Is your bladder really running your life?
I hear, all the time, that peeing in your pants is “because I had kids”, or it’s “because I’m getting older” or “But I drink a lot of liquid”…
PEEING WHEN YOU DON’T WANT TO IS NOT NORMAL!!! I don’t care if you had a ten pounder baby, or you are 85—get it checked out!!
HELPFUL LINK ON OVERACTIVE BLADDER: OVERACTIVE BLADDER
The way your bladder starts to control your life is really sneaky, and women are often surprised when I dig a little, and end up telling them that their idea of normal is quite abnormal.
Women often get a strong urge to pee and literally can start to wet themselves immediately–or they may have just under 5 minutes to make it (squeezing as tight as they can), to the bathroom. Basically the only thing that saves you is fast legs, and elastic band pants! It gets tougher as you age, and hauling your butt out of the sofa with your creaky knees, and sore back, just makes everything worse!
Next thing–you don’t want to go out to dinner, or movies, or a drive around the countryside, because you have to know where all the bathrooms are–and those bushes on the side of the road are not really going to do the job when there are no leaves to hide you! There are parts of our local highway that women literally know they can pull into on an angle–see both sides of the highway for a good kilometer, and, if they leave the door open, can pee unseen–and MANY women have come up with quick little ways to jump out of their car and pee!
It is not unusual to pee more often than every 2 hours–some women go every 30 minutes!! Getting up more than twice a night is also a problem. It screws up your sleep, so you are tired during the day–and THEN you do something that makes your bladder worse–you drink that COFFEE to wake you up! You should be able to comfortably hold your pee from first urge to pee– for about 30 minutes! Certainly, if you are not able to hold for ten minutes, it is really going to mess with your life!
The other things you may notice is:
- that you wonder why you went to the bathroom for that little bit of pee.
- you make two-sit trips (you pee, get up and …uh oh…better sit down again because you don’t think you are empty…but all you get out are a few drops.
- straining…just to make sure you don’t have to sit down again
- pressure ..or a feeling that things are falling out ‘down there’
- chronic low back ache
Just to give you an idea of what we look for, we will ask about other medical conditions.
DIABETES–now THAT is a big reason for going to the bathroom often. The thing is, is that diabetes can get you in more than one way! If your sugars are NOT WELL CONTROLLED, you will pee more! Now, I hear patients tell me that their sugars are “not as high as they used to be”—maybe they are running 10 (180 in USA), but don’t kid yourself–you are NOT controlled! You really have to either adjust those little cheats in your diet, increase your oral meds, or START INSULIN.
The other thing with uncontrolled diabetes, you can end up with nerve damage, and the nerves could be ones that control your bladder function.
The other thing I would ask about is, “When do you pee more–day or night? How much do you pee–a few teaspoons or a cup? Do you have a lot of swelling in your legs in the evening?” Sometimes, when we retain fluid, because of excess weight, vascular disease, congestive heart failure etc, your legs get pretty puffy in the evenings. When you go to to bed, and put your legs up–all that fluid drains out of your legs, and goes to your kidney–and out of the bladder. Typically , when you pee, you would then pee a pretty large amount.
WATER PILLS AND PUFFY ANKLES
This brings up another thing. Many women are taking “fluid pills”–typically furosemide, or hydrochlorthiazide. Many times, these pills are taken in the morning(and this is a wide spread habit). Many times, we doctors prescribe things and just say “take in the morning”. Now, if you have just peed off your fluid in the ankles all night, your ankles are the best they are going to be first thing in the morning–right? Now, you take your “water pill”. and then you can’t go the store, or the bank, or even out for a walk–because you are peeing all morning! Most women, I find, tend to want to do their chores in the morning.
I will call the family doctor, and ask if we can switch the water pill to the late afternoon (between 4-6 pm), and they never seem to have a problem with this. I don’t like to see it taken later than 6 pm. The idea is that by then, your ankles have been on the ground all day, and tend to be puffy. NOW, take your water pill and get those ankles peed off in the evening, when you tend to be home anyway. Get them peed off before you got to bed, and you likely won’t have to get up all night to pee them off! Make sense? Sometimes, it even means you can use less pillows to sleep at night because fluid is not going from your legs to your heart, and lungs, causing shortness of breath. Ask your doctor if this is something you can consider as part of your bladder regime.
With overactive bladder, you typically wonder why you had to go the bathroom for that little bit of pee, or you get there and literally have to wait only to get a few drops of pee!
QUICK FLICKS AND KEGALS
Kegal exercises can be helpful for some incontinence–but–you’re not going to get Christie Brinkley’s abs doing one sit up a month! You need to do Kegal’s at LEAST 30 times a day for 3 months to get any benefit. I will often tell women to put a dot of nail polish on their thumbnails–and when they see it –to do a Kegal—and OTHER people will ask “What’s the dot about?’ Another reminder.
DO NOT DO KEGALS IF YOU HAVE PAINFUL BLADDER SYNDROME!!!
