Bladder Problems

Bladder Problems

Taming a Nasty Nuisance

Your bladder, once as dependable as the Hoover Dam, has lost its reliability. Wherever you go these days, you fear the floodgates will open, embarrassing you beyond belief.

Your social life is wilting. You feel frustrated, angry and humiliated. You're too young for these kinds of problems, you tell yourself. Yet you're too bashful to ask anyone, even your doctor, for help.

"The psychological impact of a bladder problem is tremendous. If a woman between the ages of 30 and 50 begins to urinate more frequently, wets herself or has other bladder problems that she associates with aging, I'm sure that she might think 'This never used to happen to me. My god, I must be getting older. This is the first thing that happened to Aunt Millie when she started her downward slide,' " says Alan J. Wein, M.D., chairman of the Division of Urology at the University of Pennsylvania School of Medicine in Philadelphia.

But in reality, most bladder difficulties are not an inevitable sign of aging. In fact, urinary tract infections and incontinence, the two most common causes of bladder problems, can affect women at any age and can usually be treated effectively or cured, Dr. Wein says.

Here's a closer look at the causes of and remedies for these two nuisances.

When Bacteria Invade

It may begin with a severe pain every time you urinate. Soon you feel the unmistakable urge to go again, even if you went just a few minutes ago. And when you do go, a surprisingly small amount of urine trickles out. Sometimes your urine has a strong odor and you pass blood. In severe cases, you might also develop back pain, chills, fever, nausea and vomiting.

More than likely, you have a urinary tract infection (UTI), the most common bladder problem among women in their thirties and forties, Dr. Wein says. At least 25 to 35 percent of women between the ages of 20 and 40 have had at least one UTI. Of those, nearly 20 percent will have at least one recurrence, says Penny Wise Budoff, M.D., clinical associate professor of family medicine at the State University of New York at Stony Brook Health Sciences Center School of Medicine. Overall, women are up to 50 times more likely than men to develop UTIs.

That's because a woman's urethra, the tube that carries urine out of the bladder, is less than two inches long. Since it is so short, the urethra is vulnerable to invasion by bacteria that naturally live in the vagina and rectum. Sexual intercourse can drive bacteria up into the urinary tract, where these microorganisms can cause inflammation of the urethra, bladder or kidneys.

Waiting too long to urinate is another common cause of UTIs. If you go for hours without urinating, you can stretch the bladder muscle and weaken it to the point that it can't expel all the urine. This residue of urine increases your risk of infection.

Once an infection strikes, your doctor will prescribe antibiotics, says Jonathan Vapnek, M.D., assistant professor of urology at Mount Sinai School of Medicine in New York City.

While your family physician can treat a UTI, you should see a urologist or gynecologist if you have blood in your urine, recurrent UTIs or a history of kidney infections or stones, Dr. Vapnek says.

In some cases, women with UTIs may develop interstitial cystitis, a chronic disease that causes inflammation of the bladder. Women who have it often feel the urge to void up to 60 times a day. It has no known cause or cure, but its symptoms are often relieved by drugs such as steroids and antihistamines.

Although bladder infections should be brought to your doctor's attention, there are plenty of ways to prevent them in the first place. Here's how.

Fill 'er up. Drinking at least six eight-ounce glasses of water and other noncaffeinated beverages every day dilutes urine in the bladder, which makes it more difficult for bacteria to thrive, Dr. Budoff says.

Urinate often. Try to empty your bladder at least four to six times a day, Dr. Budoff says. That will help keep your bladder clear of bacteria. Going to the bathroom that often shouldn't be a problem if you drink plenty of fluids.

Quaff cranberry juice. This age-old remedy got a shot of scientific validation from researchers at Harvard Medical School, who divided 153 women into cranberry juice drinkers and non­cranberry juice drinkers. Those who drank about ten ounces a day of the tangy beverage experienced bladder infections only 42 percent as often as those who did not. The researchers speculate that cranberry juice may inhibit bacteria's ability to latch on to the bladder wall.

Let it go after sex. Urinate soon after intercourse, suggests Deborah Erickson, M.D., a urologist and assistant professor of surgery at the Pennsylvania State University College of Medicine in Hershey. Urinating will flush out any bacteria that were driven into the bladder during sex. If you have recurrent infections, ask your doctor about the possibility of taking an antibiotic after sex.

Take a close look at your birth control. Researchers at the University of Washington found a connection between recurrent UTIs and women who use diaphragms in conjunction with spermicide. Women who used this contraceptive method had much greater risk of having Escherichia coli bacteria, the most likely culprit to cause UTIs, in their urine. If you use a diaphragm with spermicide and suffer frequent UTIs, consider switching to another form of birth control, says Seth Lerner, M.D., assistant professor of urology at the Baylor College of Medicine in Houston. Consult with your doctor.

