Women's Sexual Health > Female Incontinence
- Written by Dr. Myron Murdock, Vibrance Medical Director
The most common urinary tract problem that urologists see in their offices are women with frequency of urination and the severe urge to urinate, a non-ending feeling of a fullness of the bladder. Many of these women tell horror stories about having to go to the bathroom every 15 minutes, 30 minutes or an hour. Everyday. And many women say they do not even make it to the bathroom, causing not only embarrassing social moments, but psychological pain as well.
Many women have had multiple tests, x-rays, drugs, urethral stretching (dilatation) and still continue with this major annoyance. While most cases are not serious, and not life-threatening they are life-style threatening. It is often embarrassing, uncomfortable, a major nuisance, and affects activities of daily living. The first stop is a health care professional.
In order to treat the problem you have to know what the problem is, and therefor lets talk about causes. This urgency and frequency syndrome, which I coined, is medically referred to as urethral syndrome, or unstable bladder, and is probably called such because they don't know what the problem really is and how to handle it. Just about anything irritating the bladder or the urethra (the urine tube) can give you the urgency/frequency symptoms.
Many are associated with an abnormal urinalysis and other associated urinary symptoms such as burning on urination, blood in the urine as well as cloudy urine with pus in it. However, most of the problems that have abnormal urinalyses and other symptoms can be diagnosed, treated with antibiotics, or after simple diagnostic tests treated by stretching the urethra. The remainder are the problem patients, the ones with this urethral syndrome the question is how to make a specific diagnosis and be able to treat this complex, not easily treatable disorder?
We have to think about certain entities that can give you this problem and are hard to diagnose without some special tests. The first entity is interstitial cystitis, a bladder inflammation involving mostly the muscle layers of the bladder. The cause is unknown, but is probably due to a lack of a normal substance being produced by the lining of the bladder allowing urine to enter the muscle of the bladder causing irritation and possibly stimulating some kind of autoimmune mechanism where the body becomes allergic to its own bladder muscle.
This problem is treatable with a specific medication called DMSO, which is instilled in the bladder at regular intervals, and a new oral drug called Elmiron which is taken three times a day. With these treatments 90+% of usually women with this problem can get resolution which is a far cry from the old days when two-thirds of the patients worsened and frequently became incapacitated from this disease.
Another cause of urethral syndrome, or unstable bladder is chronic ureterovesical reflux where urine backs up into the kidneys due to some congenital abnormality of the valves from the urine tubes of the kidney and the bladder. When the urine backs up into the kidney the bladder works very hard trying to empty itself, becomes thick-walled and irritable and causes frequency and urgency. In addition, after emptying the bladder the urine trickles back down filling the bladder with additional urine.
In order to solve the complicated urethral syndrome problems, your health care professional should think about the above disorders and then do appropriate evaluations. X-rays of the kidneys will determine the status of the kidneys and whether or not damage has occurred from tuberculosis of the bladder, another, but slim possibility, reflux of urine, or other bladder or urethral problems.
If a neurological condition such as a stroke, brain tumor, multiple sclerosis, diabetes, back or disc problems occur doctors may also suggest doing a pressure study on the bladder called a cystometrogram.
It involves putting a catheter in the bladder, infusing fluid which is usually a gas like carbon dioxide, then measuring the pressures in the bladder as the volume increases. At the same time the doctor can instill dye and observe the bladder before, during, and after urination to see if urine backs up into the kidneys in the case of ureterovesical reflux. You can also see if the bladder really does empty and is there any urine left behind after urination.
Another test is for your doctor to look into the bladder, which frequently can be done with a fiber optic-type flexible cystoscope. This instrument allows the physician to look at the lining of the bladder, the neck of the bladder and the urethra.
If you are concerned about interstitial cystitis the procedure must be done under anesthesia so the bladder can be stretched maximally above and beyond what one could normally tolerate, emptied, and then refilled to look for the characteristic hemorrhages associated with interstitial cystitis.
On occasion there are ulcerations in the bladder which are even more diagnostic of interstitial cystitis. With this test you are looking for inflammation, inflammatory polyps, stones, tumors, and/or pustules, all of which can be treated. Frequently they can be treated at the time of the endoscopic procedure, particularly if it is done under some type of sedation or anesthesia.
So you can see, the unstable bladder, urgency/frequency syndrome, or urethral syndrome is really a number of disorders many of which are often not diagnosed and appropriately treated.
Additional resources on incontinence are available from MayoClinic.com: