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Don’t Go It Alone: Take Charge of Common Bladder Issues

George Turini, MD

Don’t go it alone: Take charge of common bladder issues  

Gray hair, wrinkles … and problems in the bathroom? Things change as we grow older, including your bladder and urinary tract. Issues may range from the frequent urge to urinate to difficulties emptying your bladder. But what’s a normal sign of aging – and when should you call your doctor? George Turini, MD, a urologist with Northeast Medical Group who is affiliated with Westerly Hospital, answers your questions about common bladder issues.

When the flow slows to a trickle

Do you have to strain to get the urine out? Is the stream weaker than it used to be? Does the flow start and stop? When you finish, do you have the sense that you haven’t completely emptied your bladder?

“For the most part, anatomy is the key to what’s going on here,” Dr. Turini said.

For men, the prostate gland is the reason for many obstructive symptoms. The prostate sits directly below the bladder, with the urethra passing through it. When men are in their 20s and 30s, the prostate is typically the size of a walnut. As men age, the prostate grows larger, often reaching the size of a tennis ball. The prostate then begins to put pressure on the urethra, which compresses the urethra channel -- and constricts the flow of urine. 

“By the time they are 50, about half of all men will deal with some enlargement of the prostate,” Dr. Turini said. “That internal compression on the urethra squeezes it down like a tunnel – and it’s not so easy to get the urine out.” 

Many men resign themselves to living with the discomfort and inconvenience that comes with an enlarged prostate. Before considering surgery, physicians may recommend medications as the first line of treatment. 

For both women and men, tight pelvic-floor muscles can also block the flow of urine. Frequent coughing and heavy lifting that strains the abdominal core can tighten and stress the muscles, as can constipation and holding it for too long. Stress and anxiety can also play key factors.

“You might not think that this is relevant in urology, but one of the areas where we carry stress is in the pelvic floor,” Dr. Turini said. 

The long-term effect on the bladder is that it becomes “less compliant,” he said. “When you overwork the bladder, it gets thicker and harder and that changes the dynamic of the muscle.”  

According to Dr. Turini, physical therapy that includes pelvic-floor exercises, relaxation and stretching can help.

Quick! Where’s the bathroom?

Does this sound familiar? You’re getting up several times in the middle of the night to use the bathroom. You have to go to the bathroom every 20 minutes. And a cough, laugh or sneeze sends you searching for the nearest restroom. 

You’re not alone. An overactive bladder is a common condition that involves the frequent and overwhelming need to urinate. 

As you age, your bladder grows and changes, too. The muscles lining your bladder become weaker and less flexible with age. This loss of strength and stretchiness means your bladder may not empty fully when you go to the bathroom. That’s where coughing, laughing, heavy lifting or sneezing can cause you to leak a little bit — or a lot. 

These and other symptoms of urinary incontinence aren't just a natural part of aging, however. Other factors that can contribute to incontinence include being overweight, diabetes, infections, certain medications, constipation, and caffeine or alcohol consumption. Overactive bladder can also result from neurological issues, such as Parkinson’s disease, multiple sclerosis or stroke. 

Treatment for overactive bladder often begins with lifestyle changes. Dr. Turini recommends limiting what he calls “The 4 Cs” of bladder irritation: 

  • caffeine (i.e., coffee, tea, energy drinks and soda)
  • carbonation (beer, soda, seltzer or tonic water)
  • citrus fruit (oranges, grapefruits, lemons)
  • chocolate (especially dark chocolate)

Spicy foods (such as hot peppers or cayenne pepper) also irritate the bladder. 

“Certain foods and drinks can make the problem worse. We know what serves as an irritant to the bladder, but everybody is different. It’s up to you to decide what you want to live with,” he said. 

Other lifestyle changes include losing extra weight and watching fluid intake (especially before bedtime). If you smoke or use other tobacco products, ask your doctor to help you quit. Consider urinating on a regular schedule (such as every hour) and slowly extend the amount of time between your toilet trips.

Kegel exercises, which strengthen the muscles that support the bladder to prevent urine leakage, can also help. Eat more fiber and take other steps to avoid constipation, which can make the incontinence worse. If lifestyle changes are not enough, treatment may include prescription drugs.

Changes in color 

Regular urine color varies from clear to pale yellow depending on the amount of water you drink. But certain things can change the color. Foods such as beets, blackberries and fava beans can turn urine pink or red, for example. And some medicines can give urine vivid tones, such as orange or greenish-blue.

Other conditions that can cause color changes to your urine include infections, inflammation, kidney or bladder stones, leaky blood vessels, cysts or cancer. 

According to Dr. Turini, it’s important to be specific when reporting changes in the color of your urine to your doctor. 

“We often hear patients say, ‘My urine is dark.’ Is it dark, or is it actually red or bloody? There’s a distinction between the two and it’s important to know what’s really going on so we can recommend certain tests,” he said. “If there is any sign of blood in your urine, see your healthcare provider.” 

When to seek help

Don’t be embarrassed to discuss symptoms with your doctor. 

Dr. Turini recommends calling your doctor if:

  • You're embarrassed by urine leakage, and you miss important activities because of it.
  • You often rush to a bathroom but can't make it in time.
  • You often feel the need to pee but pass little or no urine.
  • Your urine stream is getting weaker, or you feel as if you can't empty your bladder all the way.
  • It hurts when you urinate or you feel a burning sensation.
  • It takes you 3 - 4 minutes to go to the bathroom every time.

Some medicines cause bladder control problems, so make sure to inform your doctor about everything you take. This includes prescription medicines, over-the-counter drugs, vitamins, minerals, herbs and other supplements. If you're not sure whether something counts as a medicine, put it on the list anyway.

In many cases, treatment can provide relief from your symptoms. Your doctor can help determine the best option for you. 

To find a urology provider at Yale New Haven Health, call 833-346-3637.