Bladder Health Basics
Bladder and pelvic floor conditions affect millions of men and women. While many patients will need the expert help of a specialist, there are things you can do to relieve your symptoms on your own. The road to better pelvic health begins with learning. Read below to learn how you can improve your symptoms.
Healthy Body, Healthy Bladder
In general, following “heart healthy” recommendations will pay dividends to your entire body and optimise your overall health and life expectancy. One important element here that affects the bladder and pelvic floor is weight control. Obesity increases pressure on the bladder and pelvic floor, leading to worsening of overactive bladder (OAB) symptoms, stress incontinence (leakage of urine on straining), fecal incontinence (leakage of stools) and other pelvic floor support problems (vaginal prolapse). Obese women may also have a more difficult time with personal hygiene, leading to higher risk of bladder infections. Furthermore, obesity makes treatment of all these conditions more challenging and less effective at times – surgical risk is increased, surgical outcomes are worse, and medical therapies can be more difficult due to associated medical problems.
There is no magic bullet when it comes to weight loss and control, and every person will have to find the method that works best for them. The healthiest weight loss comes from a slow steady reduction in caloric intake, along with a safe and effective exercise program. Regular exercise improves one’s overall health and sense of well-being. It also promotes proper hydration, which can improve bladder symptoms, it promotes blood flow to the bladder and pelvic floor, and it improves overall muscle strength and endurance.
Talk to your doctor about a weight control program that will work best for you.
Healthy Bowels, Healthy Bladder
Poor bowel habits are often overlooked as a cause of bladder problems and incontinence. Chronic constipation and straining to pass stools weakens the pelvic floor, and this can lead to stress incontinence and prolapse of vagina, both of which may be associated with overactive bladder symptoms as well.
Regardless of which bladder problem you may experience, we recommend you take steps to improve your bowel habits. These include increasing fluid intake, increasing fibre intake, and regulating one’s bowel habits.
Your family physician, or a dedicated nurse or therapist, can assist you with such a program.
Fluid and Dietary Advice
As a general rule, fluid restriction is not advisable as a means of dealing with OAB and urinary incontinence. Limiting fluids will make the urine more concentrated, which can cause bladder irritation, and actually worsen urinary urgency. Furthermore, limiting fluids will cause constipation, and it has also been shown to increase the risk of bladder infections.
It is best to try to cycle a larger volume of more dilute urine through the bladder – the recommendation is to take in at least 6 to 8 cups of fluid, mostly water, every day, to help you stay hydrated. Rather than trying to strictly adhere to guideline; however, we advise that you simply observe the colour of your urine – if it is yellow, then you may not be well enough hydrated. Try to drink enough to keep the urine fairly clear.
Selective fluid restriction is appropriate in certain situations. For example, someone who is taking in excessive fluids should be encouraged to cut back, and someone who suffers mostly from nighttime urination might be advised to cut back on fluids in the evening.
Certain compounds may trigger nerves in the lining of the bladder, worsening bladder frequency and urgency. These are known as bladder irritants. Caffeine is by far the biggest culprit, and it has been shown that reducing caffeine can improve the symptoms of OAB. This may be true for other foods, however, it varies among individuals. Suspected irritants include: Sweeteners (aspartame), spicy foods, acidic foods, and tomato-based foods. Eliminating these items one at a time from your diet is the only way to know how much they may be contributing.
Finally, alcohol most definitely can worsen bladder symptoms, as it directly increases urine production.
If you have not already heard of enough reasons to stop smoking, you may be surprised to hear that cigarette smoking has quite harmful effects on the bladder.
Smokers are 2.5 times more likely to experience urinary incontinence and pelvic floor support problems than non-smokers. Smoking weakens the pelvic floor both directly by reducing blood flow there, and indirectly by causing chronic coughing, which stretches and weakens these supports. Products of cigarette smoke may also directly cause bladder frequency and urgency, and they are certainly irritating to nerve cells in the lining of the bladder. Finally, and most importantly, smoking is the single most important risk factor for bladder cancer.
To learn more about smoking cessation, see your doctor, and visit our Links and Resources section.
Keep a Diary
A Bladder Diary provides valuable information about the severity of your condition, as well as your dietary habits, for you and your physician. This gives baseline information, and allows your doctor to follow the effects of treatment. Diaries can also provide you with important feedback that itself can help improve your urinary function.
