Bladder issues

16 March 2017.

Note: Bladder infections, incontinence, or urgency, are not directly hormone-related symptoms. However, some people find that they are more susceptible to these problems at certain times in their menstrual cycle, after giving birth, or in relation to hormone-related conditions such as Irritable Bowel Syndrome (IBS), or fibroids.


Well, in relation to menstrual cycle, hormonal medication, childbirth, or hormone-related conditions, there are two main bladder issues;

1. Bladder infections– Also known as Urinary Tract Infections (UTIs)- very common infections that can affect the bladder, the kidneys and the tubes connecting them. Anyone can get UTIs, but they’re particularly common in those with a female reproductive system [1]. Some people experience them regularly (called recurrent UTIs), sometimes because of fluctuations in the circulating level of hormones occurring during the menstrual cycle, in pregnancy, or at menopause [2].

Main symptoms: Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause: a need to wee more often than usual; pain or discomfort when weeing; sudden urges to wee; feeling as though you’re unable to empty your bladder fully; pain low down in your tummy; urine that’s cloudy, foul-smelling or contains blood; feeling generally unwell, achy and tired [1].

Note: Infections of the kidneys or ureters (tubes connecting the kidneys to the bladder) are known as upper UTIs. These can cause the above symptoms and also: a high temperature (fever) of 38C (100.4ºF) or above; pain in your sides or back; shivering and chills; feeling and being sick; confusion; agitation or restlessness. Upper UTIs can be serious if left untreated, as they could damage the kidneys or spread to the bloodstream- Consult a doctor immediately if you are suffering from these additional symptoms [1].

2. Urinary incontinence (UI) – This may be ‘stress-incontinence‘ e.g. inadvertently losing a small amount of urine when running, laughing, or sneezing; or ‘urge incontinence‘ e.g. a strong, sudden urge to urinate before losing a large amount of urine [3]. Many people experience both symptoms. Incontinence can be slightly annoying, or totally debilitating; for some people, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity, potentially causing embarrassment and emotional distress [4]. Fewer than 50% of people with urinary incontinence consult a doctor [4], due to embarrassment. If you have any form of UI, please consult your doctor, in most cases it can be completely resolved.

Note: There are two other types of urinary incontinence that require more specialised intervention- please consult your doctor immediately if you are experiencing these symptoms;

  • overflow incontinence (chronic urinary retention) – when you’re unable to fully empty your bladder, which causes frequent leaking
  • total incontinence – when your bladder can’t store any urine at all, which causes you to pass urine constantly or have frequent leaking

1. Bladder infections

Note: This is about how to avoid getting a bladder infection- if you already have one, please consult your doctor- UTIs are usually easily treated with a short course of antibiotics. Paracetamol can help with any pain. Drinking plenty of fluids may also help you feel better. Return to your GP if your symptoms don’t improve, get worse, or come back after treatment [1].

TOP TIP! Avoid citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods- which tend to make UTI symptoms worse [5].

Avoiding UTIs  in general:

UTIs occur when the urinary tract becomes infected, usually by bacteria. In most cases, this involves bacteria from the gut (via the anus) entering the urinary tract.

TOP TIPS!

  • Avoid perfumed bubble bath, soap or talcum powder around your genitals – use plain, un-perfumed varieties, and have a shower rather than a bath
  • Go to the toilet as soon as you need to wee and always empty your bladder fully; stay well hydrated and avoid caffeine; wipe your bottom from front to back when you go to the toilet
  • Empty your bladder as soon as possible after having sex; do not use a contraceptive diaphragm, or condoms, with spermicidal lubricant on them – use another method of contraception instead
  • Wear underwear made from cotton, rather than synthetic material such as nylon; use cotton washable panty-liners or pads, rather than disposable synthetic products
  • Wash your hands before (as well as after!) inserting, or removing, internal menstrual products (preferably a cup- tampon strings can transfer gut bacteria) [1].

Managing hormone-related recurring UTIs:

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms.We highlight a few of the key steps that are especially relevant for those suffering from recurring UTIs, below:

Eat lots of fibre– (and drink plenty of water too!)- constipation increases the risk of developing a UTI (especially for children- but possibly also in adults) [6].

Avoid sugary foods- Higher glucose concentrations in urine (amplifying bacterial reproduction) may explain why those with diabetes mellitus (type 2) are at increased risk of developing UTIs [7], so best to avoid sugary foods and drinks.

Exercise– together with a healthy diet- this can help to achieve or maintain a healthy body weight. A higher body-mass index appears to be associated with increased risk of UTIs in both male and female patients [8].

