Common Bladder Control Problems

Tonight we’re going to talk about bowel and bladder control primarily. So Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia and we’ve been each practicing for close to 10 years. And we’ve had five years of urology training in residency and med school before that.

And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. All right so there’s three kind of categories to kind of simplify this about bladder control issues. One is stress incontinence and I’ll describe that more in the next slides. The second is urinary retention which is the inability to actually get urine out where the urine is trapped in the bladder and you can’t fully empty the bladder and the third is overactive bladder. 

So stress incontinence is the kind of incontinence that some patients can have in which when you increase the pressure on the bladder it overcomes the ability of the sphincter to control the urine. So sneezing, coughing, laughing, standing up real quick after you’ve been sitting for a while, climbing up things like stairs, exercising and then you get a dribble or even sometimes a full emptying of the bladder as you do those activities so that’s deemed stress incontinence. And that is an issue typically with the sphincter itself and the pelvic floor with the inability to control the bladder from emptying. And that’s an issue that some women have with age or after childbirth that can occur. In regards to men that would be something that sometimes we see after prostate type procedures and then also you know something with the age that can occur. In regards to urinary retention that’s when you can’t fully empty your bladder. Sometimes patients will show up with to the emergency room or our office with the inability to empty their bladder and they need a catheter put in to drain the bladder. Other times it could be a slow chronic situation where they don’t empty the bladder fully and it builds up into a inability to empty. That’s actually dangerous because you’re not able to clear all the toxins out of your body and you can get infections or kidney failure, this is something that’s important to tease out. Usually in these cases you can have leaking but the main symptom is difficulty emptying and a weak stream. And then overactive bladder is is a quite common situation in which you have a bladder that isn’t able to hold urine for the amount of time it should in between urination. So you get frequent trips to the bathroom with strong urges to pee even though you just urinated, went to the bathroom and peed you know 20 minutes 30 minutes later you feel like you got to go again and are heading back to the bathroom. And that can sometimes progress into urge incontinence which is a type of leaking of urine as opposed to the stress incontinence where you sneeze cough strain and leak this is where you get a strong urge to pee and you can’t hold it back and then you end up having a leak before you make it to the bathroom in time.

And then a different kind of incontinence would be this fecal incontinence which is basically bowel incontinence and this is not urinary incontinence but a situation in which you have control issues with having bowel movements. So you can actually have loss of control where you have accidents with your stool sometimes that could be this like a strong urge that you cannot control or other times it’s a loss of feeling that you have to go and you can have either small accidents or a full incontinent episode with fecal incontinence

How Is Bladder Cancer First Diagnosed?

Early diagnosis of bladder cancer is crucial for successful treatment. Unfortunately, there is no specific test available for screening asymptomatic people for the disease. So diagnosis of the cancer primarily relies on the presence of symptoms.  

Working from symptoms

In fact, most cases of bladder cancer are diagnosed when patients report having blood in urine to their doctors. It is at this point that a urine test, called urinalysis, is often ordered to confirm the presence of blood in urine.  

Of course, having blood in urine does not necessarily imply that there is bladder cancer since bleeding can also be due to urinary tract infections, kidney stones, bladder stones, kidney disease, or a non-cancerous tumor. Hence, when blood is present, the urologist will go the extra mile to find out the underlying course.

Apart from blood in urine, your doctor may also suspect bladder cancer if you have urinary symptoms, such as frequent urination, burning sensation during urination, weak urine stream, nocturia, or inability to urinate.

Although occurrence of symptoms is usually the first basis for suspecting bladder cancer, it has various limitations. For instance, there are no symptoms that are specific to the cancer. This may lead to a misdiagnosis of the cancer as another disease with similar symptoms.

Also, many cases of bladder cancer show no symptoms in the early stages. So by the time you’re going to a doctor because of some symptoms, it may already be too late and the cancer could have spread to various organs and become difficult to treat.

Urinary tests

Regular urinary tests can help to detect early-stage bladder cancer. For when there is persistent blood in your urine, your urologist will be prompted to order for further tests.  Usually, when there is any amount of blood in your urine, your doctor will recommend a urine cytology test.

Urine cytology testing uses a random urine sample to check if the urine contains tumor cells. The sample is examined under a microscope to look for the cancer cells. Alternatively, the urine sample can be subjected to molecular analysis, which will detect the presence of various proteins or genes associated with cancer cells. 

Cystoscopy

This is a key bladder cancer diagnostic procedure that allows a urologist to see inside the body with the help of a thin, flexible, lighted tube called a cystoscope.  The cystoscope is inserted into the bladder through the urethra and has a camera to help the doctor clearly view the bladder. 

