How to retrain the bladder after stroke

The Royal College of Physicians in their 2016 National Guidelines for Stroke1 recommend the following two methods to regain bladder control with bladder training after stroke:

  • Retrain the bladder after stroke
  • Do pelvic floor muscle exercises

How to retrain the bladder

  • Maintain a three-day bladder diary to understand the nature of the problem
  • Create a timetable to void urine (a normal person takes 3-4 hours to fill the bladder)
  • Increase the interval by 15-minute increments weekly until you reach the 3-4 hour interval
  • When you feel the urge before the time suppress it; use relaxation methods
  • Continue the exercise for 6-12 weeks; there will be good days and bad days in between.
  • Complement it with daily pelvic floor muscle exercises

(Source: University of California San Francisco (UCSF Health2)

How to do pelvic floor muscle exercises

  • Locate pelvic floor muscles (read the next section)
  • Create a timetable for exercises: At breakfast, lunch, dinner, before bedtime; make it a habit
  • Squeeze the muscles for a slow count of three; then relax in the same way; do 15 times in one set.
  • Increase the count gradually.
  • Maintain a bladder diary (download the template from their website, modify it to suit your needs)

(Source: University of California San Francisco (UCSF Health3)

How to locate pelvic floor muscles (Figure 1 below)

  • Method 1: Tighten the anus as if not to pass gas
  • Method 2: insert a finger into the vagina and try to squeeze the finger
  • In both situations do not tighten abdominal, buttock, or thigh muscles

(Source: University of California San Francisco (UCSF Health3)

Educational tool (Figure 1)

  • Pelvic floor muscles: A graphical presentation
This image has an empty alt attribute; its file name is 1200px-1115_Muscles_of_the_Pelvic_Floor.jpg
Figure 1: The pelvic floor muscles;
image source: Wikimedia Commons from Version 8.25 from the Textbook OpenStax Anatomy and Physiology under the license of CC BY 4.0

Current situation

Bladder leakage is managed with pads and catheters without treating the cause.

Jo Booth, Professor of Rehabilitative Nursing at Glasgow Caledonian University.4

Read more…


  1. Royal College of Physicians (2016): National Clinical Guidelines for Stroke, NICE accredited
  2. University of California San Francisco (UCSF Health): University of California San Francisco; bladder re-training.
  3. University of California San Francisco (UCSF Health): University of California San Francisco; pelvic muscle exercises
  4. Jo Booth (2019): Bladder rehabilitation in stroke survivors: who don’t nurses do it? The British Medical Journal blog/Evidence-based nursing


Author: Prasantha De Silva

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