 

 


2. Bladder incontinence

Note: Incontinence is very common in people who have given birth, have Irritable Bowel Syndrome (IBS), or have fibroids. However, it is not an ‘inevitable’ problem, and one that typically responds extremely well to pelvic floor exercises, in particular. Please consult a doctor to establish the cause of your bladder incontinence, rather than assuming it is simply down to age, or childbirth etc.

Eat a healthy diet- As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms- but it is also a great way to lose weight safely, or maintain a healthy weight. Obesity is an established risk factor for incontinence, as demonstrated in several population-based studies [9, 10]. In addition, several intervention studies have demonstrated that weight loss is associated with reductions in incontinence [11-13].

Avoid caffeine and alcohol– Foods and beverages containing caffeine have been reported to be risk factors for bladder urgency, frequency and incontinence [14]. Alcohol is also known to promote bladder urgency and frequency by interfering with the signals regulating urination [15].

Avoid saturated fat–  A study investigating the possible association between dietary factors and the onset of female ‘stress incontinence’ (when sneezing, running, laughing etc.) demonstrated that total fat, and saturated fatty acids, were associated with an increased risk of incontinence [16].

TOP TIP! (BAD) Saturated fats are normally solid at room temperature. Most come from animal sources such as beef, poultry, whole-fat milk, cheese and butter, however several come from plant sources, like coconut, palm and palm kernel oils. (GOOD) Unsaturated fats come primarily from plant foods, such as nuts and seeds, and are liquid at room temperature. Examples include vegetable oils such as olive, peanut, safflower, sunflower, soybean and corn.

Take vitamin D supplements – Research show that vitamin D plays a protective role in maintaining continence. Three large population studies have provided evidence linking incontinence risk with insufficient vitamin D levels [17-19].

Avoid excess vitamin B12 or zinc?– Rather interestingly, an excess of two key vitamin/ minerals useful for maintaining hormonal health, has been found to worsen stress incontinence, in a longitudinal study of over 20,000 UK women [16]. However, it was not clear if this was because an excess (in both dietary elements) is most typically associated with a high levels of meat consumption, which also correlates with obesity, and higher levels of saturated fats… So, perhaps try reducing the amount of meat in your diet, or avoid taking specific B12 or zinc supplements, if you think this could be an issue in your incontinence?


For weight management– Long-term, moderate physical activity has been shown to be inversely related to incontinence [20] and lower activity levels are associated with 2–3 times greater likelihood of ‘stress incontinence’ in women [21]. This is because regular exercise helps maintain a healthy body weight (which reduces the likelihood of incontinence), as well as improving pelvic floor muscle strength (see below).

Pelvic floor exercises- Strengthening your pelvic floor muscles can prevent urinary incontinence [22]. The pelvic floor muscles are located between your legs, and run from your pubic bone at the front to the base of your spine at the back. They are shaped like a sling and hold your pelvic organs in place (everyone has these muscles, not just those with female reproductive organs!). This excellent NHS guide on how to strengthen the pelvic floor is a great starting point.

How to do pelvic floor exercises:

  • close up your anus as if you’re trying to prevent a bowel movement
  • at the same time, [if applicable- draw in your vagina as if you’re gripping a tampon], and your urethra as if to stop the flow of urine
  • at first, do this exercise quickly, tightening and releasing the muscles immediately
  • then do it slowly, holding the contractions for as long as you can before you relax: try to count to 10
  • try to do three sets of eight squeezes every day: to help you remember, you could do a set at each meal

As well as these exercises, practise tightening up the pelvic floor muscles before and during coughing and sneezing.

Note: for those who can afford them, there are also various products available to help improve your pelvic floor strength, or manage leaks e.g. internal dilators, or sports leggings- find out more at www.https://www.pelvicrelief.co.uk/continence/

Note: Impact sports and incontinence– Research shows that high impact sports (e.g. gymnastics, basketball) are more frequently associated with ‘stress incontinence’ than low impact sports (e.g. swimming, walking) [23]. However, this does not mean that you should avoid the high impact sports that you enjoy, just ensure that you practice effective pelvic floor exercises, (perhaps in consultation with a physiotherapist) to stop the underlying problem, or perhaps try these supportive sports shorts/ leggings?


Note: Whilst self-esteem does not, in itself, help to reduce incontinence- it can effect how quickly and well you manage the problem. Around one in four people has experienced bowel or bladder weakness. It affects both sexes, young and old, yet many people keep it a secret for years…

Try not to be embarrassed– incontinence is extremely common, and doctors will have seen many other patients with the same problem as yours… It is important that you understand the actual cause of your incontinence rather than assuming it is due to age, or childbirth- you may have fibroids, a uterine or bladder prolapse, or another health issue, so this requires professional medical support. Life is too short to needlessly worry about incontinence, especially when it is so treatable.


