Euphemistically called our ´waterworks´ with true British gentility, problems with our bladders are very common.

Up to 40% of men and women will seek advice from doctors at some stage in their lives. The problems people have are due either to difficulties with urine storage or urinary incontinence, one of the most embarrassing of all medical symptoms. Many sufferers are unable even to see their doctors due to embrassment and are suffering a lifetime of preventable misery. Over the last few years the way doctors treat bladder conditions has changed radically. Several new drugs are available and there have been a range of newer, smaller operations developed to treat urinary incontinence which are usually highly successful. However, as we learn more about the bladder and the delicate balance of acid and substances that help keep its lining healthy, we are understanding that a healthy lifestyle and diet can make major improvements to such miserable symptoms.

WHAT ARE THE MOST COMMON BLADDER PROBLEMS?

Bladder, or urinary tract infection (UTI), is the most common problem. The most prevalent organism is a bacteria called E. coli which is usually in the gut. Some people are unlucky enough to have repeated UTIs. Others have to void (wee) frequently – often up to 20 times a day – some are woken at night to empty their bladders causing chronic exhaustion due to poor sleep. One of the worst symptoms is urgency – having to rush to the toilet and sometimes not making it. Urinary incontinence is often the most distressing symptom and many sufferers find they are unable to lead normal lives because of it. Up to 25 % of women between the ages of 16 and 64 have seen their doctors because of leakage. Bladder problems are more common and may get worse as people get older due to the increased weakness of the bladder muscles and hormonal changes. They are much more likely to develop in women than men, as the urethra – the tube from the bladder – is much shorter and hence more likely to become weak, causing leakage or becoming prone to admitting infection.

WHAT ARE THE CAUSES OF BLADDER PROBLEMS?

There are three main ones. Firstly genetic bladder problems, such as leakage, can run in families. This is because collagen, the connective tissue, the ‘glue’ that holds us together, varies and some families seem to have weaker collagen and subsequently a weaker pelvic floor. Secondly pregnancy is a major cause of problems. During pregnancy and especially vaginal delivery, the pelvic floor and bladder neck can get damaged, leading to weakness and urinary leakage. The more vaginal deliveries a woman has, the greater the risk of bladder problems. That is why some women and obstetricians are arguing for delivery by planned Caesarean section to reduce these risks – a hugely controversial area. Finally problems are caused or exacerbated by lifestyle. Cigarette smoking may lead to nicotine breakdown products irritating the bladder lining. Too much caffeine from coffee and from tea (which many people forget also contains caffeine) can also irritate the bladder. Spicy foods and certain alcoholic drinks (red wine and cider in particular) can also cause irritation.

LIFESTYLE CHANGES AND THE BLADDER

Surgery and drugs should be the final solutions. In my experience of treating women with bladder problems, many symptoms can be hugely improved by a few simple lifestyle changes. First of all, it is important that the body has enough fluid. Many bladder sufferers reduce their intake because of urinary leakage: this is wrong and may be dangerous. Increasing clear fluids will help ‘flush out’ any bacteria in the bladder and help reduce the acidity of the urine which, in turn, will reduce the risk of urinary infection. Stopping smoking, reducing spicy food and modifying alcohol intake will also assist. Cutting back on coffee and tea will help, and stopping drinking them after 7pm will also, for some sufferers, help alleviate night-time symptoms. Paying careful attention to personal hygiene will also reduce the risk of urinary infections.

“Cranberry (either in supplement or juice form) taken daily has been shown in scientific studies to reduce the risk of urinary infection.”

SUPPLEMENTS AND THE BLADDER

Interest in nutritional supplements in helping problems has rocketed as scientists understand more about the way the lining of the bladder and the muscles work. Cranberry juice (either in supplements or as a fluid) taken daily has been shown in scientific studies to reduce the risk of urinary infections and the feeling of needing to void. This is because it is a substance called a ‘nitric oxide inhibitor’: simply put, cranberry juice makes it harder for bacteria causing infection to stick to the bladder lining. Several studiesare currently looking at preventing bladder cancer or reducing its risk or recurrence using dietary modifications. While some of the results are preliminary, there is a growing consensus in these studies that a healthy diet is beneficial for the bladder. For example, a recent study by the American Cancer Society looking at one million adults studied over 16 years showed that those who had used vitamin E (an antioxidant) supplements over a long period of time had a reduced risk of developing bladder cancer. Bladder symptoms are worse in women after the menopause. This is because of the reduced levels of oestrogen. Interestingly oestrogen receptors on the bladder increase after the menopause as it tries to use as much of the body’s reduced oestrogen as it can. Because of this and the desire by many women to avoid conventional hormone replacement therapy (HRT), many women find dietary supplements helpful in reducing their bladder (and other menopausal) symptoms. Soya and sage extracts contain natural phytooestrogens, ‘weaker’ oestrogens which can be used by the body to treat some of the symptoms of low oestrogen levels. Red clover is increasingly used for menopausal symptoms and recently has also been found to help male prostatic hypertrophy, a condition that may affect up to 70 % of men in later life.

KEEP HEALTHY WITH REGULAR FEMALE HEALTH SCREENING

There is growing evidence that women in the UK are opting for annual health checks by a gynaecologist in a similar fashion to those in the US. They are doing this for three reasons. Firstly to check they are healthy and if any problems are developing, for example with their periods or bladder, to pick these up promptly and treat them before they have a bigger one. Secondly they seek an annual cervical smear which currently on the NHS is available only every three years, a timescale which many women feel is simply too long. Finally they seem to value the reassurance that comes from being monitored and reviewed on an annual basis. In order to address these issues, a new company called GynaeCheck has been formed. Run by gynaecologists who have listened to what women want, its national service aims to give them the peace of mind that being reviewed regularly and looked after means. For further information on becoming a GynaeCheck member, ring 01707 877889 or have a look at www.gynaecheck.co.uk.

 

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