What Works for Bladder Trouble
When it comes to urinating, each gender has its own advantages. Isn't it great that we don't have to relieve ourselves just a bent-elbow away from the guy at the next urinal?
Well, sure. But men have the option of being able to walk behind any tree and efficiently take care of their business in a fully upright, standing position.
But the biggest drawback for women is perhaps not so obvious. In fact, it's medical. Women are more susceptible than men to three kinds of urinary problems. First, we have more stress and urge incontinence, which means unintentional leakage of urine. We're also more prone to interstitial cystitis, a painful disease of the bladder that causes you to urinate many times throughout the day and night. And we're at greater risk of urinary tract infections, a bacterial invasion that triggers a burning sensation when you urinate.
WHY THE PROBLEM?
For two out of these three conditions, doctors have an idea why women seem more vulnerable in matters of urinary health. In the case of urinary incontinence, childbirth plays a role. Having babies weakens a woman's pelvic-floor muscles. Those are the sling-shaped muscles holding the bladder and urethra in place. And when those muscles start to go, controlling urine flow is simply more difficult.
On the other hand, doctors aren't sure why women are more prone to interstitial cystitis than men. We just are, it seems.
As for urinary tract infections, the difference has to do with the urethra, the tube that empties urine from the bladder. The urethra is shorter in women than in men, and that means it's easier for bacteria from outside sources like the rectum to work its way up to the bladder and cause an infection.
In every case, you can do something to improve, treat or prevent urinary conditions, says Denise Webster, R.N., Ph.D., professor in the School of Nursing at the University of Colorado Health Sciences Center in Denver. "There's something powerful and healing and positive about taking control of a disease and being active in your own treatment," she adds.
INCONTINENCE: NO MORE ACCIDENTS
Even in your teens and twenties, you accidentally let loose a little dribble once in a blue moon. That's normal.
But as you head into your thirties and forties--and especially if you've had children--those dribbles could become regular little "accidents" that you cannot ignore. The most common kind of urinary incontinence, stress incontinence, is usually triggered by sneezing, coughing or lifting. When you have pelvic-floor muscles already weakened by childbirth, the extra strain eases up the muscles that surround and close the urethra, allowing some urine to leak out.
With urge incontinence, the second most prevalent type of urinary incontinence, your bladder muscles contract uncontrollably and you feel an urgent need to urinate. Urge incontinence may be caused by a urinary tract infection. For some women, leaking becomes worse after menopause. Before menopause, the female hormone estrogen keeps muscles surrounding the bladder limber. When estrogen production wanes, bladder muscles dry out.
Many women suffer from a combination of stress incontinence and urge incontinence, says Guy Fried, M.D., physiatrist at Magee Rehabilitation Hospital and an instructor at Thomas Jefferson University Hospital, both in Philadelphia. Sometimes the incontinence is so uncontrollable that some doctors may suggest surgery to restore pelvic-muscle function.
Usually, though, surgery isn't necessary. About 85 percent of women with urinary incontinence can either be cured, or much improved, with nonsurgical options. To stay dry, try these strategies.
Give your bladder muscles the squeeze. Learn to isolate and strengthen the pelvic-floor muscles by exercising them, advises Dr. Fried. "While urinating, you should stop your urine stream and squeeze so that you feel where those muscles are."
Once you're familiar with the muscles at the neck of the bladder that control urine flow, you can exercise them. These exercises are called Kegels, named after the doctor who invented them. Squeeze these muscles and hold them tight several times a day--while driving or sitting at your desk or watching TV, for example. Hold each squeeze for about ten seconds, then relax for ten and repeat. After you've learned Kegels, you shouldn't do them with a full bladder. Otherwise, you can increase your chance of getting an infection, says Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland.
The goal is to do six to ten at a time, about half a dozen times a day, says Dr. Fried. "The beauty is that no one has a clue that you're doing Kegels. You could be sitting in a meeting doing Kegels and no one could tell."
Learn biofeedback. If you're having trouble isolating your pelvic-floor muscles, making it difficult to do Kegels effectively, biofeedback can help show you where your pelvic-floor muscles are and make it easier to get them in shape, says Dr. Fried.
During the first session, a probe is inserted inside your vagina or rectum to measure the amount of muscular tension you exert when bearing down on the pelvic-floor muscles. A video screen shows you a printout that registers the tension level of your muscles as you're exerting pressure.
Your goal when using biofeedback for urinary incontinence is to identify the muscles involved. After a few sessions of training, you should be able to control the muscles on your own, says Dr. Fried.
