What Can Cause Poor Bladder Control?

Loss of bladder control, called urinary incontinence, is a common and usually embarrassing problem. It may manifest as leaking of urine when coughing, sneezing, jumping, or during other physical activity. But it can also occur as a sudden, strong, uncontrollable urge to urinate or wake up several times at night.

While the problem tends to occur more commonly in older people, it isn’t an unavoidable consequence of aging. In fact, you don’t have to live with urinary incontinence because you are aging.

So if urinary continence is disrupting your social life and daily routine or affecting your quality of life, speak with your doctor about it. Your urologist will usually begin with a conservative approach of recommending simple lifestyle and dietary changes to help you get relief from the symptoms. Or in some cases the doctor may recommend more aggressive medical treatments to free you from the condition.

Causes of Poor Bladder Control image

Types of urinary incontinence:

  1. Stress incontinence
    Stress incontinence occurs if exerting direct pressure on your bladder results in urine leakage. The urine leaks linked to stress incontinence typically occur when you cough, sneeze, laugh, exercise or lift a heavy item.
  2. Urge incontinence
    Urge incontinence manifests itself if you frequently experience a sudden, intense, uncontrollable urge to pass urine which results in urine leakage. With the strong urge, most find themselves urinating several times per day including throughout the night.
    Urge incontinence may be due to a minor condition, such as urinary tract infection. But it some cases it can be the result of a more severe condition such as diabetes or a neurological disorder.
  3. Overflow incontinence
    Overflow incontinence is when you experience frequent dribbling of urine. Usually the dribbling of urine is due to the inability to fully and completely empty the bladder.
  4. Functional incontinence
    Functional urinary incontinence is the result of physical or mental impairments that makes it difficult to hold urine and for many to even reach the toilet in time to relieve themselves. So many have urine leaking from their bladder as they struggle to reach the bathroom. 
  5. Mixed incontinence
    Mixed incontinence is if you suffer from more than one type of urinary incontinence. Most often mixed incontinence is a combination of urge and stress incontinence.

What can cause poor bladder control?

Many experience urinary incontinence due to an underlying medical condition, a physical problem, or a change in lifestyle.  The incontinence may be temporary if due to a change in daily habits and in those cases is an easily treatable condition. But if the condition is persistent when related to a medical condition or physical problem, undergoing a thorough evaluation by your doctor will help determine the cause of your incontinence.

Causes of temporary urinary incontinence:

  • Urinary tract infections
    Urinary tract infections may also lead to a strong urge to urinate. The urge may be too intense to the point of urine leakage before you can reach the bathroom. With the treatment of the source infection, the incontinence typically disappears.
  • Constipation
    Since the rectum is located near the bladder and shares many nerves with the bladder, having hard, compacted stool in the rectum can cause the nerves controlling the bladder to be overactive. In turn, increased urinary frequency may occur, resulting in incontinence. The incontinence usually resolves when the constipation ends.
  • Drinks that act as diuretics
    Some drinks have the ability to stimulate the bladder and increase urine volume. As a result, urine may leak due to the overwhelming volume in the bladder. Reducing the intake or avoiding these drinks helps to prevent incontinence.

    The drinks include: 
    • a. Caffeine
    • b. Alcohol
    • c. Artificial sweeteners
    • d. Chocolate
    • e. Carbonated drinks and sparkling water
    • f. Chili peppers
    • g. Large doses of vitamin C
    • h. Sedatives, muscle relaxants, and heart and high blood pressure medications
    • i. Foods with too much sugar, spices, or acids, particularly citrus fruits

Causes of persistent urinary incontinence:

