Proven Practices for Resolving Matters of the Bladder
By Geri Brin, Co-founder, M.D. For You
Illustration by: Cé Marina
Helping my 85-year-old mom long ago choose “adult diapers” for her incontinence issue I thought. “Never! I’d rather die than wear those.”
I’m still alive, and now I’m the one with the “overactive bladder.” That’s a cute way of saying I need to get to the bathroom moments after I get a sudden—and urgent—need to pee. Otherwise, I’d better be wearing an undergarment that will absorb the leak. I have “urge incontinence.”
Bladder symptoms are common as women age, reported Dr. Amanda Clark, a highly respected and prominent urogynecologist and researcher. You might need to pee more often. Perhaps you’ll experience unexpected or unwanted leaks, say when you cough, sneeze, or exercise. That’s called “stress incontinence.”
Or maybe, like me, you can no longer stall before heading for the bathroom.
“Normally, the bladder will give you a heads-up to find the bathroom in the next half hour or so, depending on how much you’ve had to drink,” Dr. Clark explained. But when you’re so desperate to pee you can barely walk another step, it means your bladder muscles are tightening on their own, even when the amount of urine is low.
Simple Roads to Relief
These three approaches apply to both urge and stress incontinence:
A. Make sure you’re not drinking too much or too little fluid. "Two liters a day—64 ounces—are recommended, unless you’re hiking in the desert,” Dr. Clark stressed.
B. Watch your diet and see if any foods irritate your bladder. Coffee, alcohol, artificial sweeteners, and carbonated drinks may be stimulants for some women, Dr. Clark added. “If coffee gets your bladder going, for example, don’t drink it if you’re going out and don’t know if you’ll have quick access to a bathroom.”
C. Get acquainted with your pelvic floor muscles. Together with connective tissue, they support important organs in your pelvis, like your bladder, bowel (large intestine), and internal reproductive organs. Besides holding the organs in place, the muscles protect your spine and organs from outside pressures such as lifting and coughing, help control bowel and bladder functions, and move waste from your body.
Squeezing your pelvic muscles narrows the urethra and anal canal so that pee and stool can’t escape. Relaxing these muscles widens these passages so that you can urinate and defecate. Healthy pelvic floor muscles allow you to squeeze and relax automatically. You can also control them deliberately, like you do when flexing a bicep.
The pelvic floor muscles, plus abdominal muscles, back muscles, and diaphragm (the muscle controlling breathing) attach to the pelvis and spine, stabilizing the center of the body, aka “the core.” While they need to be strong, they also need to have the flexibility to stretch and relax.
Stress during pregnancy, repeated heavy lifting, chronic coughing, constipation, and surgery —such as a hysterectomy—can weaken pelvic floor muscles. So can hormone changes during menopause, diabetes, and just simple aging.
"You can check the strength of your pelvic floor muscles by trying to stop your urine stream once or twice while you’re sitting on the toilet to pee," Dr. Clark explained. ”If you can do that, you’re using the right muscles, If you can’t, it's wise to see a physiotherapist, a professional who is trained to use physical methods to treat disease, injury or deformity,” she added.
More Complicated Roads to Relief
“Leakage is not a life-threatening problem, but it’s a quality-of-life issue. It can interfere with exercise, which is crucial for health, and with social activities such as going to a movie, play, or a county fair. It can limit your life,” Dr. Clark said.
If the simple treatments don’t work, Dr. Clark advises discussing the options available with a qualified healthcare provider.
For urge incontinence, these include:
Medication that reduces the urges.
An acupuncture-like procedure that involves inserting a tiny needle into the inner side of the ankle that’s attached to a little box emitting a light electrical stimulus. This is performed 30 minutes weekly for 2 weeks, then monthly. “It can be as effective as medication and has no side effects,” Dr. Clark reported.
“Botox can be injected into the bladder for more severe cases,” Dr. Clark said. Requiring a light anesthetic that partially paralyzes the bladder muscle so it can’t contract too strongly, the procedure can be performed as an office procedure or as a day surgery. “It can be a very effective treatment over time, but It should be done every six months because the Botox wears off,” Dr. Clark noted.
Lastly, a tiny needle can be inserted near the bladder nerves, which has a pacemaker-like device that keeps the bladder stimulated and more relaxed.
For stress incontinence, these include:
Devices that can be worn inside the vagina to support the bladder neck from moving too much during coughing or sneezing.
A disposable, over-the-counter device, called a pessary, that can be inserted into the vagina to provide support for women who run, for example. It can be removed when you’re not worried about leaking.
Surgical mesh that’s two to three inches long and can be placed around the bladder neck or urethra. Acting like a hammock to catch the bladder when a woman coughs or sneezes, it stops the bladder from moving up and down too much. “It’s the best stress incontinence treatment we’ve had in 100 years of surgery for this issue,” Dr. Clark explained.
“Your choice should be guided by how greatly you're affected by incontinence,” the doctor added. “The risk of mesh surgery is small, and it will make a huge difference in your quality of life."
Banishing Bladder (aka Urinary) Infections
Normally common in women, bladder infections become more frequent in menopause because decreased estrogen dramatically decreases bladder defenses, Dr. Clark said. “Fortunately, we can prescribe local vaginal estrogen for women who don’t need to take systemic hormones.”
Creams, inserts, and rings are among the ways to get estrogen into the vagina to treat it and the bladder together without creating body-wide effects. “This can cut bladder infections in half, which is huge. It also avoids the hassles associated with antibiotic therapy and yeast infections,” Dr. Clark advised.
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