While biofeedback for urinary incontinence is certainly more invasive than biofeedback for headaches, it's a far cry from surgery. And it works: In one study of 43 women who used biofeedback for incontinence associated with a disability, the procedure proved very effective. Before using biofeedback, the women averaged three or four incidents of urinary leakage a day. After six sessions of biofeedback, where the women learned to isolate their pelvic-floor muscles, the women averaged one incident or less per day.
Give acupuncture a try. Sometimes, not completely emptying the bladder every time you urinate can cause problems. When that happens, you may leak urine at a later time, notes Patrick Lariccia, M.D., director of the Acupuncture and Pain Clinic at the University of Pennsylvania in Philadelphia. "You might have a bladder that's not contracting forcefully enough, so you retain some urine every time," he explains.
In his clinical practice, Dr. Lariccia has found acupuncture to be helpful at times for this type of problem. Acupuncture sessions can help you to empty your bladder every time you go to the bathroom, he says. However, you should first have your problems diagnosed by a medical doctor, he advises. (For information on locating an acupuncturist, see page 33.)
INTERSTITIAL CYSTITIS: GET BACK IN CONTROL
Imagine, if you can bear to, having to run from your office to the bathroom every half-hour. Even worse, imagine having to go some 30 times a day and then being awakened with the urge 20 times during the night. Those nightmare scenarios are reality for many of the 450,000 women who have interstitial cystitis (IC), a mysterious bladder inflammation that affects women ten times more often than men.
"During an acute attack, a woman could end up almost living in the bathroom," explains Dr. Webster.
Besides an urgent need to urinate frequently, IC is accompanied by frequent abdominal pain above the pubic area. Doctors aren't sure what causes the problem. Some explanations point to a possible defect in the bladder's lining, a virus or even an autoimmune disease that affects many women of childbearing age. Rheumatoid arthritis and lupus erythematosus, for instance, are conditions in which the immune system doesn't function the way it should, and they may be associated with interstitial cystitis.
You can try out a whole gamut of powerful anti-inflammatory and pain medications if your doctor prescribes them for IC. But other natural, easy-to-do remedies are available. Here are the nondrug tactics that work best.
Avoid acid in foods. Cutting back on acids in your diet is one of the most helpful ways of reducing the frequency of interstitial cystitis attacks, says Dr. Webster. Foods such as tomatoes, strawberries, citrus fruit and curry or other spices contain acids that irritate the bladder, she notes.
Reach for the baking soda. To further help reduce acidity in urine, Dr. Webster recommends drinking sodium bicarbonate: Mix one-half teaspoon of baking soda with eight ounces of water and stir to dissolve the soda. Drink it three or four times a day, at no less than four-hour intervals. Do not use for more than a few days, though. Long-term daily use of baking soda is not recommended, she says.
Nix the caffeine. Dr. Webster also tells women with interstitial cystitis to avoid coffee, since it's a diuretic that makes you urinate more.
Visualize cool zones around the pain. One way to control the misery of interstitial cystitis is to use imagery to take your mind off the pain, says Dr. Webster. "You don't forget about the pain, but instead you redefine it as another sensation. For example, try concentrating on the pain being cool, a sensation often associated with comfort, rather than hot, a sensation often associated with discomfort.
"Also, try to focus on areas of comfort in your body, like your arms or shoulders, instead of concentrating on where the pain is," Dr. Webster suggests. In a survey of how 300 women with IC deal with attacks, very few of them reported using imagery. But those who did found it to be very effective, she adds.
Do meditative breathing. Deep breathing can help relax you so that interstitial cystitis won't seem to cause as much discomfort, says Steven Brena, M.D., former chairman of the Board of Pain Control and Rehabilitation of Georgia in Atlanta. Tense muscles can make IC pain feel that much more intense, he notes. When you shift your attention away from pain and toward your breathing, you'll be more relaxed.
First sit comfortably, with your back straight. Then focus on your muscles and relax them in sequence. "When I do this, I start with my feet and lower extremities--first tensing them, then relaxing them, working all the way up to the shoulders," he says. At the same time, he concentrates on his breathing. "I feel how my muscles relax when I breathe very slowly. I say, 'One in,' as I breathe in and, 'One out,' as I breathe out." Dr. Brena suggests doing a form of "meditating breathing" like this for at least twice a day for 15 minutes.