  • Pregnancy
    Pregnancy is accompanied by hormonal changes and increased weight of the fetus. These changes may cause stress incontinence.
  • Childbirth
    During vaginal delivery, the muscles that control the bladder may weaken. The nerves and supporting tissues may also be damaged.  Due to the weakening of bladder muscles and damage of nerves and tissues, a prolapse (dropped) may occur in the pelvic floor. 
    Following a prolapse—where the bladder, rectum, uterus or small intestine is pushed down from the normal position and protrudes into the vagina—bladder control diminishes, resulting in incontinence.
  • Aging
    With age, the bladder muscles weaken and bladder control reduces. Also, as you get older, involuntary bladder contractions become more common, increasing the likelihood of incontinence.
  • Menopause
    The production of estrogen—a hormone that keeps the lining of the urethra and bladder healthy—reduces after menopause. As a result, the bladder and urethral tissues deteriorate, causing or aggravating incontinence. 
  • Enlarged prostate
    Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. As the prostate enlarges, it puts more pressure on the bladder, which in turn loses control. Thus, an enlarged prostate often triggers urinary incontinence.
  • Prostate cancer
    Untreated prostate cancer can cause stress incontinence in men. Also, urinary incontinence may be an adverse effect of prostate cancer treatment.
  • Urinary tract obstruction
    Overflow incontinence can occur when there is a blockage of the normal flow to urine along the urinary tract. The obstruction may be due to a tumor somewhere in the urinary tract or a urinary stone.
  • Neurological disorders
    Disorders that interfere with the nerves involved in bladder control may trigger urinary incontinence. Neurological issues commonly associated with urinary incontinence include stroke, multiple sclerosis, Parkinson’s disease, brain tumor, and spinal injury.

When should you see a doctor?

Please see a doctor if urinary incontinence is too frequent, embarrassing, and is affecting your quality of life. Your doctor will identify the underlying cause of the problem and administer appropriate treatment. 

Plus, you should see a urologist when the incontinence:

  • Causes you to restrict your social interactions and daily activities.
  • Adversely affects your esteem, confidence, and quality of life.
  • Is accompanied by other symptoms, such as pain or blood in urine.
  • Could pose other risks, such as the risk of falls as you rush to the toilet.
  • Is suspected to be a symptom of a more serious underlying condition.

At St Pete Urology, we have a team of urologists that boasts a rich knowledge and wealth of experience in treating urinary incontinence.  Our urologists conduct a thorough physical exam and take comprehensive medical history before requesting appropriate tests to help identify the underlying cause of incontinence.

We are proud of our tailored treatments and the remarkable results we achieve with all our patients. For more information on urinary incontinence and other urological problems, visit the site “St Pete Urology.”

What is the most common treatment for bladder cancer?

If you are diagnosed with bladder cancer, there are several effective treatment options including chemotherapy, radiotherapy, and surgery. Your doctor will recommend the best treatment for you depending on your age, the stage of the cancer, the severity of the symptoms, and your overall health.

At St Pete Urology, we use a shared decision-making approach in dealing with bladder cancer. Shared decision-making means that you and your urologist work together to arrive at a personalized treatment. We are very confident in the outcomes that we achieve through this approach.

So what is the most common treatment for bladder cancer?

Surgery is the most common treatment for bladder cancer. In fact, most people with the cancer need to undergo some form of surgery.  And it is only because surgery may not remove all the tumor cells that the other treatments—chemotherapy, radiation, immunotherapy, targeted therapy—may be necessary along with or instead of surgery.

For early stage bladder cancer, the most common surgical procedure is transurethral resection of bladder tumor (TURBT), also called transurethral resection (TUR). During the procedure, the surgeon inserts a cystoscope through the urethra into your bladder and then uses a tool with a tiny wire loop, a laser, or high-energy electricity (fulguration) to remove the tumor.

If the bladder cancer is detected late, your surgeon may opt for cystectomy—a type of surgery that involves the removal of part of the bladder (partial cystectomy) or the whole bladder (radical cystectomy). Partial cystectomy is the ideal option for cancer that is still small and has spread only slightly to the muscle layer of the bladder.

But for cancer that is large or has spread deeper into the bladder muscle or to more than one part of the bladder, radical cystectomy is the go-to option. It is the removal of the whole bladder together with nearby tissues, organs and lymph nodes. In men, this may include the removal of the prostate gland, seminal vesicles, vas deferens, and part of the urethra. And in women, it can mean the removal of the uterus, ovaries, fallopian tubes, and part of the vagina.

Treatments used together with or instead of surgery

  1. Using medicines

Certain medications are effective in destroying cancer cells. Medications used to treat bladder cancer are usually in the form of chemotherapy, immunotherapy or targeted therapy.

  1. Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. The drugs are administered in two ways: local (Intravesical) and whole-body (systemic). 