Practice good hygiene. Washing your hands before and after urinating may reduce your chances of a UTI, Dr. Budoff says. When wiping your bottom, do it from front to back. That will keep potentially harmful bacteria away from your urethra. For extra cleanliness, Dr. Budoff suggests using a large, moistened cotton ball to wipe from front to back.

Shower, don't bathe. Soaking in a tub filled with soapy water or bubble bath can irritate the lining of the urinary tract, particularly if you have a history of recurrent bladder infections, says David Rivas, M.D., a urologist at Thomas Jefferson University Hospital in Philadelphia.

Stick with cotton. Snug nylon panties can restrict airflow, trap moisture and promote bacterial growth around the urethra, Dr. Rivas says. Instead, wear loose-fitting cotton undergarments that permit better air circulation. If you wear panty hose, be sure that they have a cotton crotch.

The Horror of Losing Control

When your son throws a baseball through a window or your husband plows the car into a snowbank, you shrug it off because you know accidents do happen. But the accidents that have plagued you lately aren't so easy to dismiss. You may have trouble getting to the bathroom in time or experience an embarrassing leak when you cough, sneeze or even lift weights at the gym.

"Incontinence makes some women feel older because they think it's a sure sign that they're becoming decrepit. It signifies a lack of control and suggests that other valued qualities of life, such as exercising, traveling and even living independently, are at stake," says Katherine Jeter, Ed.D., executive director of Help for Incontinent People in Union, South Carolina.

But incontinence isn't necessarily a sign of aging, Dr. Lerner says. In fact, studies indicate that about one in four women between the ages of 30 and 59 has had at least one instance of incontinence in her adult life. That's about the same rate as for women over 60.

"Incontinence isn't like gray hair. It's not inevitable," Dr. Lerner says. "It usually has an underlying physiological cause that may be treatable."

Older women tend to have incontinence for different reasons than younger women, says Tamara Bavendam, M.D., assistant professor of urology and director of the Female Urology Clinic at the University of Washington Medical Center in Seattle. Arthritis, for instance, can make it more difficult for an older woman to walk to a bathroom quickly. Older women are also more likely to take medications, and some drugs--such as those used to treat heart disease--can cause excessive urine production that overwhelms the bladder's capacity.

Of the major types of bladder leakage, stress incontinence and urge incontinence are the most common among women in their thirties and forties, Dr. Lerner says. Stress incontinence may result when pelvic floor muscles are weakened or damaged. This can occur because of pregnancy and childbirth, excessive weight or decreased hormonal production. The bladder and urethra sag, and the sphincter muscle can't completely close. So any abdominal pressure, such as a laugh or sneeze or lifting a heavy object, triggers a leak.

Urge incontinence, which can be caused by UTIs or inflammation of the bladder, occurs when irritated or overactive bladder muscles contract uncontrollably. As a result, a woman can feel a compelling need to urinate. If she hesitates, she may lose urine before she gets to a bathroom, Dr. Bavendam says. Sometimes a woman can have a combination of stress and urge incontinence.

In another type of incontinence called overflow incontinence, a woman feels no urge to void, so the bladder fills to the brim and causes so much pressure that the excess urine spills out. Diabetes is one of the primary causes of this type of bladder leakage. But women who habitually hold their urine for more than five or six hours at a time can damage their bladder muscles and develop overflow incontinence, Dr. Bavendam says. Stroke, spinal cord injuries, multiple sclerosis and other neurological disorders can also cause overflow incontinence.

It's important to remember that incontinence is not a disease but a symptom of an underlying ailment, Dr. Erickson says. So if you have a leaky bladder, don't assume that you'll need to wear adult diapers the rest of your life. More than likely, your doctor can help you. Sometimes that may mean taking drugs that will tighten the sphincter muscle or relax the bladder muscle to stop inappropriate bladder contractions. As a last resort, surgery can restore a sagging bladder to its natural position or make the urethra tight. But in most cases, simple remedies such as doing pelvic muscle exercises or making changes in diet or bathroom habits relieve the problem. Here are some ways to keep yourself dry.

Keep track. Keep a urinary log for a week or two before you see a doctor, Dr. Vapnek suggests. Note what you eat and drink, when you go to the bathroom and when and where you leak. Were you coughing, or did you feel an urge and not make it to the bathroom on time? The diary will help you and your physician track down the problem.

Know your drugs. Some medications, including diuretics, antihistamines, sedatives, anticholinergics such as motion sickness drugs and over-the-counter cold remedies, can weaken bladder control, Dr. Wein says. If you're taking any drug, ask your doctor or pharmacist if it could be contributing to your problem.

Target your diet. Some women report that consuming coffee, tea, carbonated soft drinks, artificial sweeteners, chocolate, tomatoes, hot spices and other foods and beverages makes their incontinence worse, Dr. Bavendam says. If you suspect a food may be contributing to your problem, try eliminating it from your diet for a week and see what happens. If your symptoms improve, continue to avoid that food, since it may have been irritating your bladder.

