"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.
- 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. |
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- 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. |
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| 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.
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