Deferment Techniques

Both bladder training and habit training usually incorporate deferment techniques to help suppress the urge to void.  Deferring the urge to void helps to achieve control over the bladder as well as to increase bladder capacity.  Attempting to defer voiding is quite difficult, but certain deferment techniques may help:

Pelvic floor muscle contraction.  Pelvic floor muscle contraction is what almost everyone does instinctively to prevent urine leakage when there is an urgent need to go to the toilet.  The conscious contraction of the pelvic floor muscle helps increase sphincter contraction and prevent urine leaking out while the bladder is trying to contract.  The contraction of the pelvic floor muscle also helps to switch off the bladder contraction.  Pelvic floor muscle contraction is most effective if it is applied as soon as possible after the initial sensation of the bladder contraction, as it helps to override the detrusor contraction before the pressure in the bladder is high and, therefore, more difficult to override.  The pelvic floor contraction needs to be maintained until the bladder contraction has diminished; otherwise, leakage may occur.

Perineal pressure.  Perineal pressure is a well-known technique used by both children and adults. Little girls often put their hand between their legs to put pressure on the perineum to help them hang on until they reach the toilet.  Sitting on the edge of a chair, or sitting on the arm of a chair with the chair arm pressing on the perineum between the vagina and the rectum, in females, helps to override the urge to void.  This can be supplemented with slight bouncing up and down to increase perineal pressure.  In males the pressure needs to be applied behind the scrotum towards the rectum.   Sitting on the heel with the heel placed between the vagina, or scrotum, and the rectum, can have a similar effect.  The pressure should be maintained until the unstable bladder contraction subsides.  If augmented by pelvic floor contraction, this action can help switch off the bladder contraction.  Cross thighs, tighten buttocks, toe curling may help.

Penile squeeze. Obviously, penile squeeze is a male-only technique!  The penis is squeezed just behind the tip, between the thumb and forefinger.  The grip should be firm and should be applied top to bottom, not side to side.  The squeeze technique is used often in conjunction with pelvic floor contraction.  It can be applied through the trouser pocket.  The person should not let go until it is safe to do so!

Mental distraction.  Mental distraction is probably the most commonly used deferment technique.  By taking the mind off the bladder it is possible to override the first, urgent urge to void.  Some useful forms of mental distraction are reciting poetry, doing mental arithmetic, playing mind games, or engaging in any mental activity that is totally absorbing and takes the mind off the bladder contraction and the toilet.  The mental activity should be maintained until the bladder contraction has faded.  Thinking of waterfalls, lakes or rain is rarely effective!

Deferment techniques need to be used every time the bladder has an unstable contraction.  This should be maintained until the contraction fades and normal activities can continue.  The bladder should be emptied only when it feels full.   It can take a while to find the technique that is most effective for individual patients.