What Women Want to Know: Your Bladder Matters

Many women, young and old, suffer from bladder problems.  These problems range from the occasional annoying “gotta-go,” to leaks while exercising or sneezing, to debilitating urinary frequency and loss of control.  This article details ways you can do to help your bladder function better without having to go to the doctor.

Before we review self-help solutions, let’s go over some terminology.  The “gotta-go” feeling is called urgency.  When “gotta-go” is associated with a leak, then it is called urge incontinence.  Urinary frequency describes how often a person has to urinate.

Incontinence is a general term for loss of urinary control. 

Most women with bladder problems suffer from urinary frequency and urgency.  These are the classic overactive bladder symptoms.  Many women also suffer from urinary incontinence to varying degrees.  Urologists and urogynecologists are doctors who can help these problems with medication and surgery.  This paper discusses what you can do on your own before visiting the doctor’s office for help.

Pelvic strengthening exercises

Pelvic floor exercises, known as Kegel exercises, are a simple way to improve bladder function.   While this takes persistence and dedication, there is no risk, no cost, and very little time investment.   The key to Kegel exercises is to perform them correctly and often.  Proper technique involves tightening the urinary sphincter muscle.  This can be verified by placing a finger in the vaginal opening and feeling the contraction around the finger.  An alternative verification technique is to stop the flow of urine by contracting the sphincter (although you should not do the exercise routinely while voiding).

Once you learn how to contract the proper muscle group, then you are ready for the exercise program.  A common technique for Kegel exercises involves holding each contraction for 3-10 seconds, and doing 50-100 exercises per day.  If Kegel exercises are performed regularly, overactive bladder symptoms will usually improve (frequency and urgency), and most women will also have improvement in mild to moderate urinary incontinence.

Optimal weight

Achieving and maintaining optimal weight improves bladder function.  Body mass index (abbreviated BMI) is a common tool to determine whether an individual is overweight or obese.  BMI can be calculated very easily (Figure 1).  The BMI, while not a perfect representation of fitness level, does provide a rough idea of optimal weight, overweight, and obesity (Figure 2).

Studies have shown that women with BMI at or above 30, had at three times the risk of severe incontinence compared to women whose BMI was 24 or less.¹ Another study showed that the earlier in life that a woman becomes obese, the more severe her incontinence will be. ²  Many studies show that the higher the BMI, greater weight gain, and central adiposity (gain of weight in the abdomen), leads to higher urge incontinence.  Further, overweight individuals who subsequently achieve optimal weight also do achieve improved continence.

Diet and fluid intake

Some dietary components can affect overactive bladder symptoms.  For example, eating vegetables, bread, chicken decreases urinary frequency and urgency.³  Conversely, diets with higher fat intake and greater energy intake tend to worsen overactive bladder symptoms. 

Caffeine, carbonation, and artificial sweeteners also worsen overactive bladder symptoms.  The artificial sweeteners aspartame and saccharin actually enhance bladder muscle contraction (and therefore increase urgency and frequency) by affecting calcium channels in bladder muscle cells.  Ascorbic acid and citric acid (found in many carbonated beverages) also increase calcium flow and therefore bladder overactivity.   In addition, ascorbic acid also increases release of a signal between cells, also causing increased activity of bladder muscle.

Some individuals, especially the elderly, reduce overall fluid intake to reduce trips to the bathroom.  This technique does reduce urgency and frequency symptoms during the day and night.  However, it may cause dehydration with resultant poor kidney function and potentially kidney stones.

Vitamins and supplements

Higher intakes of vitamin D and protein have been shown to improve urinary urgency and frequency.  Intake of vitamin C has demonstrated mixed results.  Vitamins B6 and niacin have no effect on overactive bladder symptoms.  There are many supplements advertised which claim improve bladder performance.  While some may be helpful, detailed studies have not been done to objectively demonstrate improvement.   One natural product, cranberry juice, has garnered much media attention.  This has mostly been studied with respect to prevention of urinary tract infection, not prevention of overactive bladder or incontinence.  Recent studies and reviews show no significant cost-effective reduction of urinary tract infections when cranberry products were used as prevention.

Behavioral modification

 Timed voiding is a form of behavioral modification to help with urge incontinence.  Timed voiding simply means urinating “on the clock” rather than waiting for the urge.  For example, a woman could void every 2 hours on a schedule throughout the day.  This technique can help those who cannot get to the bathroom fast enough once the urge to urinate occurs.

Conclusion

You can take action now to improve your bladder health.  You can strengthen the urinary sphincter muscle by performing Kegel exercises.  If overweight, you can gain better bladder control by achieving proper weight.  Eating certain foods more often while avoiding others will help with overactive bladder symptoms.   Timed voiding will reduce loss of control due to urgency.  These are proven methods that you can do on your own to enhance your bladder function.

References

1. Danforth KN et al. Risk factors for urinary incontinence among middle aged women.  Am J Obstect Gynaecol 2006;194:339-45.

2. Mishra GD et al.  Body weight through adult life and risk of incontinence in middle-aged women;  Results from a British prospective cohort.  Int J Obes  2008;32:1415-22.

3. Robinson D, Giarenis I, Cardozo L.  You are what you eat:  The impact of diet on overactive bladder and lower urinary tract symptoms.  Maturitas 2014;79:8-13.

Figure 1 

Body Mass Index (BMI) Calculation

Step 1. Multiply your height (inches) times itself.

Step 2. Divide your weight (pounds) by your answer from step 1.

Step 3. Multiply your answer from step 2 by 703. This answer is your BMI.

Example:

Step 1. 66 inches x 66 inches = 4,356 inches

Step 2. 150 lbs/4,356 inches = 0.03443526 lbs/in

Step 3. 0.03443526 lbs/in x 703 = 24.

Figure 2 

Body Mass Index (BMI)

18.5 - 25    Optimal weight

25 - 30       Overweight

30+            Obese