Weak bladder worries
Dear Dr Mitchell,My problem is a weak bladder. What can I do to overcome this? I am in my 60s and had a complete hysterectomy when I was 49. I am not sexually active. Also, I have frequent bouts of chest congestion and sinusitis and was given antibiotics which give me yeast infections so I have to take meds for this. Looking forward to your response
A weak bladder may be associated with loss of urine when you sneeze, cough or laugh. It may also be associated with frequent urination of small amounts of urine at intervals or the feeling of urgency where you have to rush to pass urine for fear of wetting yourself before reaching the toilet.
As you get older and continuing after the menopause, the muscles that support the bladder base become weak because of the low levels of oestrogen associated with ageing and ovarian failure. In addition, if you have had several babies, especially big babies, delivered vaginally, this can weaken the pelvic floor. Prolonged labour and delivery or rapid delivery and the use of forceps or vacuum at the time of delivery can also damage the pelvic floor muscles.
If you have diabetes mellitus then this can cause damage to the nerve supply to the pelvic floor and result in prolapse or severe weakening of the muscles resulting in loss of bladder control. Chronic sinusitis with coughing, severe bronchial asthma, and chronic obstructive airway disease secondary to smoking can also be associated with damage to the pelvic floor. Chronic constipation with straining to pass stool is also another important factor associated with weak pelvic floor muscles and a weak bladder.
Some women habitually lift heavy objects such as furniture, flower pots and wet clothes in a washing pan and this can cause weakening in the pelvic floor and bladder muscles as you get older. Women who are severely overweight with a large abdominal wall with overhanging belly fat are at increased risk for prolapse of the uterus, bladder and rectum with associated urinary problems.
It is important that you lose weight, stop smoking, treat any chronic lung problem that you might have, prevent constipation with appropriate diet high in dietary fibres, and stop the heavy lifting around the house if these apply to you. This will help to reduce your symptoms and worsening of any damage to your pelvic floor muscles.
It is important that you get a urine culture done to rule out a bladder infection since this can make the symptoms worsen, or it in fact may be the actual cause of the loss of urine. A detailed pelvic examination to determine if you have significant pelvic floor prolapse including rectal prolapse should be done. In mild cases pelvic floor exercises to strengthen the muscles (Kegels) should be done.
If there is significant prolapse of the bladder and vaginal wall then surgery can be done to correct the problem. A ring pessary can also be inserted into the vagina to help reduce the prolapse or support the bladder base thus reducing the symptoms. This has to be cleaned and reinserted every three months to prevent infections and irritation of the vaginal walls. It can be used as a long-term means of correcting the problem if surgery is not desired.
Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