Walk away from pain. If you have IC, enjoying a daily walk could be a vital way of keeping up your spirits and maintaining overall good health, says Dr. Webster. "But most women with interstitial cystitis have to avoid any exercise that jiggles the bladder, such as running or aerobics. Walking is gentle, yet strenuous enough to keep your energy level up. Theoretically, it may also increase the flow of endorphins, which are natural painkillers in your body," she notes.
Acupuncture Eased Her Cystitis Pain
Desperate for relief from interstitial cystitis, Kirsten Kurtz, 57, a nurse in St. Louis Park, Minnesota, turned to the Eastern practice of acupuncture--with good results.
"The pain started when I was pregnant with my daughter 20 years ago," Kurtz says. "I had a gnawing discomfort, I thought, in my intestinal area. It just hurt all over.
"I'd go the bathroom every hour, and I was losing sleep," she says. "I was pretty irritable about the whole thing. The doctors offered me tranquilizers, which I turned down."
Kurtz was referred to a physician who said that she had an autoimmune problem of some kind, which means the immune system overreacts and turns on itself. "I was referred to a urologist who finally told me, 11 years after the first symptoms, that I had interstitial cystitis."
A year after her diagnosis and now desperate for help, Kurtz started acupuncture. "I noticed a marked relief in the discomfort within the first couple of treatments. I no longer needed to take ibuprofen every four to five hours. And I can go up to three hours without having to get up and urinate at night," she adds.
Acupuncture enabled Kurtz to do things she'd always wanted to do, like going to her son's cross-country running and cross-country skiing meets. Before she started acupuncture, Kurtz says that she couldn't even watch a whole meet. "I'd have to time it so that I would get there and be gone within an hour. And I was lucky if I could wait that long," she says. But with the new therapy, things are different. "Last winter, I was able to stay for a couple of hours."
Kurtz also took a three-week trip to Russia. "Fortunately, bathrooms were readily available. But before acupuncture, I would never have had the courage to go."
Kurtz now goes for acupuncture treatments every four to six weeks. She also credits a low-acid diet (no citrus fruit, for example), drinking a lot of water, exercise and prayer for reducing her pain. "The quality of my life has been improved sensationally," she says.
URINARY TRACT INFECTION: FIGHT FUTURE ATTACKS
When you gotta go, you gotta go. But sometimes, you just think you gotta go because when you go, you don't gotta go nearly as badly as you thought you had to.
With a urinary tract infection (UTI), your bladder may seem confused. But if you have a frequent, urgent need to urinate and you get a burning or pain in your urethra when you go the bathroom, you probably have a UTI. A doctor's visit is definitely in order, especially if you see blood in your urine, since you might have a more serious bladder or kidney disorder. Your doctor will most likely give you a short course of antibiotics to kill the bacteria that enters the bladder and causes the problem in the first place. But whether or not you're on antibiotics, you'll want to try these healing helpers to reduce immediate discomfort and prevent future infections.
Go with a flow. Drinking plenty of fluids will help your bladder get rid of accumulated bacteria in the urine, notes Richard J. Macchia, M.D., professor and chairman of the Department of Urology at the State University of New York Health Science Center in New York City. "When you have a urinary tract infection, you need to flush the bacteria out. If the urine stays in the bladder, the bugs keep doubling their population rapidly. Constantly flushing keeps their numbers down." You should drink enough to keep your urine colorless. Colorless urine is a good sign that you're drinking enough fluids, he notes.
Get juiced. Drinking cranberry juice cocktail can both prevent and treat urinary tract infections, notes Dr. Macchia. "In several published studies, just drinking three eight-ounce glasses of cranberry juice cocktail a day significantly reduced the incidence of urinary tract infections in elderly women." So while you're drinking lots of fluids, be sure to include some glasses ofcranberry juice cocktail.
Cranberry juice cocktail is effective because it has an unidentified ingredient that prevents the bacteria in the urine from sticking to the lining of the bladder, Dr. Macchia notes. It proved its antibacterial properties when a group of 153 women drank either three glasses a day ofcranberry juice cocktail or had a drink that looked and tasted like it but wasn't actually cranberry juice cocktail. Only 15 percent of the urine samples of the women who drank cranberry juice cocktail contained bacteria that could potentially cause a UTI, while 28 percent of the other urine samples had the bacteria.
Cranberry Juice Cured Her
Plagued by frequent urinary tract infections, Rhonda Hershey, a 34-year-old bankruptcy representative in Manhattan Beach, California, heard thatcranberry juice might help. She gave it a try--with good results.
