Bladder Health - Things to know when you have to “go”

By Karthik Tanneru, M.D.
MUSC Health - Urology

We use our bladder several times each day, but we never really focus on bladder health. The normal capacity of the bladder is 400-500 milliliters. Some bladder health symptoms to be aware of are; frequency urinating more than 6-8 times in a 24-hour period; nocturia, defined as the feeling of needing to urinate greater than one to two times during sleep; a sense of urgency, meaning a strong desire to empty your bladder; urge incontinence (leakage of urine) or straining to urinate and poor urine flow. It’s essential to understand bladder health to identify problems and when to seek medical advice.

Bladder dysfunction due to aging

Older adults experience symptoms such as frequency, urgency, urinary incontinence, and impaired emptying. Physiologic changes like decreased bladder muscle strength, loss of estrogen affect blood flow leading to the loss of urethral muscle mass, prostate obstruction in men, and alterations in central neurological control mechanisms contribute to these symptoms. Diabetes mellitus, Dementia, and several types of medications may contribute to these symptoms. Constipation also plays a significant role in retaining urine.

It is possible to consider behavioral interventions to include prompted or timed voiding, reduction in fluid intake, or avoidance of bladder irritants. If behavioral changes fail, pharmacologic therapy or surgical therapy is an option for treatment.

Overactive bladder

Some signs of overactive bladder syndrome (OAB) can be symptoms of urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia.

Treatment for OAB includes lifestyle modifications such as avoiding caffeinated beverages. Other modifications also include reducing other bladder irritants and restricting fluid intake in the evening hours. Behavioral therapy, along with bladder retraining and pelvic floor muscle rehabilitation, are effective treatment options too.

Antimuscarinic agents and beta-3 agonists are OAB medical therapy options. If medication is not tolerated or is ineffective, injecting botulinum toxin A (Botox) into the bladder or sacral neuromodulation is available.

Stress Urinary Incontinence

An involuntary loss of urine from physical exertion, sneezing or coughing, can be attributed to defects in urethral support, urethral coaptivity, urethral composition, or neurologic innervation. These bladder symptoms are more common in women than in men. Reasons for these symptoms in women can be due to childbearing, obesity, and constipation.

Medical treatment for urinary incontinence includes strengthening of the pelvic floor muscles by exercises, injectable agents for urethral bulking, or via surgical support using a sling, or placement of artificial urinary sphincter (AUS).

Neurogenic bladder

A neurogenic bladder is a result of many common neurological diseases such as multiple sclerosis, spinal cord injury, Parkinson's disease, stroke, Dementia, or neuropathy. Treatment for this type of bladder dysfunction depends on the type of neurogenic bladder. The type is identified based on symptoms and a test called a urodynamic study. The urodynamic study involves placing tiny catheters inside the bladder to measure pressure changes.

Tips for maintaining a healthy bladder

• Drink enough fluids, especially water (six to eight, 8-ounce glasses of fluid each day)
• Urinate at least every 3-4 hours – Waiting long can weaken bladder muscle and increase the risk of infection and stones.
• Cut down on coffee, tea, alcohol, and sodas
• Avoid constipation
• Quit smoking- you are three times more likely to have bladder cancer if you smoke.
• Maintain a healthy weight - exercise regularly and do pelvic floor exercises (Kegels exercises)
• Women should wipe from front to back after urinating. This helps keep bacteria from getting into the urethra.
• Wear cotton underwear and loose-fitting clothes.
• Urinate after sex to flush away bacteria that may have entered the urethra during sex.

Dr. Karthik Tanneru is a Urologist and Urologic Robotic Surgeon at MUSC Health Florence Medical Center. For more information or to make an appointment, please call 843-673-7525 or visit our website.