Apart from assessing the bladder, a cystoscope can be used to take a small tissue sample (biopsy) or to treat early-stage tumors without surgery.  Cystoscopy is a simple outpatient procedure performed in the doctor’s office, and is quite effective in detecting growths in the bladder and determining if there is need for biopsy or surgery.

Biopsy

If your doctor finds abnormal growth in your bladder during cystoscopy, a biopsy is the next and most definitive step. Also called transurethral resection of bladder tumor (TURBT), a biopsy involves the removal of a small amount of tissue from the bladder for examination under the microscope.

Usually the tumor, together with a sample of bladder muscle near the tumor, is removed. But additional biopsies of other parts of the bladder may also be necessary depending on the cystoscopy results. The tissue samples obtained during TURBT are analyzed by a pathologist to confirm bladder cancer, identify the type of tumor, and to find out how deeply it has spread into the layers of the bladder.

What are the warning signs of bladder cancer?

Because the bladder holds urine produced by the kidneys, the warning signs of bladder cancer usually relate to urination. Urine is made in the kidneys and moves down the ureters to the bladder, which then stores the urine to allow for an infrequent, controlled urination.

Blood in urine

The earliest warning sign of bladder cancer is blood in urine, also called hematuria. The blood may be present in the urine regularly or appear sporadically over the course of days or weeks. Plus, it may change the color of urine to orange, pink or dark red—though sometimes there may be no apparent urine color change.

Blood in urine is a critical sign of the cancer because early-stage bladder cancer does not often cause pain or other symptoms except bleeding. In fact, bladder cancer is usually diagnosed after patients tell their doctor about having urine in their blood.

Gross hematuria is when blood is present in urine in such a large quantity that the patient can see it. But sometimes, there may be microscopic hematuria, whereby the blood is present is such a small amount that it can’t be seen by the naked eye, though can be detected by a urine test. 

Nevertheless, blood in urine is not always an indicator of bladder tumor. It could be due to other less serious conditions, such as urinary tract infections, bladder stones, kidney stones, kidney disease, or non-cancerous tumors. Plus, in women, blood from menstruation may appear in urine and could cause a false-positive test result.

Urinary symptoms

While changes in urination are often a sign of less serious conditions, such as urinary tract infections, overactive bladder, benign tumor, bladder stones, or in men, an enlarged prostate, they may also be an early warning sign of bladder cancer.

Urinary symptoms that may indicate bladder cancer include:

  1. Pain or burning sensation during urination
  2. Frequent urination
  3. Nocturia—having to urinate many times throughout the night
  4. Feeling the urge to urinate even when the bladder is not full
  5. Having the urge to urinate, but being unable to pass urine
  6. Weak urine stream
  7. Lower back pain, often on one side of the body

When experiencing these changes, it is advisable to speak with your doctor as soon as possible. Your doctor will do a medical exam and order specific tests to help identify the cause of the symptoms. The doctor will also be able to rule out the cancer or run further tests to diagnose the cancer so that you are put on early treatment.

Advanced bladder cancer warning signs

Not everyone with early-stage bladder cancer will have symptoms. In some people, the first warning signs appear when the cancer has already grown too big or has spread beyond the bladder. 

Warning signs of advanced bladder cancer include:

  1. Pelvic pain
  2. Lower back pain, usually on one side
  3. Fatigue or general body weakness
  4. Inability to urinate
  5. Swelling of the feet
  6. Bone pain
  7. Unexplained weight loss
  8. Loss of appetite

For bladder cancer that has spread to other parts of the body, the symptoms typically depend on the affected organ. For instance, if the cancer has spread to the lungs, it may produce shortness of breath or persistent coughing.

Equally, if the cancer has spread to the liver, it may cause jaundice (yellowing of the skin or eyes) and abdominal pain. And if the cancer has spread to bones, it may lead to bone pain or a broken bone (fracture).

Timely diagnosis and treatment

If you are having blood in urine, urinary symptoms or other disturbing changes, speak with your doctor about them. The doctor will seek to establish how long, how severe, and how often you have been experiencing the symptoms. 

Together with performing a physical examination and ordering lab tests, the doctor will try to figure out the problem. If bladder cancer is suspected, your doctor will request for further tests to confirm the diagnosis.

 For more information on bladder cancer, its signs and symptoms, risks and prevention, and diagnosis and treatment, visit the site “St Pete Urology.”

9 Tips to Keep Your Bladder Healthy

The bladder’s function is to store urine and allow urination to be infrequent and controlled. Bladder problems may lead to bothersome issues such as incontinence, infections and overactive bladder. While you may not be able to prevent every possible bladder problem, taking appropriate measures can help to lessen many of them.

