What to do if your bladder bothers you?
An initial assessment should start with urine testing and culture. If this is normal, then a bladder diary or record of what you drink is important. This diary should include amounts and types of liquids (water, caffeine, juice, etc.) and how often you void and if there is any urine leakage. This bladder diary can then be reviewed with your doctor. Initial strategies on managing urine leakage usually involves pads. The pads should be designed for incontinence and not menstrual loss. These pads pull moisture away from the vulva and can be drying which is why it is important to protect the vulvar skin with emollients like Aquaphor. Chronic exposure to wet pads can result in contact dermatitis and skin breakdown causing irritation and vulvar discomfort. Information on pad varieties and urinary incontinence supplies is available from advocacy groups such as The Simon Foundation www.simonfoundation.org.
Lifestyle modifications are always considered as initial treatments. Lifestyle changes typically should be tried for 12 weeks before moving on to more aggressive treatments like medicine or surgery. Modest weight loss (~10-15 lbs.) can significantly decrease stress incontinence and to lesser extent urge incontinence. Limiting alcohol, caffeinated and carbonated beverages and not drinking more than 64 oz. a day can mitigate urinary incontinence. Managing constipation, chronic cough, and not smoking can make a big difference. Correctly contracting pelvic floor muscles (Kegels) can help and is demonstrated on YouTube with https://www.youtube.com/watch?v=wRKhtfbJHdo with physiotherapist Michelle Kenway. Personal biofeedback devices, Pericoach http://www.pericoach.com/, Elvie https://www.elvie.com, can work just like a Fitbit to help you Kegel correctly and track your progress. Patients have better outcomes with regular Kegels performed correctly 10-12 contractions, 2-3 times daily. Certified pelvic floor physical therapists can be helpful with teaching proper Kegel technique and help with body mechanics that put less pressure on the pelvic floor. Phone app reminder Pelvic Track https://www.pelvictrack.com or journal entries can help make these pelvic floor contractions a “daily habit”. Bladder retraining, most effective for urge incontinence, helps to retrain your bladder to hold more urine and increase the storage capacity between voids. A bladder diary will identify the shortest voiding interval and the goal is to lengthen these intervals and void on a schedule. Urgency between voiding is controlled with either distraction or relaxation techniques i.e. Performing mental math, deep breathing, or quick pelvic floor contractions “quick flicks.” When you go two days without leakage, the time between scheduled voids in increased.
Medications/Devices/Surgery: Low dose vaginal estrogen can help and if you are peri-menopausal or menopausal. Loss of tissue health from less estrogen can be associated with bladder dysfunction, urgency, frequency and incontinence. Low dose replacement of estrogen into the vagina 2x weekly for three months has been proven to decrease bladder bother. A 2012 systematic review of four randomized trials of postmenopausal women found that vaginal estrogen was associated with less incontinence. MonaLisa Touch vaginal laser has demonstrated similar efficacy to vaginal estrogen in a recent randomized trial. Stress incontinence is when leaking is caused by coughing, sneezing, jumping and urine comes out from too much pressure on the bladder. If conservative measures are not helpful, then devices like intravaginal supports like Poise Impressa, https://www.poise.com/en-us/, pessaries, or surgical mesh slings can significantly reduce stress incontinence.
OAB (overactive bladder) is a symptom complex with urgency (strong sudden urge to void) and frequency defined as voiding more than 8 times in 24 hours with or without leaking urine. Leaking when you get the urge to void and cannot make it the toilet in time is called urge incontinence. With an overactive bladder, there is an inability to store urine. OAB is not cured but is managed. Medicines you take for other medical problems may contribute to bladder problems. Diuretics for high blood pressure, antidepressants and antipsychotics may cause urinary retention. Narcotics for pain and some blood pressure medicine like calcium channel blockers may reduce bladder contractility. Some over the counter sleep meds and cold remedies may affect bladder storage. Behavioral therapies are first line treatment and include weight loss (5-10%), not smoking, pelvic floor strengthening, avoiding bladder irritants. Bladder irritants can include spicy foods, citrus fruits and juices, tomato-based foods, alcohol, drinks with caffeine and nicotine. Avoiding constipation and limiting fluid intake after dinner can reduce getting up to urinate after you go to sleep. If these lifestyle changes are not sufficient, then medications can be taken to calm the bladder muscles down. When this does not work, Botox injections into the bladder wall has proven helpful. Refractory cases of bladder urgency and incontinence may be treated with implanted devices which deliver painless electrical impulses to calm the bladder down.