Heart Disease is the #1 killer of men and women, worldwide. The heart is a vital muscle that beats every minute of every day, morning and night; we know we must eat healthy and exercise to care for it. I myself spend a great deal of time and expense caring for my skin -- it is part of every first impression I make and is the largest organ of the body. But, the urinary bladder . . . it is a muscle that is largely ignored; taken for granted, until damage is done. Billions of dollars each year are spent in the U.S. to treat bladder disease, which can make a significant adverse impact on your quality of life. If you think you needn’t concern yourself . . . not in my lifetime, it's not a bet you're likely to win.
In 2010, experts in the field of urology met to define a consensus statement toward the impact of Bladder Health on the overall health of an individual, including emotional well-being, forming the first US public health statement to address bladder health (Lukacz, E. S., 2011). They agreed upon a number of conditions/symptoms to be included in the heterogeneous group of approximately 1.9 billion people worldwide (>48% or people over 20 years of age, in 2008) that live with an "unhealthy urinary bladder" or "Lower Urinary Tract Symptoms" (LUTS).
- Overactive Bladder (OAB)
- Bladder Outlet Obstruction
- Bladder Pain Syndrome/Interstitial Cystitis (often misdiagnosed as fibromyalgia, endometriosis, IBS and recurrent UTI's)
- Urinary Tract Infection (UTI)
- Bladder Cancer (which is more prevalent in men; risk increases with age)
Serious Consequences of Urinary Bladder Disease -- considerable financial cost, born by individuals and society for costs associated with personal protection supplies (pads), at the low end, and in severe cases placement in nursing homes. Total costs in 2007 for Overactive Bladder were estimated at $65.9 billion in the U.S. (Ganz, M.L., 2010), whereas estimated costs of UTI were $1.6 billion in 2003 (Foxman, B., 2003). Among older men and women, overactive bladder is associated with increased risk of falls and fractures (Darkow, T., 2005). LUTS is associated not only with increased anxiety, but also impacts Quality of Life (QOL), which can lead to depression, reduced productivity, decreased physical activity, including sexual function. I am impressed that Trudy has already discussed ways to deal with each of these issues, reclaiming her life from potential debilitating consequences of a compromised urinary system.
Healthy Bladder -- did you know?:
- In adults, capacity of bladder is 300-400 ml
- Normal Frequency averages 8x daily (every 3-4 hrs. + 1 or fewer trips at night)
- Daily intake should average 2400 ml/day (US Food Science Board recommends fluid intake volume 0.5 oz./lb./24 hrs.)
- The Urinary and G.I. tracts share neural signaling pathways (peripheral nerves) and may be the reason that constipation is associated with bladder disfunction (Coyne, K.S., et al., 2011)
The scope of this study group did not specifically address the added complication of a neurogenic component leading to symptoms (neurogenic bladder). However, healthy bladder function is dependent on signaling from the lining of the bladder to the pelvic floor muscles that control urination at the urethra/neck of the bladder to relax, and thus release the contents of the bladder, when it is nearing capacity. Interruption of the signal could lead to many of the symptoms discussed, as well as other symptoms of neurogenic bladder, such as urine retention. Maintaining a disease-free bladder is that much more important for those already living with a dis-connect between the neurological and urinary-muscular systems; it means one less strain with which your body needs to cope.
Trudy -- who works in the field of education, should find this particularly interesting:
the expert panel creating the statement on a healthy bladder recognized that the health of the adult bladder can be impacted by incidents from childhood, including access frequency to bathroom facilities. They hope that by improving the understanding of normal toileting patterns and their potential interruption by "environmental factors" including situations where toilets become the scenes of bullying and thus lead to unhealthy "holding behavior" (Vernon, S., et al 2003) -- potentially leading to subsequent damage to the bladder over time, is a situation that can be averted. Securing bathroom privacy, safety and cleanliness for children in schools should be a given, but can be achieved through proactive work on the part of educators and administrators.
Recommendations for Improving/Maintaining Healthy Bladder Function
- Consume an adequate level of fluid per day to maintain a urination frequency period of every 3-4 hrs.
- Moderate consumption of food/beverages known to irritate the bladder (Dietary Considerations)
- Adopt a relaxed position for urination and allow time to empty the bladder
- Maintain muscle tone with pelvic floor muscle training and pre-emptive pelvic floor contraction (Knack maneuver) to improve and maintain bladder health
- Avoid/control constipation
- Maintain a healthy weight (obesity can lead to compromised bladder function)
- Quit Smoking
Dr. Emily Lukacz, (Assoc. Professor of Reproductive Medicine, UCSD), et al. believe that by supporting the guidelines of the International Consultation on Incontinence -- by educating and raising awareness amongst the general population and healthcare providers -- bladder disease can be alleviated and in some cases prevented. Working to increase understanding and attention resulting in new public health policy that recognizes the importance of a healthy bladder would inevitably lead to more individuals seeking help earlier, and physicians better equipped to recognize symptoms.
Be proactive, spread the word . . . Maintaining Bladder Health is a critical component of Healthy Living! Change starts with you.
--Julia Parker
The Biosleuth
References
1: Lukacz ES, Sampselle C, Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, Palmer MH. A healthy bladder: a consensus statement. Int J Clin Pract. 2011 Oct;65(10):1026-36. doi: 10.1111/j.1742-1241.2011.02763.x. PubMed PMID: 21923844; PubMed Central PMCID: PMC3206217.
2: Coyne KS, Cash B, Kopp Z, Gelhorn H, Milsom I, Berriman S, Vats V, Khullar V. The prevalence of chronic constipation and faecal incontinence among men and women with symptoms of overactive bladder. BJU Int. 2011 Jan;107(2):254-61. doi: 10.1111/j.1464-410X.2010.09446.x. PubMed PMID: 20590548.
3: Darkow T, Fontes CL, Williamson TE. Costs associated with the management of overactive bladder and related comorbidities. Pharmacotherapy. 2005 Apr;25(4):511-9. PubMed PMID: 15977912.
4: Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003; 49:53-70. doi: http://dx.doi.org/10.1016/S0011-5029(03)90000-9
5: Ganz ML, Smalarz AM, Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, Pashos CL. Economic costs of overactive bladder in the United States. Urology. 2010 Mar;75(3):526-32, 532.e1-18. doi: 10.1016/j.urology.2009.06.096. Epub 2009 Dec 29. PubMed PMID: 20035977.
6: Latini JM, Mueller E, Lux MM, Fitzgerald MP, Kreder KJ. Voiding frequency in a sample of asymptomatic American men. J Urol. 2004 Sep;172(3):980-4. PubMed PMID: 15311017.
7: Lukacz ES, Whitcomb EL, Lawrence JM, Nager CW, Luber KM. Urinary frequency in community-dwelling women: what is normal? Am J Obstet Gynecol. 2009 May;200(5):552.e1-7. doi: 10.1016/j.ajog.2008.11.006. Epub 2009 Feb 27. PubMed PMID: 19249726; PubMed Central PMCID: PMC2695664.
8: Vernon S, Lundblad B, Hellstrom AL. Children's experiences of school toilets present a risk to their physical and psychological health. Child Care Health Dev. 2003 Jan;29(1):47-53. PubMed PMID: 12534566.
Further Online Reading:
Stay current about Recommendations for Continence
Continence Promotion Committee (International Consultation on Incontinence)
