
About half of stroke patients lose bladder control. One-fourth leave the hospital with the problem. Still, 15 per cent deal with it at the year’s end.
What are the best practices to regain bladder control after a stroke?
Standard guidelines recommend two best practices.
- Bladder re-training with timed toileting.
- Pelvic floor muscle strengthening.
Bladder re-training with “timed toileting (voiding):
The 2023 UK National Guidelines for Stroke recommend “timed toileting” to improve bladder control after a stroke.
What is timed toileting?
“Timed toileting” helps to “re-train the bladder after a stroke. It is a behavioural technique.
To achieve that, we need a bladder timetable.
The following infographic list steps you can follow to create a bladder time table. It is available at the the UCSF3 (the University of California San Francisco) Health website.

- Step 1: Create a three-day bladder diary to understand the nature of the problem
- Step 2: Create a urine void timetable
- Step 3: 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
- Step 4: Continue the exercise for 6-12 weeks; there will be good days and bad days in between.
- Step 5: Complement it with daily pelvic floor muscle exercises
Pelvic floor muscle strengthening
The guidelines also recommend training pelvic floor muscles.
How to train pelvic floor muscles

- Step 1: Locate pelvic floor muscles (read the next section)
- Step 2: Create a timetable for exercises: At breakfast, lunch, dinner, and before bedtime; make it a habit
- Step 3: 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.
- Step 4: Maintain a bladder diary (download the template from their website, and modify it to suit your needs)
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 the abdominal, buttock, or thigh muscles
An educational graphic tool (Figure 1)
- Pelvic floor muscles: A graphical presentation

Image source: Wikimedia Commons from Version 8.25 from the Textbook OpenStax Anatomy and Physiology under the license of CC BY 4.0
Do you know how a stroke causes bladder problems?
Read the following posts…

- How stroke robs bladder control: strokecarer.com
- What bladder problems stroke can cause: strokecarer.com
- How measuring urine leak helps in bladder control activities
- University of Health Network: How to do pelvic floor muscle exercises: University Health Network: This includes a graphical presentation of pelvic floor muscles and some other methods of locating the muscles.
References
- Jo Booth (2019): Bladder rehabilitation in stroke survivors: who don’t nurses do it? The British Medical Journal blog/Evidence-based nursing
- Royal College of Physicians (2016): National Clinical Guidelines for Stroke, NICE accredited
- University of California San Francisco (UCSF Health): University of California San Francisco; bladder re-training.
- University of California San Francisco (UCSF Health): University of California San Francisco; pelvic muscle exercises
- Stroke Network, SouthWest Ontario: Module 4: Incontinence.