Do you have an urge to pee – constantly? It might not be your coffee habit; you could have an overactive bladder. But not to worry. These latest treatments and helpful tips can take the urgency out of your day…
A coffee refill, another glass of wine – they’re sure to send you to the ladies’ room. But are you taking far more bathroom breaks than you used to without knowing why? And what’s considered normal anyway?
Generally, eight bathroom visits a day is typical.
More breaks than that – especially if they disrupt your day or wake you at night – could mean you have an overactive bladder (OAB), according to D.C. urologist Arnold J. Willis, M.D., a faculty member at George Washington University Medical School.
“The real issue is urgency and whether the frequency [of bathroom breaks] interferes with the quality of your life,” Willis says.
About 17 million people suffer from OAB, the often sudden and compelling urge to urinate – and an occasional inability to hold back until you reach the toilet.
Although it’s more common as we age, women in their 30s and 40s are at particular risk, says Willis.
That’s because pregnancy and childbirth can weaken pelvic floor muscles, which support the bladder and relax every time you urinate. And the estrogen loss that comes with menopause dries vaginal tissues, shortening and weakening the muscle pressure around the urethra (the tube that carries urine from the bladder), leading to leaks.
Why the waterworks? Essentially, something’s wrong with how your bladder lets the brain know it’s time to pee.
Normally, when the bladder’s three quarters full of urine, the sacral nerves that control the bladder tell your brain that you have to go. As you pee, bladder muscles contract, forcing urine to flow.
If you have an overactive bladder, the sacral nerves start signaling an urgency to urinate too early – when the bladder is only half full – and the bladder muscles contract more often and more urgently. It all leads to more frequent bathroom trips and occasional leaks.
It’s not curable, but is it possible to manage OAB and get back your life? Yes!
Here are doctor-recommended tips and medical breakthroughs to bring you relief:
Lifestyle Changes to Lessen the Urge
Upping your tolerance of OAB symptoms can help you avoid accidents and discomfort. Here are 6 key ways to get through your day:
1. Limit your liquids.
The less you drink, the fewer times you’ll have to go.
While doctors generally recommend sipping 8-9 cups of water a day, according to the Mayo Clinic, how much to drink when you have OAB depends on the person, so ask your doctor for guidelines, Willis says. It could be one of the causes of frequent urination.
What you’re drinking also affects your urge to pee.
“Caffeine and alcohol are diuretics,” says Judd Boczko, M.D., a urologist in private practice in White Plains, N.Y. “So they cause you to make more urine.”
They’ll also stimulate the bladder, he adds, as will decaffeinated coffee – it’s not totally caffeine-free – and green tea. This causes extra irritation that the nerves sense, which makes you think you have to pee when you don’t.
Switching to decaf teas and other liquids will help.
2. Put the squeeze on.
If you’ve had children, you’re probably familiar with Kegel exercises, the repeated squeezing of pelvic muscles that helps women push during childbirth. Those same muscles control the flow of urine.
“Kegels strengthen the pelvic floor muscles that affect bladder control,” says Boczko, who recommends doing at least ten 10-second squeezes three times a day to keep from leaking.
Willis recommends even longer Kegels workouts: 15-20 minutes twice a day.
“You may say, ‘I don’t have time,’” he says. “But you can do them while you’re listening to music or at a stoplight.”
3. Lose the excess weight.
“The heavier you are, the more weight you place on your pelvic floor muscles,” Willis says. Pressure on these muscles weakens them, meaning more little leaks.
Excess weight also increases pressure on the bladder, he adds, making you feel an urge to pee.
4. Focus on fiber.
Because the bladder and bowel are next to each other, constipation can be one of the causes of frequent urination.
“You can stretch the pelvic floor muscles by straining [to move your bowels],” Willis says.
To stay regular, add more fiber to your diet with foods like brown rice, whole wheat bread, fruits and vegetables. Willis also recommends taking a fiber supplement, like Metamucil, twice a day.
5. Keep your cool.
Spicy foods like chili, taco sauces and wasabi can irritate the bladder lining, increasing your urge to go, according to Willis.
Choose milder spices like cilantro, mint and oregano to flavor dishes.
6. Take time to unwind.
Mortgage payments, deadlines, crowded commutes – all that stress affects your bladder, making you have to go even more, although doctors are unclear why, says Boczko.
