June 5, 2020 by Adrienne Sylver
Keeping Your Bladder Healthy
It’s not something you’re likely eager to talk about, even with your doctor. In fact, the American Urological Association cannot pinpoint the number of Americans who suffer from bladder conditions that often lead to leaking urine and too-frequent trips to the bathroom. It estimates, though, that anywhere from one-quarter to one-third of Americans suffer from some form of bladder condition or bladder-control problem.
While many conditions can affect the bladder, the most common are urinary incontinence, interstitial cystitis and recurring urinary tract infections, or UTIs, according to Sujata Yavagal, M.D., a urogynecologist affiliated with South Miami Hospital’s pelvic health and incontinence program and with Baptist Hospital.
“It’s important for people to realize that these conditions are treatable,” she said. “But you must tell your doctor when you have symptoms relating to your bladder function.”
Types of Urinary Incontinence
Urinary incontinence is the leaking of urine. The types of urinary incontinence are stress incontinence, urgency incontinence and mixed incontinence. Stress incontinence occurs when there’s a sudden change in pressure in the pelvis caused by activities such as laughing, coughing, sneezing or exercise. Urgency incontinence, commonly called overactive bladder, is a frequent urge to go to the bathroom, even when the bladder isn’t full. Mixed incontinence means people feel the need to go to the bathroom often and leak urine when they exert pressure through physical activity.
Incontinence Following Pregnancy
Dr. Yavagal notes that women may first experience urinary incontinence following the delivery of a baby. While it can resolve after about three months postpartum, incontinence should be reported to a doctor as soon as it’s recognized to ensure that any necessary treatment begins early.
As women age, their risk for urinary incontinence increases, but Dr. Yavagal says incontinence isn’t normal. To improve overall bladder health, she recommends performing Kegel exercises to strengthen the pelvic floor muscles. She also recommends lifestyle changes like maintaining a Body Mass Index of 25 or less, quitting smoking, getting regular exercise and avoiding constipation by following a healthy diet regimen.
She also urges paying attention to your toilet habits. Urinating too often, even when your bladder isn’t yet full may contribute to urgency incontinence. “You don’t want to hold your urine too long, but you don’t need to void every hour either,” she advised. “Normal bladder capacity is about 13.5 to 20 ounces of fluid, which takes about three or four hours to collect with normal fluid intake.”
Treatment Options for Incontinence
For stress urinary incontinence, pelvic floor physical therapy, like that offered through South Miami Hospital’s Pelvic Health & Continence Testing program and bladder sling surgery are treatment options available. Dr. Yavagal also points out that over-the-counter intravaginal bladder supports, worn like a tampon, are now available to prevent leaks.
For overactive bladder, fluid management, pelvic floor physical therapy, medications and Botox injections have proved effective treatments, she says. Also, a pacemaker-like device for the bladder has shown positive results.
Another bladder condition that Dr. Yavagal often sees in her practice is interstitial cystitis, characterized by flare ups of chronic pelvic pain and an urgent and frequent need to urinate, thought to be caused by the bladder’s reaction to an irritant. Also referred to as IC, painful bladder syndrome, bladder pain syndrome or chronic pelvic pain, interstitial cystitis often mimics a urinary tract infection, Dr. Yavagal says, but lasts much longer and can be harder to diagnose.
Managing Interstitial Cystitis
For patients with IC, diet and fluid management may be effective first-line defenses for controlling painful flare ups, according to the American Urological Association’s guidelines. More aggressive therapies involve pelvic floor rehabilitation, taking painkillers and surgical approaches.
Recurring Urinary Tract Infections
Teenage girls and postmenopausal women, especially, may suffer from recurring urinary tract infections, Dr. Yavagal says. The main risk factors for these infections, across all age groups, include a family or personal history of them, not emptying the bladder prior to or after sexual intercourse and vaginal dryness in postmenopausal women. Dr. Yavagal recommends seeking medical attention at the first signs of a new infection.
Treatments for Frequent UTIs
While antibiotics often are prescribed for urinary tract infections, Dr. Yavagal follows the advice of the Centers for Disease Control and Prevention (CDC), which warns that the overuse of antibiotics to treat urinary tract infections is leading to bacteria developing a resistance to the drugs, thereby making these treatments less effective in the future.
Instead, Dr. Yavagal recommends behavioral approaches to preventing UTIs in the first place. These include drinking sufficient amounts of fluid, practicing proper wiping techniques and voiding after sexual intercourse. And while there’s no scientific evidence that drinking cranberry juice or taking cranberry supplements will prevent UTIs, many have noted benefits and this approach isn’t harmful, she says.
“Because the most common bladder conditions are multifaceted in their causes, we don’t fully understand why they occur,” Dr. Yavagal said. “And while 100 percent prevention isn’t possible, we know the most effective ways to treat them, which can be life-changing for women, if they open up to their doctors about these issues.”
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