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Bladder Control

Bladder Control

Jennifer Anger, M.D, M.P.H. (Assistant Professor) gives expert video advice on: What can I do if I can't make it to the bathroom in time to urinate?; What can I do if I lose control of my bladder when I sneeze, cough or laugh?; What can I do if I lose control of my bladder when I lift weights? and more...

What can I do if I can't make it to the bathroom in time to urinate?

There are a lot of conservative measures that can really improve urging incontinence. I see lot of patients that come to see me and I ask some do they drink lot of water and most a time they say, “I try”. What I have to teach patients is to let go of that idea that you need to drink a lot of water. For the patients who leak on the way to the toilet, we have to through away that, six to eight glasses of water a day. Patients who pee a lot, leak a lot and the big recommendation I make for patients with urging incontinence is to cut back on their fluids. I recommend only four eight ounce glasses a day or around a leader of fluid intake and that include all liquids. Often caffeine, can be an irritant and so we recommend moderate caffeine use. I do not advocate quitting caffeine because if someone told me that I'd be pretty upset, but moderate caffeine use. In addition to that, Kegel exercises which are pelvic floor exercises can help delay the leak or give a patient a little more time to go to the bathroom.

What can I do if I lose control of my bladder when I sneeze, cough or laugh?

Leakage with cough, laugh, sneeze is most common in women, women who have had a vaginal delivery. It can also happen when someone has predisposing factors, like age, obesity, and also something like, smokers might be predisposed because they cough a lot. If it's mild, or happens soon after a vaginal delivery, a woman can learn Kegel exercises to help strengthen the pelvic floor muscles. When it doesn't improve with Kegel exercises, we have great treatment options. One is a temporary means to bulk up the urethra with some type of agent such as collagen, or other types of materials. And what I think the new gold standard is, is a surgical procedure called the sling. That has actually become very popular since the mid-nineties. It's an operation that has good efficacy, and actually the morbidity is low. There's also a procedure done from an abdominal approach called the Birch procedure, which is also effective, and before the sling was considered the gold standard.

What can I do if I lose control of my bladder when I lift weights?

For patients who leak urine with weight lifting, that tends to be what we call mild stress incontinence. Often people may not necessarily leak all the time with cough, laugh, sneeze but they'll leak with jumping. The classic is jumping on a trampoline and I often say, you know, if you leak jumping on a trampoline but no other time, that's not that bad. That's what we would say is mild stress incontinence. So it is a type of stress incontinence and it can be treated just the same way that we would treat someone for leakage with cough, laugh and sneeze. Two main types of incontinence are stress incontinence and urge incontinence. Urge incontinence occurs when someone gets an urge and leaks on the way to the toilet.It's part of a spectrum of what we call overactive bladder. It includes urinary frequency, meaning I have to go all the time; urgency, which is I've got to go now; and leakage on the way to the bathroom, if a patient or a person doesn't make it to the toilet they leak with an urge and that's called urge incontinence. Forty percent of patients, of people, with incontinence have mixed incontinence, meaning they have both stress and urge incontinence.

What can I do if I lose control of my bladder constantly?

If a patient leaks urine constantly, it's probably best to see a physician. Because we can better help the patient figure out what kind of leakage they have. Patients who leak all the time may have severe stress incontinence, so they can't even tell if it's urge or not. They may have severe urge incontinence. Not all patients with urge incontinence feel the urge. We call that unaware incontinence. Often it's a kind of urge incontinence but the patient just doesn't know. And also, patients with severe stress incontinence may leak all the time where it may be at one time started with cough, laugh, sneeze, then progressed in severity where they leak all the time. So at that point, it would be necessary I think, to see a specialist to help identify what kind of leakage they have. Because identification of the type of leakage is key to being able to treat that leakage.

What can cause 'stress incontinence'?

Stress incontinence is classically leakage with cough laugh or sneeze. It occurs as a result of a weakening in the urethra. The urethra is the tube that allows urine to flow from the bladder out to the free world or normally in the toilet. Unfortunately for a lot of people, into a pad or into their underwear. So stress incontinence usually is a result of in women, vaginal delivery it can also result from other predisposing factors like aging, family, history, or a family predisposition and coughing from smoking. in addition to aging sometimes there's a thought that it can be in addition to aging maybe having lower estrogen levels can weaken the tissues. Men usually don't have stress incontinence unless they have had a procedure on their prostrate, such as a prostatectomy for cancer or a transurethral resection of the prostrate which is often performed for benign prostate disease So stress incontinence in men is less common than in women.