For Intravesical chemotherapy, a prescribed drug is delivered to the bladder through a catheter inserted via the urethra.  The drug destroys superficial tumor cells that come into contact with it, but may not be effective for deeper tumor cells or cancer cells that have spread to other organs. The most frequently used local therapy drugs are mitomycin-C, gemcitabine (Gemzar), docetaxel (Taxotere), and valrubicin (Valstar). 

Systemic chemotherapy means that a drug or combination of drugs is taken orally or injected into the veins. The drug travels through the bloodstream to various parts of the body and shrinks, slows down or kills cancer cells that may have spread beyond the bladder. 

Whole-body chemotherapy is done in cycles to give the body time to recover between treatments. Every cycle lasts a few weeks, while a complete treatment may take several months. Plus, systemic chemotherapy is often done before surgery to help shrink tumors, make them easier to remove, make surgery safer, and minimize the likelihood of a recurrence. 

The drug cisplatin is the most commonly used systemic chemotherapy drug to treat bladder cancer, particularly for the most frequent type of the cancer, known as urothelial carcinoma. The drug damages the DNA of tumor cells so they can’t reproduce. Cisplatin is typically used in combination with other drugs. The most common combinations are:

  1. Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC)
  2. Gemcitabine and cisplatin (GC)

iii. Cisplatin, methotrexate, and vinblastine (CMV)

  1. Paclitaxel, gemcitabine, and cisplatin (PGC)
  2. Dose-dense (DD)-MVAC, which has mostly replaced MVAC. It has the same regimen as MVAC, has a growth factor support, and administered with short time between treatments.
  3. Immunotherapy

The treatment exploits the body’s own immune system to attack cancer cells. The attack on cancer cells is triggered by materials made either by the body or in the laboratory. There are two types of immunotherapy: local and systemic.

In local immunotherapy, the doctor injects an immune-boosting germ, usually interferon or BCG (Bacillus Calmette-Guerin) into the bladder via a catheter. The material draws the body’s immune cells to the bladder and activates the cells to fight cancer cells.

Systemic immunotherapy is primarily focused on immune checkpoint inhibitors. The drugs used, such as Atezolizumab (Tecentriq), Avelumab (Bavencio), Nivolumab (Opdivo) or Pembrolizumab (Keytruda), have the ability to block the protein PD-1 found on the surface of T cells.  Since protein PD-1 usually stops the immune system from destroying cancer cells, blocking it empowers the immune system to better eliminate cancer cells.

  1. Targeted therapy

The treatment involves using drugs that can target and destroy specific proteins, genes or tissues that enable the growth and survival of cancer cells. Drugs used, such as Erdafitinib (Balversa), Enfortumab vedotin—ejfv (Padcev) and Sacituzumab govitecan (Trodelvy), have the ability to block the growth and spread of cancer cells.

Before targeted treatment, the doctor runs genomic tests to identify the genes, proteins, and other factors contributing to the tumor. This helps to find the most specific molecular targets. 

  1. Radiation therapy

It is the use of high-energy x-rays or other particles to destroy cancer cells. The treatment is administered in the form of external-beam radiation, which is radiation given from a machine located outside the body. The alternative, called brachytherapy or internal radiation therapy, which uses implants, is not ideal for bladder cancer. 

A radiation therapy regimen, or schedule, consists of a specific number of treatments delivered over a set period of time.  

For bladder cancer, radiotherapy is used:

  1. When you have early-stage bladder cancer
  2. When you have early-stage cancer but can’t have surgery
  3. As a follow-up to TURBT or partial bladder removal surgery
  4. To prevent or treat symptoms of advanced bladder cancer

Safe, unparalleled bladder cancer treatment

Are you experiencing bladder cancer symptoms? Or are you worried that your urinary symptoms could be due to bladder cancer?

At St Pete Urology, we have a team of urologists that are skilled, knowledgeable and experienced in bladder cancer diagnosis and treatment. So you can trust us to detect the cancer in its early stages and to administer the most appropriate treatment. 

Through our collaborative, compassionate, multidisciplinary approach, we ensure that our patients get the best possible bladder cancer care. Visit us today for an accurate, timely diagnosis.

For more information on bladder cancer risks, prevention, signs and symptoms, 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.