Bladder Problems

Men and women alike are prone to bladder and urinary problems with aging. Three main problems occur with the bladder – incontinence (urine leakage), infection and cancer. Routine daily activities can be easily derailed by urinary problems. Frequent trips to the bathroom can disrupt daytime activities and make for restless sleep. Urinary leakage is not only inconvenient but can be also socially embarrassing.

Urinary incontinence is the loss of bladder control. The cause for incontinence is usually different for men than women. For most men, problems with the prostate is the underlying cause. Prostate enlargement causes restriction in the urinary flow resulting in bladder deterioration. The treatment of urinary incontinence from prostate enlargement may involve medications or surgery.

However, women lack a prostate, so the cause of incontinence is often more complicated. Women who complain of stress urinary incontinence have leakage with coughing, sneezing or strenuous physical activity. The cause of stress urinary incontinence may be due to weak muscles of the pelvis or urinary sphincter due to the previous trauma of childbirth. With aging, the muscles of the pelvis lose their elasticity and tone leading to poor urinary control. The treatment for stress urinary incontinence may involve pelvic floor exercises (ie. Kegel exercises) or possibly surgery.

Women may also have another form of poor bladder control called urge incontinence. Urge incontinence occurs when there is a strong sensation to urinate leading to leakage before a woman can reach the bathroom. The cause of urge incontinence is multifactorial but is often due to a hyperactive bladder. Urge incontinence is best evaluated with urodynamics, a detailed analysis of the sensory and contractility function of the bladder. The treatment of urge incontinence may include oral medication, pelvic muscle retraining and possibly sacral nerve modulation.

Urinary infection (UTI) of the bladder account for more than 7 million doctor’s office visits and 1 million emergency room visits per year. Financially, the estimated total annual cost from UTI is approximately $1.6 billion. In general, UTI’s are more common in women than in men. The symptoms of a UTI include pain in the bladder with fever or blood in the urine. Bothersome symptoms require a urine culture and treatment with the appropriate antibiotics. More serious infections may require hospitalization and intravenous antibiotics. Most importantly, the urologist will advise on UTI prevention strategies to reduce recurrence and bacterial antibiotic resistance.

Bladder cancer is the 8th leading cause of cancer in America, occurring more often in men and women. Cigarette smoking is the leading cause of bladder cancer. Usually, bladder cancer presents with blood in the urine. Often, there are no symptoms whatsoever. Early diagnosis of bladder cancer with close monitoring are often curative. The urologist will need to inspect the bladder with an in-office procedure called cystoscopy. If a tumor is found, prompt surgical removal will be needed.