What is 'urge incontinence'?

Urge incontinence occurs when someone gets an urge and leaks on the way to the toilet. It's part of a spectrum of what we call overactive bladder. It includes urinary frequency, meaning "I have to go all the time," urgency which means "I've got to go now" and leakage on the way to the bathroom, where if a person doesn't make it to the toilet they leak with urge. That's called urge incontinence.

Can I have both urge and stress incontinence at the same time?

Forty percent of people with incontinence have mixed incontinence meaning they have both stress and urge incontinence.

How can Kegel exercises help me control my bladder?

Kegel exercises are often taught to women initally after vaginal delivery. The way one can recognize their pelvic muscles are to practice stopping and starting your urinary stream. Though if that once one recognizes those muscles, they can then practice holding their muscles and we say hold them in count to ten slowly, hold them in, and then repeat that several times in a row, maybe ten times in a row. And you can't do many Kegel exercises but we usually say that doing that three times a day. And that stronger those muscles are, the more protected from stress incontinence and if someone has cough coming, they can actually squeeze their pelvic floor and stop stress incontinent episode. If an urgent incontinence, squeezing those muscles could actually give them a little more time to the toilet. Some patients does not recognize their muscles, one way is that, woman can place her fingers in their vagina and squeeze their muscle so she could actually feel the muscles contracting, then she's doing it right. For patients who don't recognize Kegel muscles, often they can work with the pelvic floor rehabilitationist and actually learn them. They can do with what we call floor rehabilitation. The best way for men is to practice stopping and starting their urinary stream. Men, also, after prostate surgery are often instructed on Kegel exercises and they are just effective for men. Unfortunately, there are a group of men and women who don't get enough dryness from the Kegel exercises and that's when the urologist or your gynecologist fit in.

Is it normal to have bladder control problems as I get older?

Although incontinence is definitely more common with aging and it progresses in frequency and severity with age, we don't consider it to be a normal part of aging because we have treatment options. There are, depending on the type of leakage a patient has, there are a lot of treatment options, many of which involve the patient; restricting fluids, not letting their bladder get too full, learning pelvic floor exercises. When that doesn't work then there's treatment options that we can do. For urge incontinence we often treat medically with medication. And with stress incontinence there are surgical treatment measures. Some are very minimally invasive and some are more invasive.

What can I do about bed-wetting?

Enuresis, which is bed-wetting, happens in young people and in older people, and a lot of people who just sleep too heavily. It can be due to patients with an overactive bladder, but they do not wake up because they are heavy sleepers. Often when I have a patient who wets the bed at night, I have patients fill out a void in diary. They collect their urine in a hat they put in the toilet and dump it. And the important thing to find out for me, is are they actually making more urine at night? Because that we treat differently than patients who have over active bladder that they sleep through. So I think that getting up at night or peeing at night in the bed, or enuresis, should be evaluated by a physician.

What is an 'overactive bladder'?

An Overactive Bladder includes a spectrum of symptoms that include urinary frequency, or getting up and going to the bathroom frequently, urgency, having the urge to get to the toilet, urgent continence, which is not making it to the toilet, as well as what we call nocturia, getting up at night to pee. It is very common with aging. When people do have overactive bladders we like to check a urinalysis to make sure there's not a urinary infection or blood in the urine which could be indicative of other processes causing the symptoms. This is primarily treated with medication as our first line of therapy in addition to fluid restriction, which is very helpful for people with Overactive Bladder.

What can I do if I get a sudden urge to urinate, but nothing comes out?

Some patients complain of a sudden urge to urinate and they get to the toilet and nothing comes out. That is a classic sign of a urinary tract infection, although some people do get symptoms of urgency. If a patient leaks on the way to the toilet, then we can safely say that's overactive bladder. Often people get urgency, but don't actually have urine in their bladder for a few reasons. One, it can be part of the overactive bladder symptom complex. They could also have what we call bladder hypersensitivity, where they just feel a little bit of urine in their bladder and they want to pee. Or they could simply have a urinary tract infection. I would recommend being seen by a physician to determine what is the cause of this.

Can infections cause bladder control problems?

Leakage with infection usually does go away once the infection is adequately treated. If it doesn't go away and the infection's treated, it may be overactive bladder that maybe was exacerbated by the infection.