The bladder is a hollow, round and flexible pouch-like organ – close in size to that of a grapefruit – that is responsible for acting as a storage unit for urine before it leaves the body. The bladder itself consists of four different layers – the first layer, which is known as the epithelium, acts as a lining on the inside of the bladder; the second layer, known as the lamina propria, consists of connective tissue, muscle and blood vessels; the third layer, known as the muscularis propria and detrusor muscle, consists of thick, smooth bundles of muscles; and the fourth and final layer, known as the perivesical soft tissue, which consists of fat, fibrous tissue and blood vessels. In addition to these four layers, the bottom of the sack of the bladder consists of an opening that connects to the urethra, a duct that is responsible for transmitting urine from the bladder and out of our body.
There are a number of different disease and conditions that can affect the bladder. Among some of the most common bladder-related problems I see as a family physician are overactive bladder and urinary incontinence. Overactive bladder is a condition in which the bladder is unable to hold urine normally, resulting in the feeling of a sudden urge to have to urinate, or you may experience an accident. Urinary incontinence is described as loss of bladder control, and could be a sign of something as simple as consuming too much fluid or a more serious problem, such as a urinary tract infection, which will be explained in more detail below. As for what causes overactive bladder and urinary incontinence, there are many – including lifestyle and medical causes. One example includes the consumption of alcohol and caffeine. These particular beverages act as diuretics and cause the body to produce more urine than usual. While medical conditions such as Parkinson’s Disease, Multiple Sclerosis (MS), diabetes and kidney disease can all cause overactive bladder. In addition, men who have an enlarged prostate can also develop OAB, and acute urinary tract infections in both men and women can also lead to symptoms that are similar in nature to OAB.
When it comes to treating overactive bladder and urinary incontinence, one option is by doing pelvic floor exercises. These exercises can help strengthen the muscles around the neck of the bladder and the urethra. In addition, weight loss can also be beneficial, as well as paying attention to your intake of fluid. In some cases, oral medication may also be prescribed to help relieve symptoms, while there have also been some cases in which patients have undergone Botox injections into the bladder to help control muscle movement – though this is considered to be a more invasive method of treatment.
As mentioned, urinary tract infections can also cause bladder incontinence. A UTI occurs when bacteria enters the bladder through the urethra and multiplies, resulting in symptoms such as leaks of urine, in addition to a burning or stinging sensation during urination, urine that appears cloudy, dark or bloody in colour, urine that has a foul odour, pain in the back and/or lower abdomen, as well as fatigue, fever and chills – which could also be an indicator that the infection has reached your kidneys. To determine whether or not a UTI is what’s causing these symptoms, your will have a urinalysis done – which is often performed on the spot at most doctor’s offices, meaning you will be able to start treatment right away. Antibiotics are the first line of treatment used for urinary tract infections, which can include medications such as Sulfamethoxazole, Nitrofurantoin, Fosfomycin, Ciprofloxacin, Cephalexin, Azithromycin, and Levofloxacin. The type of medication that your doctor chooses to prescribe, and the dose is usually dependent on the severity of your symptoms.
Another common but complex bladder problem is known as interstitial cystitis – also sometimes referred to as IC, PBS, or bladder syndrome. It is more common in women than men, though it can affect both genders. Symptoms can include urinary urgency and frequency, in addition to painful periods, pain in the lower abdomen, urethral or vaginal area, as well as pain during sexual intercourse. It is not known what causes this condition, nor are there any tests that can actually diagnose whether or not you have it. When it comes to treating interstitial cystitis, the focus is on reducing the severity of the symptoms. Some of these treatment methods can include use of oral medication, (such as NSAIDs and tricyclic antidepressants) in addition to lifestyle changes.