WHAT IS THE BLADDER AND URINARY INCONTINENCE?
The bladder is a muscular organ that stores the urine produced by the kidney. Urinary continence is maintained by the bladder neck, the pelvic floor muscles and the external urethral sphincter (1).
A healthy bladder can store up to 700 ml of urine. The bladder expands when filled, and at volumes of 250ml to 300 ml, signals are sent to the brain to trigger the urge to urinate (2). In releasing urine, the muscles of the bladder walls contract to push the urine out and the sphincter muscles which are on the neck of the bladder relax allowing the urine to flow out (2).
The process of being in control of the bladder and voluntary voiding involves muscles and nerves that send signals to the brain (2). This process is important for daily, healthy functioning; the process is learned and developed in early childhood.
Urinary incontinence is the involuntary or abnormal voiding of urine, as well as having problems storing the urine in the bladder. It is caused by abnormalities in the anatomy or functioning of the bladder and/or urethra (3).
RISK FACTORS FOR URINARY INCONTINENCE
- Diabetes (4,5,6)
- Old age (7,8,9)
- Obesity (10,11,12)
- Post-menopausal therapy and contraceptives (13)
- Caucasian ethnicity (14,15,16)
- Smoking (16,17)
- Neurological conditions such as Parkinson’s or stroke (18,19,20,21,22,23,24,25,26)
SYMPTOMS OF URINARY INCONTINENCE
Urinary incontinence is categorized based on the cause of the problem (3).
Urge Urinary Incontinence
- Associated with hyperactivity of the bladder
- Symptoms include involuntary urine leakage due to frequent, sudden and intense urges to urinate (3,7)
Stress Urinary Incontinence
- Associated with reduced functioning of the urethra
- Symptoms include involuntary urine leakage due to exerted effort such as laughing, sneezing or coughing (3,7)
- Associated with high urethral activity and low bladder activity
- Symptoms include involuntary urine leakage due to incomplete emptying of the bladder
- Occurs more often in men who have benign prostatic hyperplasia (3,7)
The symptoms of urinary incontinence vary on the severity of the condition. For example, if it is mild to moderate, urine leakage could range from a couple drops occasionally, as compared to severe cases of complete bladder emptying on a daily basis (27).
RECENT FACTS OR STATISTICS ON URINARY INCONTINENCE
In the United States, 2017 estimates show that 25 million adults suffer from some form of urinary incontinence (28).
In 2010, estimates showed that women experienced urinary incontinence almost twice as much as men. Up to 37% of women between the ages of 20 to 39 years report some incontinence, while up to 39% of women over the age of 60 report experiences of daily incontinence (29).
MEDICAL TREATMENT OF URINARY INCONTINENCE
The first line of pharmacological treatments of choice for urinary incontinence are anticholinergic or antimuscarinic medications. These drugs work by blocking the muscarinic receptors on the detrusor muscle to control its contraction (30,31). Some of these antimuscarinic medications include:
- Oxybutynin – marketed as Lyrinel and Ditropan (32)
- Tolterodine – marketed as Detrol (33)
- Trospium – marketed as Sanctura (34)
- Fesoterodine –marketed as Tovia (35)
- Darifenacin – marketed as Enablex (36)
- Solifenacin – marketed as Vesicare (37)
Common side effects of these medications include: headache, dizziness, dry mouth, diarrhea, heartburn, nausea, visual and audio hallucinations, blurred vision, drowsiness, change in urination habits, painful urination, and swelling in hands, chest, and face (33,34,35,36,37)
NATURAL WAYS TO SUPPORT A HEALTHY URINARY TRACT
Practices to Support a Healthy Urinary Tract:
- Pelvic floor muscle exercises
- Bladder training
- Voiding logs
- Habit retraining (7,38,39)
- Refrain from smoking cigarettes
- Alter diets to reduce carbohydrate intake
- Increase physical activity (10,11,12,16,17)
Natural Supplements That Support a Healthy Urinary Tract:
- Vitamin D (40)
- Gosha-jinki-gan (41,42)
- Vinpocetine (43)
- Sodium Chondroitin Sulfate (44)
- Cranberry (45,46,47)
- Lukacz E, Sampselle C, Gray M et al. A healthy bladder: a consensus statement. Int J Clin Pract. 2011;65(10):1026-1036. doi:10.1111/j.1742-1241.2011.02763. x.
- How does the urinary system work? PubMed Health. 2018. Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072568/. Accessed April 5, 2018.
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- Phelan S, Grodstein F, Brown J. Clinical Research in Diabetes and Urinary Incontinence: What We Know and Need to Know. J Urol. 2009;182(6):S14-S17. doi:10.1016/j.juro.2009.07.087.
- Lifford K, Curhan G, Hu F, Barbieri R, Grodstein F. Type 2 Diabetes Mellitus and Risk of Developing Urinary Incontinence. J Am Geriatr Soc. 2005;53(11):1851-1857. doi:10.1111/j.1532-5415.2005.53565.x.
- Danforth K, Townsend M, Curhan G, Resnick N, Grodstein F. Type 2 Diabetes Mellitus and Risk of Stress, Urge and Mixed Urinary Incontinence. J Urol. 2009;181(1):193-197. doi:10.1016/j.juro.2008.09.007.
- DeMaagd G, Davenport T. Management of Urinary Incontinence. Pharmacy and Therapeutics. 2012;37(6):345-361.
- Morrison A, Levy R. Fraction of Nursing Home Admissions Attributable to Urinary Incontinence. Value in Health. 2006;9(4):272-274. doi:10.1111/j.1524-4733.2006.00109.x.
- Shamliyan T, Wyman J, Ping R, Wilt T, Kane R. Male Urinary Incontinence: Prevalence, Risk Factors, and Preventive Interventions. Rev Urol. 2009;11(3):145-165.
- Richter H, Kenton K, Huang L et al. The Impact of Obesity on Urinary Incontinence Symptoms, Severity, Urodynamic Characteristics and Quality of Life. J Urol. 2010;183(2):622-628. doi:10.1016/j.juro.2009.09.083.
- Subak L, Richter H, Hunskaar S. Obesity and Urinary Incontinence: Epidemiology and Clinical Research Update. J Urol. 2009;182(6):S2-S7. doi:10.1016/j.juro.2009.08.071.
- Wing R, Creasman J, West D et al. Improving Urinary Incontinence in Overweight and Obese Women Through Modest Weight Loss. Obstetrics & Gynecology. 2010;116(2, Part 1):284-292. doi:10.1097/aog.0b013e3181e8fb60.
- Townsend M, Curhan G, Resnick N, Grodstein F. Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal Women. J Urol. 2009;181(5):2170-2175. doi:10.1016/j.juro.2009.01.040.
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- Gupta A, Taly A, Srivastava A, Thyloth M. Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?. Ann Indian Acad Neurol. 2009;12(2):104. doi:10.4103/0972-2327.53078.
- Gelber D, Good D, Laven L, Verhulst S. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24(3):378-382. doi:10.1161/01.str.24.3.378.
- Yeo L, Singh R, Gundeti M, Barua J, Masood J. Urinary tract dysfunction in Parkinson’s disease: a review. Int Urol Nephrol. 2011;44(2):415-424. doi:10.1007/s11255-011-9969-y.
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