So–to do a KEGAL, for the first time, you do it in the bathroom. When you are peeing, you squeeze all your muscles down there, and also squeeze your butt muscles too. Hold this for five
Have you actually been checked for bladder infection? I am still amazed that that simple thing often has not been done, and how often we find a urinary tract infection.
I DO like to get a catheter urine when someone is referred to me about their bladder. The reason I do this is that it tell me a LOT. I will talk with the woman, and let her know she needs to tell me when she has an urge to pee (she is undressed from the waist down so we can move quickly). I quickly get a catheter sample, and can tell how much urine is in her bladder that gave her the urge to pee, and I get a lovely clean urine sample ( I mean REALLY–it can be hard to get a good sample if you have trouble reaching down to wipe yourself, and then you have to aim into that stupid little cup with pee going everywhere)! At the same time, I can assess the bladder and whether is is “dropped”, if it is painful when touched (see interstitial cystitis post), if there are any obvious growth, and how healthy the tissues of the vagina look. Menopause can dry things out down there–and that includes the bladder.)
I will ask about your periods or if none, then about symptoms of menopause. Is intercourse dry and uncomfortable, or painful? The bladder and urethra (the tube from your bladder to the outside of your vulva), also needs good tissues–and I’m not talking Charmin’. The actual skin of your bladder also can suffer from hormone loss.
SEIZURE DISORDER/SLEEP APNEA
Occasionally, I will get an “odd” story–not fitting a clear picture of overactive bladder, and this can be a challenge. I have had several women over the years, who will say the only time they lose urine is at night, or they wake up and never realized that they had wet the bed(they also have daytime loss)—-and in the end , after referrals to sleep units for assessment, may have severe sleep apnea, and lose urine during moments of a drop in oxygen level, OR may actually be having seizure activity–absence seizure being the cause. Grand mal seizure? –well, the patient would know if she had THAT problem–it’s those little hidden seizures that may last just last a few seconds–and that can also be a big problem when driving, if you “blank out” at a critical moment).
Sometimes the simple reason for incontinence is that you are not ABLE to get to the bathroom because you can’t move very quickly, due to joint issues, history of stroke, Parkinson’s, M.S. etc.
Urine incontinence often goes along with constipation–and I think, in many cases, is due to simple inadequate fluid intake. People tell me “I drink all day”–but when you get down to it–they are SIPPING–and may only get 2-4 8 oz cups of liquid down a day.
Maybe this will help explain the importance of drinking enough of the right liquids (and caffeine in tea, coffe, and soda are NOT the right fluids).
If you put your bare hand into a bottle of pure bleach, your hand will be screaming to get out in a few seconds, and will come out looking pretty raw from the irritation of the chemical. Now, if you put a half cup of bleach into a washing machine full of water, you may be able to dunk your hands for much longer.
Your kidneys get rid of ammonia, and other liquid wastes from your body. If you don’ t dilute down the chemicals, it is like the bleach scenario—irritates your bladder, which screams, “Get this outta here”-and off you run to the bathroom. Make sense? By restricting your fluids, often because you are afraid to drink more, since you pee all the time, you actually make the problem worse!
This is where getting assessed by your doctor, changing your diet and using bladder medications, you can start to get your life back!
You really need to cut out caffeine and soda. If you feel you just can’t LIVE without caffeine then try decaff (still has caffeine but much less), and stick to one cup a day. There is no taste to caffeine. I can put pure industrial strength caffeine on your tongue–and no taste! You might say it helps you to stay awake–and that is true–but is also screws up your sleep, and the DEEP sleep we need to feel rested.
If I told you that the medication to treat overactive bladder had the following side effects:
insomnia, fatigue, anxiety, sweating, breast tenderness and cysts, palpitations, overactive bladder, irritable bowel/diarrhea, headaches
you probably wouldn’t take it….but these are things that caffeine can cause. Check this out…
Sometimes, just adjusting your diet can take care of overactive bladder. OH—AND DON’T TOUCH ANYTHING CRANBERRY!!!
I don’t care what “they” say—-cranberries AGGRAVATE overactive bladder and painful bladder syndrome. Doctors often tell you to take this without even doing a thorough work up–so if your problem is chronic, cranberries are not going to help. You need PROOF of infection BY CULTURE!
Following a bladder friendly diet can help with your symptoms—I hear countless stories about how certain foods irritate the bladder.
THe ICNETWORK has a great list–and I refer patients to that site.
There are many meds that can help–each of which you would discuss with your doctor.
oxybutynin, Toviaz, Enablex, Oxytrol, Vesicare, Detrol, Myrbetriq
I know the drug companies would love to see you n these meds for life–but I do find that over 75% of women can get off the meds within 6 months, if they start taking care of their bladder.
I will often have women stop their meds when they have had normal bladder control for 3 months and see how they do–worse case—you have to start meds again for another few months and try again.