A to Z Disease

Summary for HealthiNation's Bladder Problems

Hosted by Dr. Holly Atkinson, Internal Medicine

Bladder Problems Overview

An estimated 13 million Americans suffer from bladder problems, or Urinary Incontinence (UI). The condition is often associated with age, gender, and physical changes that occur with surgery, pregnancy, or menopause. Regardless of the cause, bladder control problems aren't just a normal part of aging and can be treated.

How Bladder Problems Develop

The bladder is the organ that stores urine. It has a small tube, called the urethra, that allows urine to pass from the body. Beneath the bladder is a muscle called the "pelvic floor muscle." This muscle is usually contracted, which helps support the bladder and keep urine from leaking. During urination, the neck of the bladder relaxes and the urethral sphincter opens. At the same time, the bladder muscle, called the detrusor muscle, contracts to expel the urine.

Types of Bladder Problems

Stress Incontinence. This is the most common type of bladder problem. It's the loss—or leakage—of urine caused by pressure on your bladder from a sneeze or cough, or exercise. This typically affects women, but it can occur in men after the removal of the prostate gland.

Urge Incontinence. This is sometimes called Overactive Bladder. It happens when the bladder muscle contracts, even when the bladder isn't full. This is characterized by a sudden urge to urinate, which sometimes causes accidents. The condition can be caused by side effects of drugs, nerve damage, stroke, or neurological diseases such as MS, Alzheimer's and Parkinson's Disease. Sometimes, the cause of urge incontinence just can't be explained.

Overflow Incontinence. People with Overflow Incontinence dribble or leak urine on a frequent or constant basis. This occurs because the bladder doesn't empty completely during urination. Overflow Incontinence can be caused by prostate problems, nerve damage from diabetes or even as a side effect of some medications. It far more frequent in men than women.

Mixed Incontinence. This is the presence of more than one of the above conditions. Typically, the problem stems from a combination of Stress and Urge Incontinence.

Functional Incontinence. This type usually affects older adults, and is especially prevalent in individuals residing in nursing homes. This type of incontinence usually results from a physical disability like arthritis or a neurological disease like Alzheimer's.

Overnight Incontinence. This can happen in adults who take certain medications or drink too much alcohol. This can also happen in children who are either toilet trained or are still toilet training.

Treating Bladder Problems

Incontinence should be treated under the supervision of your doctor. Treatments fall into four main categories:

Behavioral Techniques. Behavioral treatments focus on lifestyle changes and also on strengthening the muscles involved in urination. This is usually done with "Kegel" exercises. Kegel exercises are a good way to strengthen the pelvic floor muscle (the muscle you tighten to hold your urine or when you're trying to keep from passing gas).

Other behavioral techniques include bladder training and timed urination. Bladder training means teaching the bladder to hold urine for a certain amount of time after you feel the urge to go to the bathroom. Your doctor may start by asking you to delay bathroom trips for five minutes after the urge. That delay will be extended as you progress in treatment.

Another bladder training method is called double voiding. This means trying to empty the bladder for a second time soon after an initial urination. This ensures that the bladder is completely empty, and should cut down episodes of overflow incontinence.

Medications. Medications to treat bladder problems have proven to be successful, usually when used in combination with behavioral techniques. Before taking any of these medications, talk to your doctor about side effects.

* Antispasmodic medications work by stopping frequent bladder contractions. They are prescribed for those with Urge Incontinence.
* Certain anti-depressants can relax the bladder muscle, resulting in fewer urges to go to the bathroom.
* Antibiotics may be used if the cause of incontinence is an infection of the urinary tract or an enlarged prostate.
* Hormone therapy treatments are available for women after menopause or for children.

Medical Devices. Some medical devices can help stop urinary incontinence by either closing the urethra, or supporting the bladder, like the pelvic floor muscle does.

Surgery. Surgery is usually done as a last resort and may not be right for everyone.