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Bladder Problems - Treatment

Overview | Diagnosis | Treatment | FAQ

When you only have one symptom or if your symptoms are vague, it can be more difficult to determine the problem. If you have any of the following symptoms you should contact your doctor as soon as possible as they may be indicators of a more serious problem:

• A strong, constant urge to urinate
• Bloody or hazy urine
• Discomfort or burning when urinating
• Pain in the back, side or groin
• Fever accompanied by any of the above symptoms

Below are just a few common urinary problems along with information on treatment:

Urinary Tract Infection / Cystitis

In cases where symptoms are characteristic of a UTI and if you are normally in good health, antibiotics will be the initial treatment. The drugs prescribed and the duration depends on your health condition and the type of bacteria found in your urine. Your doctor will need to know of any other medications you're taking or any medical allergies.

To ensure that the infection is completely eliminated, it is important to take the entire course of antibiotics prescribed by your doctor.

If you have repeated UTIs, your doctor may recommend a longer dosage of antibiotic treatment or a self-treatment program with short dosages of antibiotics at the beginning of your urinary symptoms.

If a severe UTI occurs, hospitalization and intravenous therapy may be necessary. If infections are persistent or you suffer from chronic kidney infection, your doctor will likely refer you to a urologist.

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Frequent Urination

Treatment is usually determined by the underlying cause of the frequency. In some cases, antibiotics and medicine may be prescribed to alleviate the discomfort.

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Urgent Urination

Depending on the specific case, urgency may be treated by antibiotics. Other typical treatments of urgency can include bladder and bowel training, special diet, Kegel exercises, medications, and treatment of muscle spasms.

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Urinary Retention

A thin, flexible tube, known as a catheter, will be placed in your urethra. It maneuvers into your bladder and releases the urine into a bag. This is conducted both as a diagnosis and as a treatment of the immediate symptoms.

In addition, a variety of medicines may also help to reduce the blockage and promote urination.

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Biofeedback

Biofeedback is a painless and non invasive therapy used to treat various types of urological conditions. The goal of Biofeedback is to raise the patient's awareness and conscious control of their unconscious physiological activities.

Some of the urological conditions that benefit from Biofeedback Therapy include:

• Stress Urinary Incontinence
• Urge Incontinence
• Mixed Incontinence
• Fecal Incontinence
• Interstitial Cystitis
• Pelvic pain
• Chronic Prostatitis

Bladder Cancer

If bladder cancer is confined to the surface of the bladder, it can be treated with a minimally invasive outpatient procedure called a transurethral resection. A special instrument called a resectoscope is inserted through the urethra into the bladder. A semicircle of thin wire at the end of an insulated ‘cutting loop’, is attached to a retractable devise that is part of the resectoscope. Under direct vision, the cutting loop is positioned just beyond the bladder tumor. A foot switch is then activated which sends electric current through the tip of the cutting loop. The tip of the activated cutting loop is then retracted inside the sheath, which cuts through the bladder tissue beneath the tumor, scoops out the tumor, and snips it off. The tumor is flushed out and sent to the pathologist for further evaluation. Once the entire tumor has been excised, the loop is used to seal the area using a different frequency of current.

Over time, bladder tumors, like skin cancers, tend to recur. In fact, bladder tumors recur up to 75% of the time. Furthermore, 15% of the time, bladder tumors become more aggressive or invade deeper. Accordingly, repeat cystoscopy is routinely performed over time according to established protocol. Furthermore, repeat imaging studies of the upper urinary tract may be indicated. For a detailed discussion of the diagnosis and management of non-invasive bladder cancer, click here for the American Urological Association’s clinical guidelines.