So keep stress levels low – with relaxation techniques such as meditation, deep breathing exercises or progressive muscle relaxation, says Willis.
His tips: When you’re starting to stress, breathe in slowly to the count of 10, then release your breath, again counting to 10. Repeat several times throughout the day.
To relax muscles, lie on the floor, tensing and releasing various muscle groups one by one, starting at your head and moving down to toes.
If you’re frequently stressed, see a psychotherapist, who can prescribe an antidepressant like amitriptyline (Elavil) to lessen anxiety, Boczko advises.
Medical Options to Manage OAB
Lifestyle changes can help, but only in conjuction with medical treatment, says Willis. Here’s what your doctor may recommend:
1. Medication
Lifestyle changes are the first line of OAB defense, but if you don’t get relief, your doctor may prescribe an antimuscarinic. This category of drugs blocks nerve endings to the bladder, making it contract less often and less urgently so you don’t feel the urge to pee.
But too high a dosage can shut you down altogether – stopping bladder contractions and keeping you from urinating, says Willis. “So we start low and work up to a dosage that’s effective.”
Patients are asked to keep a diary for a month or two, logging each time they use the bathroom so a doctor can monitor the drug’s effects.
Side effects include dry mouth and eyes, constipation and, in rare cases, blurred vision. “In those cases, you might have to cut back on dosage or switch drugs,” Willis says.
If you have narrow-angle glaucoma, a progressive eye disease, check with your eye doctor before taking these drugs, because they can increase pressure within the eye, aggravating symptoms.
2. Non-surgical treatments
Urgent PC: Doctors may also treat OAB with a non-surgical procedure, such as the office-based treatment Urgent PC.
In this technique, approved by the Food and Drug Administration (FDA) in 2005, the doctor inserts a small needle near your ankle that’s hooked up to an electrical stimulator and sends impulses up your leg to the sacral nerves, disrupting the nerve signals that normally make you have to pee.
The result: more bladder control.
“It’s like acupuncture,” Boczko says. “A patient comes in once a week for 12 weeks for a half-hour. Then I taper [off] the treatments.”
Most patients need repeat treatments every six months, although some can stop after one round.
How well does it work? A 2010 multi-center trial found that 60% of patients improved after treatment, compared with only 22% of the control group – a similar result to studies on OAB medicines, says Boczko.
Renessa: This non-surgical option is used for women who pee before reaching the bathroom, says Willis.
“It’s very innovative and gets women out of diapers,” he says.
In this treatment, a doctor inserts a small tube into the bladder through the urethra and applies a low-temperature heat that mildly damages tissue. When the treated tissue heals, it’s firmer, tightening the urinary tract opening so it won’t leak.
The procedure requires nine in-office treatments that take 60 seconds each.
Is it effective? A 12-month multi-center U.S. clinical trial involving 250 women found that 76% were incontinent less often and 58% no longer had to wear pads.
Botox: While still only in experimental stages and not FDA-approved for this purpose, some doctors inject Botox directly into the bladder wall, according to Willis.
Patients undergo multiple injections and treatments, and it has been shown to help with relaxing bladder muscles and the OAB urge to go.
3. Surgery
For patients who don’t respond to lifestyle changes, medication or non-surgical options, a doctor may recommend sacral nerve stimulation. A small device is permanently and surgically implanted in a patient’s bottom that automatically sends impulses to the sacral nerves, delaying signals to the brain telling it you have to go.
“By sending direct electrical impulses to those nerves, you moderate the bladder’s threshold,” Boczko says.
For example, if you feel the need to urinate when your bladder is holding only 2 ounces of urine, the implant may delay the nerve signal so you get an urge only when the bladder is 8 ounces full. (A healthy bladder can usually hold up to 16 ounces of urine for 2-5 hours, according to the National Institute of Diabetes and Digestive and Kidney Diseases.)
This surgery has drawbacks, says Boczko: The battery has to be changed every 5-8 years. And the lead wires may get dislodged and have to be reinserted.
But it's effective: According to a 2007 review of a multicenter trial involving 163 patients with incontinence and overactive bladder, 65% were helped by sacral nerve stimulation.
Health writer Dorothy Foltz-Gray is a frequent contributor.
Are You Having Bladder Problems?
Leak when you laugh? Have a constant urge to pee? Incontinence is a problem that can be managed. Knowing the causes and common triggers can help you stay dry and out of the bathroom.
No comments:
Post a Comment