What should you do to keep your bladder healthy?

1. Drink plenty of fluid

Drinking plenty of fluid increases the volume and frequency of urination, which in turn helps to flush out bacteria from your bladder. Water is the best fluid for your bladder and should be at least half of your daily fluid intake.

Ideally, you should drink 6-8 eight-ounce glasses of water every day. But if you engage in intense exercise or activity, you may need to drink more to compensate for fluid loss. On the other hand, if you have a condition such as heart disease or kidney failure, you may need to drink less. Speak with your doctor about how much fluid is right for you.

2. Avoid smoking

Smokers are more likely to develop bladder control issues than non-smokers. Cigarette smokers also tend to have more severe bladder symptoms. For heavy smokers, there is a tendency to develop a chronic cough, which exerts added pressure on the bladder and worsens urinary incontinence. Plus, tobacco smokers are three times more prone to bladder cancer than non-smokers. Avoiding cigarette smoking is good for your bladder health.

3. Get active

Physical activity not only relieves bladder problems but also prevents fluid buildup in the legs. Fluid retention in the legs—usually due to heart disease or a sedentary lifestyle—can lead to bladder control issues. You can reduce fluid retention through low-impact moderate activity such as biking, swimming or walking briskly for at least 30 minutes at least 5 days a week.

4. Do Kegel exercises

Weak pelvic floor muscles are a common cause of urine leakage (incontinence). Kegel exercises target and strengthen pelvic floor muscles and keep urine from leaking when you sneeze, laugh, lift or have a sudden urge to urinate. Speak with your urologist about what kind of exercise will benefit you the most.

5. Avoid bladder irritants

Certain foods and beverages can irritate the bladder and trigger bladder problems. Known bladder irritants include alcoholic beverages, apples, apple juice, bananas, brewer’s yeast and carbonated drinks. Others are chilies, chocolate, citrus fruits, coffee, cranberries, grapes, nuts, raw onions, raisins, soy sauce, tomatoes and vinegar.

While you don’t have to stop eating your favorite foods and drinks entirely, reducing the amounts can improve your bladder symptoms.

6. Maintain a healthy weight

Being overweight is a risk factor for incontinence, particularly stress incontinence. The excess weight exerts more pressure on the abdomen and bladder and weakens pelvic floor muscles. In fact, nearly 50-percent of older people who are overweight struggle with bladder incontinence.
By losing weight in the abdominal area, you can reduce pressure on the bladder and pelvic muscles and improve bladder control. In many cases, weight loss improves incontinence symptoms or gets rid of them completely. Make healthy food choices and engage in regular exercise to achieve and maintain a healthy weight.

7. Prevent constipation

Bladder problems are quite common in people with constipation because a full rectum presses the bladder wall causing either outflow obstruction or increased spasm. Also, constipation makes pelvic muscles overactive, which causes dysfunction in stool and urine elimination and leads to an overactive bladder. You can reduce constipation by drinking enough water, eating high-fiber foods (like whole grains, fruits, and fresh vegetables), and being physically active.

8. Manage medications

Some medications can trigger bladder control problems. For example, high blood pressure prescriptions tend to increase urine output and relax bladder muscles resulting in urine leakage. Drugs such as antidepressants, muscle relaxants, antihistamines, sedatives, and tranquilizers may hinder bladder contraction and reduce awareness of the need to urinate.

You should not stop taking your medications just because you suspect they are responsible for your bladder issues. Instead, and before making any change, speak with your doctor about your concerns. The doctor may adjust the dosage or offer a different medication. In cases where the benefits of the medications far outweigh the related bladder issues, your doctor will work with you on alternative ways to ease symptoms.

9. Flush out bacteria

Proper cleaning of the genital area before and after sexual intercourse helps to reduce bacteria and prevents bladder infections. Passing urine before and after sex helps to flush out bacteria and stops their entry into the urethra during sex.

Since holding urine in the bladder for too long increases the risk of infection and can weaken bladder muscles, make sure to pass urine as often as possible. Use the bathroom at least every 3 to 4 hours, and when urinating, don’t rush. Take your time to fully empty your bladder.

At St Pete Urology, we provide expertise in the diagnosis and treatment of urinary disorders. Our urology specialists will work with you to develop an individualized treatment plan for your problems. We value our multidisciplinary and compassionate approach to caring for our patients. For more information on the prevention, diagnosis and treatment of urinary disorders, visit the St Pete Urology website.

Signs of Bladder Problems

Bladder problems are very common and can range from mild issues like a urinary tract infection to life-threatening conditions such as bladder cancer. It is important to be aware of your bladder health and symptoms that can indicate a problem so you can seek prompt medical treatment when needed.