If bladder cancer invades into the muscle fibers of the bladder, it is usually necessary to remove the bladder, which is called a radical cystectomy. A new ‘bladder’, called a neobladder, can be created from a section of the intestinal tract. The tubes that drain urine from the kidneys, called ureters, are connected to the neobladder. Depending upon the situation, it may be possible to create a ‘continent’ neobladder: the neobladder can be either be reconnected to the urethra, or a tabularized portion of the neobladder, or a portion of the appendix that is connected to the neobladder, can be brought out to the surface of the skin. The normal uethral sphincter mechanism in the urethra or the tubular arrangement in the neobladder prevents loss of urine. It is necessary to routinely insert a small catheter through the small opening at the skin level to drain the stored urine in the neobladder. If the neobladder is connected to the urethra, it may also be necessary to catheterize the neobladder. Alternatively, the two ureters can be connected to a portion of intestine that is brought to the skin level as an ileostomy, which continuously drains into a bag.

Our biofeedback therapist collaborates with the physician and spends time talking to the patient, conducts a thorough evaluation of their individual situation, and determines a personalized treatment plan. A typical appointment with our biofeedback therapist generally takes one hour of the patient’s time. The treatment regime normally takes six to eight visits. Medicare and most private insurance plans cover these services. Patients can self refer or physician refer for Biofeedback.

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Hematuria

Generally, treatment for hematuria depends on the cause and in most cases; blood found in urine may be evaluated and treated on a non-emergent basis. Hematuria may be treated with antibiotics in some cases. When the cause of blood in the urine is known, it should be treated.

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Urinary Incontinence

Common at-home therapies, such as diet and medication alteration along with reduced liquid consumption before sleep, can immediately improve urinary incontinence. If simple treatments do not alleviate incontinence symptoms, other treatment methods may be used. Some treatment options include, non-invasive outpatient procedures, medications and surgery. In most cases, incontinence can be controlled or cured with proper treatment.

There are many treatments available for incontinence. One easy way to improve your continence is by doing pelvic floor muscle exercises. Your pelvic muscle stretches from your front pubic bone to your tailbone in the back. This muscle supports the bladder, large intestine and the uterus.

How to Find the Pelvic Muscle:

To find the pelvic muscle, Imagine that you are at a party and the rich food you have just consumed causes you to have gas. The muscle that you use to hold back the gas is the same one that you want to exercise. Some people find this muscle by voluntarily stopping the stream of urine. A man might stand in front of the mirror after bathing and tighten the muscle. You should see your penis rise slightly.

Exercising the Muscle:

Begin by emptying your bladder. Then try to relax completely. Tighten the muscle and hold for a count of 5 or 5 seconds. You should feel a sensation of lifting of the area around the vagina or of pulling of the rectum.

When to Exercise:

Do 15 exercises in the morning, 15 in the afternoon and 20 at night. Or else you can exercise for 10 minutes 3 times a day. Initially you may not be able to hold this contraction for the complete count of 5. However,start slowly and then build to 10 contractions over time The muscle may start to tire after six or eight exercises. If this happens stop and go back to exercising later.

Where to Practice these Exercises:

These exercises can be practiced anywhere and anytime. Begin practicing them lying on your bed. Once you have mastered them lying down, practice them sitting in a chair. Then advance to practicing them standing. Resting one foot on a small stool or rung of a chair may help to relax your abdomen.

Common Mistakes:

Never use your stomach, legs or buttock muscles. To find out if you are also contracting your stomach muscles, place your hand on your abdomen while you squeeze your pelvic muscle. If you feel your abdomen move, then you are also using these muscles. Avoid holding your breath. Inhale and exhale slowly while counting. In time you will learn to practice effortlessly. Eventually, work these exercises in as part of your lifestyle, tighten the muscle when you walk, before you sneeze, as you stand up, and on the way to the bathroom.

When will I notice a Change?

After 4 to 6 weeks of constant daily exercises you will begin to notice less urinary accidents, and after 3 months you will see even a bigger difference.

Can These Exercises Hurt Me?

