• Injuries to the urinary tract or to the nerves or muscles that control its organs
• Neurological conditions such as multiple sclerosis, spina bifida, or Parkinson’s disease
• Pelvic organ prolapse
• Pressure on the bladder due to obesity or pregnancy
• Side effects of treatments such as surgery or radiation therapy
• Urinary tract infection
• Weakened pelvic floor muscle

How Patients Can Help Themselves

It’s possible to improve urinary incontinence through behavioral techniques, lifestyle changes, and certain exercises, including:

• Bladder training: When the urge to urinate arises, delay a trip to the bathroom by 10 minutes. Over time, increase the duration so that a bathroom visit is made only once every 2.5 to 3.5 hours.
• Timed voiding: Schedule a trip to the bathroom every two to four hours rather than waiting for the urge to urinate.
• Double voiding: After urinating, wait a few minutes and try again. This can help the bladder empty more effectively.
• Pelvic floor therapy/muscle training: Kegelexercises can help strengthenthe muscles that stop the flow of urine. Tighten (contract) those muscles for three seconds, then relax them for three seconds. Work toward doing at least three sets of 10 to 15 repetitions per day.
• Quitting smoking: A chronic cough can put pressure on the pelvic muscles.Smoking has also been shown to significantly contribute to the risk of stress incontinence and urinary urgency in women.
• Weight loss: Extra weight can contribute to urinary incontinence by putting pressure on the bladder or the tube that allows urine to pass out of the body (urethra).
• Dietary changes: Avoid caffeine, which irritates the bladder, and alcohol, which causes frequent urination. Cut back on spicy and acidic foods, which can also make incontinence symptoms worse.
• Smart lifting: Whenever possible, avoid lifting heavy objects. When it’s necessary to lift a heavy object, engage the pelvic floor muscles before and during the lift.

Treatment for Urinary Incontinence

Our specialists design treatment plans that are customized to each patient’s individual needs.

Stress incontinence

We typically begin treatment for stress incontinence with conservative methods such as behavioral techniques, lifestyle changes, and pelvic floor exercises.

Other nonsurgical treatment methods for female stress incontinence include:

• Vaginal pessary: Small plastic device that patients can insert into the vagina to support pelvic organs and improve bladder control
• Over-the-counter vaginal devices (such as Impressa) designed to gently support the urethra might help with mild forms of stress incontinence

If surgery is needed, our skilled specialists offer procedures such as:

• Injectable bulking agents: Bulking agent injected into tissues around the upper part of the urethra toimprove the closing ability of the sphincter
• Retropubic colposuspension: Surgery performed either laparoscopically or by abdominal incision that closes the urethra and bladder neck
• Sling surgery: Use of tissue from elsewhere in the body or synthetic material to create a support that helps keep the bladder neck closed
• Artificial sphincter: In rare cases, and more commonly in men, an inflatable cuff can be placed around the bladder neck (where the bladder meets the urethra); the cuff is controlled by a pump located in the labia (women) or scrotum (men)

Urge incontinence

Similar to that of stress incontinence, treatment for urge incontinence often starts with behavioral techniques, lifestyle changes, and pelvic floor exercises.

Our specialists might also prescribe medication and other nonsurgical therapies to improve bladder function. These include:

• Medications to allow the bladder to hold more urine
• Botox® injections into the bladder to relax muscles
• Sacral neuromodulation: Placement of an implantable lead in the sacrum, which allows the bladder to accommodate urine and improve urinary urgency and urge incontinence
• Percutaneous tibial nerve stimulation: 12 weekly treatments (followed by a maintenance program) using an acupuncture needle to gently stimulate the tibial nerve in the ankle to improve urinary urgency

If surgery is needed, our skilled specialists offer procedures such as augmentation cystoplasty, which is a surgery to make the bladder larger.

Clinical Trials

UT Southwestern’s clinical trials program gives patients access to treatments that are often unavailable at other health care facilities. Depending on the specific condition and the type of incontinence, UT Southwestern can offer patients promising therapies years before they are offered to the public. A variety of clinical trials using new devices and ground-breaking agents to treat stress and urge incontinence are currently available at UT Southwestern.

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What is timed voiding and double voiding?

What is timed voiding for urinary incontinence?

What are 4 types of urinary incontinence?

What is the purpose of a timed voiding protocol?