Bladder disorders are common as we age. In fact, many people think they are normal and live with their condition even if it begins to limit their activities. But there is effective treatment for bladder disorders, and at Providence Saint John’s our specialists work with you to provide personalized care that addresses your unique condition.
The leaking of urine, or urinary incontinence, can be a problem for women, but not all types of leakage are treated the same way. In some women with pelvic organ prolapse, the bladder falls from its proper place in the pelvis, which can put women at increased risk for leakage, incomplete bladder emptying, and recurring infections.
Here are some of the main bladder disorders:
- Stress incontinence: Urine leaks during increased pressure in the pelvis. This can occur during physical activity such as exercise, and also when sneezing, laughing and coughing.
- Urgency incontinence with overactive bladder: This occurs when a person has a sudden and strong urge to urinate that cannot be controlled or put off. The result can be leakage before reaching the bathroom. Some women are able to reach the bathroom in time, but the urgency, frequency, or waking up in the night to pee are still bothersome.
- Recurring urinary tract infections: Some women with pelvic floor disorders suffer from recurrent urinary tract, or bladder, infections. Urinary tract infections, also called UTIs, are considered a recurring problem when a person has three or more infections a year, or two in 6 months. It is important to properly diagnose infections with a urine culture, and to investigate which antibiotic is effective. Sometimes infections may be resistant to certain antibiotics.
- Interstitial cystitis / Painful bladder syndrome: This condition causes chronic pain in the bladder and pelvic area, often with sporadic “flares”. People with IC/PBS may need to urinate frequently, may have pain when the bladder is full, and may find that certain foods trigger flares.
At Providence Saint John’s, we start the diagnosis process with a thorough physical exam. Depending on your symptoms, your doctor may want to perform additional tests. They could include:
Urine analysis and urine culture: A sample of urine can be analyzed to look for infection or blood in the urine.
Postvoid residual: A test, performed with either an ultrasound or a catheter, to ensure that you do not have too much urine left in the bladder after you empty.
Urodynamics: A test to determine how well your bladder is functioning, how much it can hold, and the pressures in the bladder during filling and emptying.
Cystoscopy: A procedure in which a tiny camera is used to examine the inside of the bladder.
Treatment for a bladder disorder will depend on the cause and severity of the condition. If surgery is required, Providence Saint John’s offers a wide range of options that are minimally invasive to ensure a quick recovery.
Your comprehensive care team at Providence Saint John's will work with you on a treatment plan that could include:
- Losing weight: Losing weight can reduce pressure on the pelvic floor and urine leakage. Even women who do not achieve their ideal body weight can see an improvement in bladder function with a 5% decrease in weight.
- Quitting smoking: Smoking raises the risk of pelvic floor disorders in women.
- Dietary changes: Reducing the intake of caffeine, fizzy drinks, and alcohol, which are bladder irritants, may help alleviate symptoms.
- Monitoring fluid intake: Decreasing fluids, especially in the evening, can ease leaking and trips to the bathroom.
- Biofeedback therapy: This therapy is used to strengthen or relax the pelvic floor muscles. It can help improve bowel and bladder functions.
- Pelvic floor muscle exercises: More than simply Kegels, these exercises involve squeezing and relaxing the pelvic floor muscles. A professional physical therapist can teach patients how to better control the muscles we use to prevent leakage.
- Medication: Your doctor may prescribe medication that works by blocking signals that can cause spasms in the bladder, thereby reducing urgency, frequency, and nighttime awakenings.
- Pessary: A pessary is an option for women with stress urinary incontinence or overactive bladder. A pessary is a silicone device that is inserted through the vagina to hold pelvic organs in place and support the urethra, thereby lessening or eliminating urine leakage.
- Posterior Tibial Nerve Stimulation: A thin acupuncture needle may be placed in the ankle and used to stimulate the nerve that runs up the leg and near the bladder. This low-risk treatment that takes 30 minutes per session is done in the doctor’s office.
- Botox injections: Botox injections are used in some cases of overactive bladder. Botox works by relaxing the bladder muscle and increasing the bladder’s storage capacity. Such injections can be done in the office or under sedation, according to the patient’s preference.
- Urethral bulking: A bulking agent, usually a paste-like substance, is injected into the muscle wall of the urethra. The bulking agent narrows the urethral tube and preventsurine leakage. Bulking procedures can be done either in the office or under sedation, according to the patient’s preference.
If surgery is necessary, these procedures are possible:
- Mid-urethral sling: A mesh strap, or “sling,” is used to support the urethra and is highly effective at preventing stress incontinence episodes.
- Sacral Neuromodulation: Often called a “pacemaker for the bladder,” the InterStim device treats overactive bladder, urgency incontinence, urinary retention, and fecal incontinence. After placement of a thin wire, the therapy is trialed for 1-2 weeks to see if it is successful. If a patient has at least a 50% improvement in her symptoms, a small battery is placed under the skin, and the patient may adjust the stimulation herself using a remote control.
At Providence Saint John’s, our specialists will work with you to choose the best surgical option for your condition.