NO! These exercises cannot harm you in any way. Most people find them relaxing and easy. If you get back pain or stomach pain after you exercise, then you are probably trying too hard and using stomach muscles. Go back and find the pelvic muscle and remember this exercise should feel easy. If you experience headaches then you are also tensing your chest muscles and probably holding your breath.

Practical tips for improving bladder control

Click here to open and print a downloadable PDF with this information, new window will open.

Urinary leakage also called urinary incontinence is defined as the accidental loss of urine caused by coughing, straining or not being able to get to the bathroom in time when there is a sudden urge to urinate. Millions of men and women experience some degree of urinary leakage. The steps listed below can help effectively manage urinary incontinence.

Step 1:

1. Learn how to perform pelvic floor exercises (abbreviated PMEs) by contracting (squeezing) the muscles that are used to start and stop urine flow. These exercises can help prevent urinary leakage. Be sure not to contract facial, abdominal, or buttock muscles or lift your shoulders at the same time. Begin by contracting the pelvic muscles in “quick flicks” lasting 3-6 seconds at a time. Next, practice contracting pelvic muscles for longer periods of time until you can squeeze the muscles continuously for 10 seconds. Rest 10 seconds between each of the longer contractions. Gradually increase the number of 10-second contractions in a lying, sitting, and standing position. Try to perform 10 to 20 sets of the longer contractions three times daily in each position.

2. If you smoke, quit.

Step 2:

1. Record a three-day voiding diary. Make a list of 7 columns on a piece of lined paper. At the top of each column, list the time of day, type and amount of fluid intake, type and amount of food intake, amount voided in ounces, amount of leakage (small, medium, or large), activity when leakage occurred, and presence or absence of urgency. Record the appropriate information in each column for a total of three days. (2) Avoid foods

2. Avoid foods and beverages that are acidic or contain caffeine since they can irritate the bladder. Also drink at least a quart of water daily. Dehydration causes constipation and produces acid urine that irritates the bladder and increases urine odor.

3. Refer to the bladder diary and identify things that cause urinary leakage and avoid them if possible. Also, try urinating “by the clock” at regular intervals before the onset of urgent urination. For example, if you leak when you wait more than 2 hours to urinate, set your watch and urinate every hour and a half. If you continue to experience urgent urination, ask your healthcare provider about prescribing anti-spasm medication.

4. Practice ‘freezing and then squeezing’ three quick PMEs (quick flicks) when a sudden urge to urinate strikes. Once the urgency sensation passes, proceed directly to a restroom and urinate. Before changing position or coughing, practice three quick flicks of PMEs and hold the last contraction while changing position.

5. Use a moist wipe after urinary leakage to cleanse the skin, and apply a protective moisturizing skin cream or a film-like material if the leakage is severe or skin becomes irritated. Deodorizing sprays and liquids and tablets can help contain urine odor. A variety of disposable and reusable absorbent products are available for mild, moderate, and severe urine loss. Other devises to control urinary leakage are also available if necessary. Detained information about products and where to buy them is available from the National Association for Continence 1-800-252-3337, www.nafc.org.

6. Assemble a “spill kit” with protective skin wipes, a zip-lock plastic bag for disposal, and a spare absorbent pad. Keep a spare kit in a pants or coat pocket, in the car, and at work.

7. Wearing dark pants and using protective pads on upholstery and bedding can provide added security.

Step 3:

Spiritual Care: It is normal to experience mood swings when you have a chronic condition such as urinary incontinence. Share your concerns with your partner, health care provider, and spiritual counselor. Honest communication can dispel unspoken fears and make it easier to handle things.

Step 4:

Treatment: If urinary leakage doesn’t respond to the measures listed above and it adversely impacts your quality of life, talk to one of our AUNC practitioners about other options that may be available.

Step 5:

Don’t give up hope.

Click here to download a PDF entitled "Overview of the Management of Post-prostatectomy Urinary Incontinence" by Mark W. McClure, MD, FACS Cheryl McClure Elliott, RN, MSN, ANP

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