Problems With Urination

Urinary incontinence and urinary tract infections, or UTIs, are both common problems that affect millions of people every year.

If you experience leaking urine during activities like coughing, laughing or bending over; if you feel sudden, strong urges to go to the bathroom but do not always make it in time; or if you wet the bed at night, you may be suffering from a bladder issue causing urinary incontinence. It is important to discuss these symptoms with your doctor, who can help find solutions so you enjoy a better quality of life.

If you are experiencing a burning sensation during urination, a frequent urge to go, cloudy urine or a fever, you might have a UTI. A physician can determine the best route to deal with it, most likely involving antibiotics, to clear up the infection before it can spread to the kidneys and become more serious.

Pain In The Bladder

If you have been experiencing issues with the urinary tract for more than six weeks without signs of an infection, and if there is also pain and a feeling of pressure in the bladder area, you might be dealing with interstitial cystitis. This is a chronic health condition that can range from mild to severe. Every case of IC is different, so your doctor will work closely with you to reach a diagnosis and determine a treatment plan.

Warning Signs Of Bladder Cancer

The first sign of bladder cancer is usually blood in the urine, also known as hematuria. Sometimes the blood is not visible and will only be noticeable during urinalysis performed as part of a physical exam. Other times, enough blood may be visible to tint the urine pink, orange or dark red. Blood in the urine also can be a symptom of other serious issues such as kidney stones or an infection.

Other signs of bladder cancer can include indications of less severe bladder problems, such a frequent urge to go, a burning sensation during urination, or difficulty relieving yourself. Symptoms of more advanced bladder cancer include an inability to urinate, lower back pain, swollen feet or bone pain.

Whenever you experience new symptoms or difficulties with your urinary system, it is important to contact your doctor as soon as possible. The urologists at St Pete Urology are here to help with bladder problems of all kinds so you can live your happiest, healthiest life. For more information, visit the St Pete Urology website.

5 Things You Need To Know About Bladder Cancer

Bladder cancer is a health condition where malignant tumors start growing in the urinary bladder. While it is a condition that typically affects older adults, bladder cancer can affect all age groups. It is the fourth most common cancer in the United States, and has a 50-70 percent possibility of recurring.

1. What Is Bladder Cancer?

This type of cancer is characterized by aggressive cell growth in the bladder, a muscular organ that stores urine. Instead of a growing in the usual fashion, these mutated cells multiply rapidly and uncontrollably. Transitional cell carcinoma is the most common type of bladder cancer, and occurs in the bladder’s inner lining.

2. Signs and Symptoms

The most common symptoms include blood in the urine, frequent urination, severe itching, and general discomfort. Some may even experience excruciating pain. Just like prostate cancer, middle-aged men are the most susceptible to this disease. In fact, the symptoms are identical despite the fact that it affects different organs. Unfortunately, just like prostate cancer, the symptoms are not easily detected and it often develops quietly.

3. Causes

While the exact cause cannot be pinpointed, smoking is believed to be the leading cause of this type of cancer. Smoking forces the body to process harmful chemicals that are ultimately released through your urine. Exposure to industrial chemicals found in leather, rubber, paint, and even hair dyes can also trigger the growth of cancer cells. This explains why people who are most at risk include factory workers, machine setters, rubber workers, and hairstylists.

4. Detection and Prevention

To diagnose this cancer, a urologist will perform a cystoscopy procedure where a flexible tube with a camera is inserted in the urethra. Abnormal lesions are then biopsied and analyzed. Early detection of the disease can also be made through a patient’s urine sample.

To prevent this cancer, cut down or stop smoking tobacco. If you work in any of the professions that expose you to industrial chemicals, it may be wise to consider other career options to cut down the possibility of the disease. Regular consumption of fruits and vegetables like carrots and citrus will also help you cut down the risks.

5. Treatment Options

In the United States alone, there is an estimated 55,000 yearly cases of this type of cancer. The good news is that it is curable given the right methods of treatment. Urologists in St Petersburg, for instance, give a number of options to combat cancer of the bladder and this includes the following: radiation therapy, surgery, immunotherapy, and chemotherapy.

However, before a patient is treated, a thorough examination should be done. This is because treatment is based on the cancer type and its specific stage. The cancer patient’s age and general wellness are also major factors to consider before choosing the treatment.

Regardless of the treatment choice, urologists in St Petersburg will suggest that cancer patients be well-aware of the risks. For one, it involves a commitment to strictly follow the doctor’s advice. Cancer of the bladder is something that should be addressed promptly. The earlier it is diagnosed and treated, the greater chance for full recovery.