Diaries should be completed before or just after your initial assessment, a month or so after any treatment intervention and periodically thereafter. It is best to evaluate two 24-hour periods each time – one on a work day, and one on a weekend or holiday.
The goal of bladder training, or retraining, is to gain a greater control over urinary urgency, to accept larger amounts of urine, and to reduce urge-related accidents. To be successful, this therapy requires significant motivation, and is best done with the assistance of a dedicated therapist, and occasional voiding diaries to provide feedback.
Initially, you are asked to adopt a regular schedule of urination; for example, set a goal of only urinating every hour or two by the clock. When an urge to urinate DOES come on, try to suppress this using one of the following techniques.
- Stop what you are doing and stay still
- Squeeze the pelvic floor 5 or 6 times quickly, 2-3 seconds each contraction
- Keep rest of body relaxed
- Focus on something else, such as counting backwards
- Finally, as the urge passes, try to walk to a bathroom at a normal relaxed pace
Gradually, you will be able to lengthen the interval between urinations.
Strengthen and Control Your Pelvic Floor Muscles
The pelvic floor consists of a number of muscles and soft tissues that support the organs in the pelvis. This complex group of structures is attached to the bones and ligaments in the pelvis, and is closely tied into the sphincter (valve) muscles of the urinary tract and rectum. As such, they play an important role in urinary and bowel function, physical support of the organs, and sexual function.
With weakening and stretching from age, chronic coughing and straining, childbirth, or surgery (hysterectomy in women and prostatectomy in men), these structures can lose their ability to support the pelvic organs leading to urinary and fecal incontinence, and/or pelvic organ prolapse.
With increased tension or impaired relaxation of these muscles, pelvic pain as well as urinary and bladder dysfunction can result. This can lead to retention of urine, burning on urination, bladder infections, overactive bladder symptoms, chronic constipation and fecal incontinence.
It is important to maintain good strength and tone of the pelvic floor muscles, as well as to properly relax them during urination and bowel movements. Visit our section on pelvic floor muscle exercises, or book an appointment with our dedicated Pelvic Health Physiotherapist to learn more.
Urinating too often at night?
Overactive bladder (commonly but not always associated with an enlarged prostate in men) is a common cause of frequent nighttime urination. In these instances, urinary frequency occurs both in the day and at night, and it is usually bladder urgency that wakes the person from sleep. If this sounds like you, then we encourage you to see your doctor, and to view our Educational Videos on overactive bladder and prostate problems.
Many patients have bothersome nighttime urination (nocturia) that is not related to a bladder problem. Some people are just light sleepers, or suffer from insomnia, and out of habit they get out of bed to urinate when they awake, even without a great urge to do so.
Another common cause of nocturia is sleep apnea, whereby a person has short periods while sleeping where he/she stops breathing. This leads to increased production of a certain hormone that increases urine production. If you think this could be the case with you, see your doctor or request an assessment at a sleep clinic.
Finally, a very common cause of increased nighttime urination is fluid retention (swelling) in the legs and feet, which can be caused by insufficient veins in the legs or by heart or kidney problems amongst others. If you experience this you may urinate more at night because, when you lie down at night, the fluid that collects in your legs and feet is no longer held down in your extremities by gravity, and is allowed to get back into the circulation. The body then has to clear out all this excess fluid, and starts making more urine. To help manage this problem, if it is comfortable, try taking afternoon naps during the day with your head down and feet up on pillows above the level of your heart. This will help get rid of more fluid in the day time when it is more convenient for you. Beyond this, you should see your physician, as medications, or adjustments to your medications may be required.
To learn more about frequent nighttime urination (nocturia), see your doctor and/or view our Educational Video on the subject.
Emptying Your Bladder Properly
It is important to remember that just as we need to learn to actively contract our pelvic muscles to help combat overactive bladder symptoms, prolapse and incontinence, we must also focus on relaxing those same muscles while urinating. As noted above, poor relaxation of the pelvic floor during urination can worsen OAB symptoms, and can lead to retention of urine and bladder infections etc.
Pelvic floor relaxation should be the first step to initiate urination, and this relaxation must be maintained through the entire void. To do this, take plenty of time, relax, and breathe slowly while urinating, and try not to strain if it can be avoided. Doing pelvic floor exercises properly, and working with a dedicated therapist can help regain better control over these muscles.