Keeping our bladder in good health

As we grow older, we tend to need to urinate more frequently as our bladder tissue becomes less elastic, and therefore, can hold less urine before it needs to be emptied. — 123rf.com

The bladder is a hollow organ that stores urine.

The kidneys filter waste and harmful substances in the bloodstream and converts them into urine.

The urine then traverses the ureters, which are tubular structures, to reach the bladder.

The amount of urine produced in a 24-hour period depends on the individual’s fluid intake, with an average of 1.5 litres and a range of 1-2l.

The bladder holds the urine until the time and place is right for the body to get rid of it.

When the bladder is full, its nerves send signals to the brain.

When one is ready to urinate, the bladder wall muscles contract and a valve opens to let the urine out through the urethra, another tubular structure.

The urethra in the female is shorter than in the male.

With increasing age, the bladder tissue becomes less elastic.

This leads to the bladder being less able to hold as much urine as before, resulting in more frequent urination.

The urethra can also become partially or totally blocked.

This is due to weakened muscles that cause the bladder or vagina to fall out of their pre-menopausal position (i.e. prolapse) in women.

The urethra can also be blocked by an enlarged prostate gland in men.

The weakening of the bladder and pelvic floor muscles leads to problems with bladder control, making it harder to hold urine and causing it to leak (i.e. urinary incontinence) or not being able to completely empty the bladder (i.e. urinary retention).

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There are several measures everyone can take to enhance their bladder health.

Urination

One should urinate often and when needed.

The advisable frequency is once every three to four hours.

Prolonged retention of urine in the bladder not only weakens its muscle, but also increases the likelihood of urinary tract infection (UTI).

One should take sufficient time to empty the bladder fully when passing urine.

If one rushes, the bladder may not be fully emptied, and if the urine stays in the bladder too long, it increases the likelihood of infection.

One should be relaxed when passing urine as it makes it easier to empty the bladder fully.

Sitting on the toilet helps to relax the bladder and pelvic floor muscles.

Women should wipe from front to back after opening the bowels.

This is essential to prevent gut microorganisms from getting into the urethra and then upwards to the bladder and causing an infection.

Sexual activity can lead to the movement of microorganisms from the vagina and/or bowel to the urethral opening, and from there, ascending into the bladder.

As such, passing urine shortly after sexual activity will reduce the likelihood of infection.

Pelvic floor exercises

The pelvic floor comprises layers of muscle and other tissue.

It stretches like a hammock from the pubic bone in front to the coccyx (tailbone) at the back, and from the left pelvic side bone (i.e. left ischial tuberosity) to the right one.

The pelvic floor muscles are normally thick and firm.

They support the bladder and bowel, and in the case of women, the uterus as well.

They control the release of urine, faeces and flatus (i.e. gas), and delay emptying until it is convenient.

Contraction of the pelvic floor muscles lifts the pelvic organs and tightens the openings of the vagina, urethra and anus.

Relaxation of these muscles allows passage of urine, faeces and gas.

The pelvic floor muscles are important for erectile function and ejaculation in men, and sexual sensation and arousal in women.

During pregnancy, the pelvic floor muscles provide support for the foetus and are relaxed during parturition (childbirth).

Pelvic floor (also known as Kegel) exercises help hold urine in the bladder.

Doing such exercises daily strengthens these muscles, which can help keep urine from leaking when one sneezes, coughs, laughs, or has a sudden urge to pass urine.

These exercises may also help avoid infections by frequent emptying of the bladder.

They can be done at any time.

All one has to do is to pretend that you want to prevent yourself from answering nature’s call by pulling in the genital area and buttocks when squeezing the muscles, then holding the position for about 10-15 seconds.

The squeezes should be repeated 10 to 15 times rapidly.

The pelvic floor muscles will be strengthened over time.

ALSO READ: Men can benefit from Kegel exercises too

Healthy lifestyle

A healthy lifestyle contributes to bladder health.

Maintaining a healthy weight by making healthy food choices and doing physical activity, reduces the likelihood of urine leakage.

People who are overweight are more likely to have bladder problems because too much body fat strains the pelvic floor and puts pressure on the pelvic nerves, which increases the urge to pass urine.

Everyone should consume sufficient fluids, especially water.

It is important to drink enough as more than half the human body comprises of water.

The fluids drunk clear out waste, certain chemicals and microorganisms.

If insufficient water is drunk, the urine will have less water, which can irritate the bladder.

However, not all fluids are the same.

Drinks containing caffeine like coffee, tea and soft drinks, can increase symptoms like frequent and urgent need to pass urine.

Alcohol can also worsen bladder problems.

Reducing or limiting such fluids may be helpful.

How much one needs to drink depends on one’s body size, activities and where one resides.

A useful rule of thumb is to drink enough fluids so that urine is passed every few hours.

People with medical conditions like kidney or heart disease need to drink less.

The doctor will be able to provide advice on fluid consumption.

Some people with bladder problems complain that their condition is aggravated by some foods and drinks like citrus fruits and juices, artificial sweeteners and tomato-based dishes.

Changing the diet in such cases may help alleviate matters.

Regular exercise prevents bladder and bowel problems, as well as helps to maintain a healthy weight.

Physical activity reduces the likelihood of constipation, which can crowd the bladder and cause problems, and diabetes, which increases the likelihood of bladder problems.

When constipation occurs, there is usually too much faeces in the colon.

This can put pressure on the bladder, preventing its expansion.

The consumption of high-fibre foods like whole grains, vegetables and fruits, drinking enough water, and physical activity, can prevent constipation.

Bladder problems and bladder cancer are more common in smokers.

The cessation or reduction of smoking will address this.

Know your medicines

There are some medicines that increase the likelihood of urine leakage because they dull the nerves in the bladder.

This leads to one not feeling the urge to pass urine.

It is important to know the side effects of the medicines that one is on.

Seek medical attention

The common bladder problems include infection, particularly in women; urinary incontinence; and urinary retention.

It is advisable to consult the doctor if one has any of the following symptoms:

• Frequent passing of urine
• Passing urine many times at night
• Pain or burning sensation before, during and after passing urine
• Cloudy urine
• Blood in the urine
• Inability to hold urine or leaking urine
• Problems initiating urination
• A weak stream while passing urine
• Trouble emptying the bladder, or
• An inability to pass urine.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.