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

Why Do I Keep Getting UTIs?

Urinary tract infections (UTIs) are caused by bacteria or E.coli in the organs of the urinary tract — the kidneys, ureters, urethra and the bladder. Most UTIs affect the urethra and the bladder alone. While UTIs affect both men and women, the rate of prevalence and recurrence is higher among women, with about 50 percent of all women expected to contract the infection at least once in their life time and 20-30 percent expected to suffer a recurrence.
The high prevalence of UTIs among women is attributed to the fact that the urethra in women is shorter than in men. The urethra in women is placed closer to both the anus and the vagina. Bacteria from the anus and those that enter the vagina during intercourse have only to travel the short length of the urethra to reach the bladder. Besides gender, the other risk factor for UTIs for both genders is advanced age.

Causes of recurrence

A case of UTI is said to be recurrent or persistent if a patient contracts at least four infections in a period of one year. Recurrence of UTIs occurs almost solely among women. Other than the positioning of the urethra in their bodies, this recurrence may be caused by factors such as:

1. Failure to complete a dose of antibiotics. Once the benefits of taking the prescribed antibiotics start to manifest, some patients stop taking the drug because they think the UTI has cleared. Urologists discourage this behavior and advise patients to complete the dose to reduce the chances of any left over bacteria causing a recurrence.

2. Sex is a risk factor. Sexually active women face a higher risk of contracting a UTI because of the transmission of bacteria during intercourse. The risk can be reduced by urinating before and after sex or by taking an antibiotic before or after sex if a doctor prescribes it.

3. Post-menopausal hormonal changes. Menopause lowers estrogen levels in women causing an imbalance in the bacteria in the vagina. This makes women susceptible to infection and recurrence. A urologist can prescribe a vaginal estrogen cream to remedy the problem.

Women are genetically predisposed to contracting UTIs, both because of their anatomy and hormonal changes as they get older. But UTIs in women are highly treatable and are only rarely very serious. If anyone experiences persistent infections, she should seek the advice of expert urologists, such as those found in St. Pete Urology. The experienced specialists at St. Pete Urology can offer consultation, diagnosis and treatment for any UTI problems. For more information, visit the “St Pete Urology” site.