If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any other suggestions, or tips, for managing incontinence- please let us know– we can share them with others!


Further information:


Page last reviewed and updated: June 2018


References:

  1. NHS. (2016) Urinary Tract Infections in Adults [ONLINE] Available at: http://www.nhs.uk/conditions/Urinary-tract-infection-adults/Pages/Introduction.aspx. [Accessed 31 March 2017].
  2. Hextall A. (2000) ‘Oestrogens and lower urinary tract function’ Maturitas.  Aug 31;36(2):83-92. Review. PubMed PMID: 11006496.
  3. NHS. 2016. Urinary Incontinence. [ONLINE] Available at: http://www.nhs.uk/conditions/Incontinence-urinary/Pages/Introduction.aspx. [Accessed 31 March 2017].
  4. Koch LH. (2006) ‘Help-seeking behaviors of women with urinary incontinence: an integrative literature review’. J Midwifery Womens Health Nov-Dec;51(6):e39-44. Review. PubMed PMID: 17081925.
  5. Friedlander JI, Shorter B, Moldwin RM. (2012) ‘Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions’. BJU Int Jun;109(11):1584-91. doi: 10.1111/j.1464-410X.2011.10860.x. Epub 2012 Jan 11. Review. PubMed PMID: 22233286.
  6. Loening- Baucke V. (1997) ‘Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood’ Pediatrics 100:228-32
  7. Fünfstück, R., Nicolle, L.E., Hanefeld, M., Naber, K.G. (2012) ‘Urinary tract infection in patients with diabetes mellitus’ Clinical Nephrology. 77:40–48.
  8. Semins MJ, Shore AD, Makary MA et al. (2012) ‘The impact of obesity on urinary tract infection risk’ Urology 79: 266–9 doi:
    10.1016/j.urology.2011.09.040. Epub 2011 Nov 30. PubMed PMID: 22130358.
  9. Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S.(2003) ‘Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study’ BJOG 110: 247–54
  10. Coyne KS, Kaplan SA, Chapple CR et al. (2009) ‘Risk factors and co-morbid conditions associated with lower urinary tract symptoms: EpiLUTS’. BJU Int 103 (Suppl. 3): 24–32
  11. Wing RR, West DS, Grady D et al. (2010) ‘Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months’ J Urol 184: 1005–10. 56
  12. Subak LL, Whitcomb E, Shen H et al. (2005) ‘Weight loss: a novel and effective treatment for urinary incontinence’ J Urol 174: 190–5. 57
  13. Subak LL, Wing R, West DS et al. (2009) ‘Weight loss to treat urinary incontinence in overweight and obese women’ N Engl J Med 360: 481–90
  14. Jura YH, Townsend MK, Curhan GC et al. (2011) ‘Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence’ J Urol 185: 1775–80
  15. Seim A, Hoyo C, Ostbye T, Vatten L. (2005) ‘The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study’ BJU Int 96: 88–92
  16. Dallosso H, Matthews R, McGrother C, Donaldson M. (2004) ‘Diet as a risk factor for the development of stress urinary incontinence: a longitudinal study in women’ Eur J Clin Nutr 58: 920–6
  17. Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM. (2004) ‘Nutrient composition of the diet and the development of overactive bladder: a longitudinal study in women’ Neurourol Urodyn 23: 204–10. 45
  18. Badalian SS, Rosenbaum PF. (2010) ‘Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey’ Obstet Gynecol 115: 795–803. 46
  19. Vaughan CP, Johnson TM 2nd, Goode PS et al. (2011) ‘Vitamin D and lower urinary tract symptoms among US men: results from the 2005–2006 National Health and Nutrition Examination Survey’. Urology 78: 1292–7
  20. Townsend MK, Danforth KN, Rosner B et al. (2008) ‘Physical activity and incident urinary incontinence in middle-aged women’ J Urol 179: 1012–6. discussion 6–7.
  21. Maserejian NN, Kupelian V, Miyasato G et al. (2012) ‘Are physical activity, smoking and alcohol consumption associated with lower urinary tract symptoms in men or women? Results from a population based observational study’. J Urol 188: 490–5.
  22. Kissler K, Yount SM, Rendeiro M, Zeidenstein L. (2016) ‘Primary Prevention of Urinary Incontinence: A Case Study of Prenatal and Intrapartum Interventions’. J Midwifery Womens Health. Jul;61(4):507-11. doi: 10.1111/jmwh.12420. Epub 2016 Mar 11.
    Review. PubMed PMID: 26971402.
  23. Simeone C, Moroni A, Petteno A et al. (2010) ‘Occurrence rates and predictors of lower urinary tract symptoms and incontinence in female athletes’. Urologia 77: 139–46

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.