Puff no more. Women who smoke are 2.5 times more likely to develop incontinence than women who don't light up, says Richard Bump, M.D., associate professor and chief of the Division of Gynecologic Specialities at Duke University Medical Center in Durham, North Carolina, who studied incontinence among 606 smoking and nonsmoking women. He suspects that excessive coughing, which is common among smokers, weakens pelvic floor muscles and causes stress incontinence. Smoking may also irritate bladder muscles, so they contract more often and cause leaks. So if you smoke, quit.

Drink up. "A lot of women will cut back on their fluids in the hope that less in equals less out," Dr. Jeter says. But doing that may make you more, not less, likely to have problems, because highly concentrated urine irritates the bladder and causes it to contract to rid itself of that urine as soon as it can. Restricting fluids can also lead to dehydration, constipation, UTIs and kidney stones. Drink at least six to eight glasses of water, juices or other fluids a day, Dr. Erickson says.

Loosen up. Constipation can contribute to incontinence. When your rectum is full of stool, it can put pressure on the bladder and increase the risk of urge incontinence. So be sure to eat a high-fiber diet that includes fruits, vegetables and whole-grain breads and cereals.

Dr. Jeter recommends a recipe of 1 cup of applesauce, 1 cup of oat bran and ¼ cup of prune juice in a bowl. Add spices such as cinnamon or nutmeg for taste, then refrigerate. Introduce the mixture into your diet slowly, building up to two tablespoons each evening as needed, followed by an eight-ounce glass of water. The water is essential, says Dr. Jeter; without it, adding fiber can actually make matters worse.

Do a double take. If you feel like your bladder isn't draining completely, try double voiding. To do it, remain on the toilet until your bladder feels empty. Then stand up for 10 to 20 seconds, sit down, lean slightly forward over your knees, relax, and wait until your bladder empties completely, Dr. Jeter says.

Shed a few pounds. Excess weight strains the pelvic floor muscles and increases the risk of incontinence, Dr. Vapnek says. "Women who are moderately overweight tell us that the loss of just five to seven pounds means the difference between being wet and staying dry," Dr. Jeter says. Ask your doctor if losing a few pounds might help you.

Dodge booze. Alcohol is a diuretic that will make you produce a lot of urine very quickly. So if you have an incontinence problem, drinking alcohol can make it worse, Dr. Rivas says.

Use those muscles. Kegel exercises can strengthen the pelvic floor muscles and reduce your chances of a leak, Dr. Erickson says. To do Kegels, squeeze the muscles in your rectum as if you were trying to prevent passing gas. This should also tense the pelvic floor muscles. Feel the sensation of the muscles pulling upward. That's the sensation you want to achieve when doing these exercises. Squeeze the muscles, hold for a slow count of four, then relax for another count of four. Try to do 10 sets of Kegels each day. As these muscles become stronger, gradually increase the time you squeeze until you can hold the position for 25 to 30 sets of ten seconds each. Your bladder control should improve within three to four weeks.

As an alternative, consider using weighted vaginal cones. The cones, which are about the size of a tampon, are available in sets of five increasing weights ranging from ¾ ounce to 3 ounces. When you insert a cone into the vagina, you must squeeze the pelvic floor muscles to hold it in. When the muscles tire, the cone slips out.

"If you can hold the cone in, you know that you're doing your Kegels right," Dr. Erickson says. "You'll probably be able to hold the cone in for just a couple of minutes at first, but as your muscles get stronger, you can hold it in for longer and longer. I tell my patients that when you can hold a cone in for 15 minutes, then it's time to move on to the next higher weight." For more information about the cones, write to Lifestyle 2000, P.O. Box 3115, Princeton, NJ 08543-3115.

Balance your needs. Bladder control is often a matter of equilibrium, Dr. Bavendam says. The average women can go three to four hours without voiding. But if you urinate every hour, for instance, you won't stretch the bladder to its full capacity. On the other hand, if you wait longer than four hours, you may be straining your bladder muscles to the point that they can't hold in the urine anymore.

If you tend to hold your urine too long, don't fight nature, Dr. Erickson says. When you feel the urge to void, do it, even if you have to excuse yourself from an important business meeting. It may prevent an embarrassment later.

If you urinate more often than you'd like, try bladder retraining. To do it, urinate when you first get up in the morning, then set a timer for one hour. When the timer sounds, go to the bathroom, even if you don't feel the urge. Then reset the timer for another hour. Do this every waking hour for a week. Then each subsequent week, add 30 minutes to the time between bathroom trips until week seven, when you should be at four hours. If you feel the urge to void before the time is up, do Kegel exercises or concentrate on a distracting task, such as recalling the phone numbers of ten friends or relatives, until the urge passes.

For more information about incontinence, send a self-addressed, stamped business-size envelope to Help for Incontinent People, P.O. Box 544, Union, SC 29379, or the Simon Foundation for Continence, P.O. Box 835, Wilmette, IL 60091.