"I've been getting urinary tract infections since I was about six years old," says Hershey. "For some reason, I seem to be susceptible. Maybe it's because I don't drink enough water."
When a urinary tract infection strikes, Hershey is miserable. "I'd be doubled over in pain, with a burning pressure that's horrible. You can't do anything."
Hershey's mother told her about the benefits of drinking cranberry juice, citing evidence that it curbs infections by making the bacteria less adherent to the bladder.
"We have a cafeteria at work, so I can easily get cranberry juice, even on the job," she says. "And I love the taste. So whenever I start feeling the symptoms of a urinary tract infection coming on, I drink two large glasses ofcranberry juice cocktail. It really helps. I almost never get full-blown infections anymore."
Sip blueberry juice. Another good fruit for fighting urinary tract bacteria is the blueberry, says Dr. Fugh-Berman. "Cranberries and blueberries are related, so, like cranberries, blueberries have the qualities that make bacteria less adhesive." She suggests eating about a pint of blueberries a day or putting them in a blender with enough water to make a tastyblueberry juice. You can also try alternating the blueberry and cranberry juice cocktails if you want variety, she notes.
Try nature's blend. The herbs buchu and uva ursi, combined with juniper berries, have the power to remove bacteria from the urine and make you urinate, says Andrea Sullivan, Ph.D., a naturopathic and homeopathic physician in Washington, D.C. "Mix equal amounts of each tincture--buchu, uva ursi and juniper berry--together. Put 30 drops in warm water and drink it three or four times a day," she says. "They work as renal antiseptics, which help clean out the kidneys and bladder." Stop using the tincture if you don't see an improvement within seven days sinceuva ursi shouldn't be used for more than a week, cautions Dr. Fugh-Berman.
Have an essential soak. Sitting in a bath half-filled with warm or tepid water and a few drops of essential oils can ease the external burning of a UTI, says Valerie Cooksley, R.N., holistic nurse and aroma practitioner in the Seattle area and author of Aromatherapy: A Lifetime Guide to Healing with Essential Oils.
To concoct this soothing bath, you need three drops of essential oil of sandalwood (Santalum album), two drops of tea tree (Melaleuca alternifolia) essential oil, one drop of essential oil of chamomile (Anthemis nobilis), two tablespoons of honey and two tablespoons of apple cider vinegar, according to Cooksley. In a small dish, combine the essential oils and honey. Add the cider vinegar to the bath and then the honey mixture, which helps hold the oils together so they don't just float to the top of the water. Soak for 15 to 20 minutes, she suggests.
"Sandalwood is antibacterial, tea tree is a wide-spectrum antiseptic and chamomile is anti-inflammatory. When you sit in the bath, the whole combination of oils is very cooling and healing," she says.
Note: If you find you're allergic to any of the essential oils, omit it from the blend. To test for an allergy to an essential oil, place one drop of any essential oil on a cotton swab and wipe it on your inner forearm. If the area appears red or feels itchy within 30 minutes, don't use the oil.
Keep in mind that while an essential-oil soak will temporarily soothe your symptoms and complement medical treatment, it's not a substitute for antibiotics.
Get vital vitamins with a good multivitamin. Vitamins A and C and beta-carotene (the plant form of vitamin A), along with the mineral zinc, can strengthen your immune system. And the stronger your immune system, the better it will fight a urinary tract infection, notes Dr. Sullivan. She recommends 10,000 international units ofvitamin A, 25,000 to 50,000 international units of beta-carotene and 30 to 50 milligrams of zinc a day. (Check with your doctor before taking amounts of zinc over 15 milligrams a day.)
Caution: Women who are pregnant should never take daily supplements of 10,000 international units or more of vitamin A and other women of childbearing age should check with their doctors before taking that much.
If you have a UTI (as opposed to an irritated bladder), Dr. Sullivan recommends taking 1,000 milligrams of vitamin C, which can help make the urine more acidic and less hospitable to bacteria. You can take that amount of vitamin C up to four times a day--but no more than that. More than 1,200 milligrams of vitamin C a day can cause diarrhea in some people.
Check your contraception. Some birth control methods may contribute to recurring urinary tract infections, says Dr. Fugh-Berman. Diaphragms may kink the urethra, causing urine to back up into the bladder, preventing the bladder from emptying completely. Also, spermicides may change the vaginal flora, causing an overgrowth of the bacteria E. coli, the most common cause of urinary tract infections, she explains.