Bladder Issues – A Patient Journey
Bladder issues can affect people at any stage in life and can be either long term (chronic) or short term (acute), and symptoms can vary in their severity depending on the condition. Despite the existence of numerous treatments for different conditions, problems of the bladder can have a big impact on quality of life and many people continue to suffer in silence.
Types of bladder problems
Some of the most common bladder conditions are Overactive Bladder Syndrome, Urge Incontinence, Stress Incontinence, Cystitis and Urinary Tract Infections. Less common conditions include Bladder Cancer and Bladder Stones. Although there are noticeable differences between these conditions, patients can experience symptoms of a similar sort:
- Overactive Bladder Syndrome - OAB (overactive bladder syndrome) is one of the most common bladder problems, with as many as 1 in 6 adults reporting some symptoms of OAB at one time or another. It occurs when the bladder squeezes suddenly while the bladder is not full. Those who live with OAB have no control over their symptoms, which can occur without warning. These symptoms can include an urgent need to go to the toilet, going to the toilet more frequently, waking to use the toilet numerous times during the night (Nocturia) and in some cases leaking urine before you can get to the toilet (Urge incontinence).
- Urge Incontinence - Urge incontinence is the second most common cause of incontinence. Most commonly seen in women, it can affect people at any age, with most developing symptoms in early adult life, including an urgent desire to pass urine and sometimes leaking urine before you get to the toilet.
- Stress Incontinence - Stress incontinence is the most common form of incontinence, and is most commonly seen in women over the age of 40, with as many as 1 in 5 women over this age having some degree of stress incontinence. It is usually caused by the weakening of the muscles used to prevent urination (including the pelvic floor muscles and the urethral sphincter). When the bladder is put under pressure (such as when you cough, laugh, sneeze or exercise) the bladder cannot withstand the pressure and as a result urine can leak.
- Cystitis & UTI’s - Cystitis is defined as inflammation of the bladder, and is usually caused by a bladder infection. It is one of the most common types of urinary tract infection (UTI), is seen most commonly in women, and is in most cases more of a discomfort rather than a severe condition. In the majority of cases, symptoms will subside within a matter of days, however, some people can experience frequent bouts of cystitis, requiring more intensive treatment including antibiotics. Symptoms include pain, burning or a stinging sensation when urinating, feeling the need to go to the toilet more frequently than normal, dark, cloudy or strong smelling urine, pain in lower abdomen and generally feeling unwell and exhausted.
- Bladder Cancer - Bladder cancer is caused by the growth of abnormal tissue, known as a tumour, developing in the bladder, more specifically the bladder lining. In some cases, the tumour can spread into the surrounding muscles. Bladder cancer is commonly seen in smokers, with over half of all cases estimated to be caused by smoking. The most common symptom is blood in the urine, which, although usually painless, is a clear indicator that you may have a bladder problem. If you experience any symptoms associated with bladder cancer, or you fear you could be at risk, please do visit your GP for analysis and to find out more about preventative measures you can take.
- Bladder Stones - Bladder stones are hard lumps of minerals that form inside the bladder when it's not completely empty of urine. Symptoms associated with bladder stones can remain unnoticed if the stones are small enough to pass while urinating. However, most people do experience symptoms due to the stones irritating the wall of the bladder or blocking the flow of urine. Many will experience pain or difficulty when peeing, lower abdominal pain and may see blood in their urine. Although bladder stones can affect women, they are most commonly seen in men aged 50 or older, with research suggesting that the problem can be linked with prostate issues. As with bladder cancer, if you have any of the symptoms of bladder stones, it’s worth speaking to your GP.
Bladder problems can also be a consequence of a birth defect, such as spina bifida as well as other illnesses, such as neurological conditions (conditions which affect the brain and spinal cord, including Parkinson’s disease and multiple sclerosis). Although many bladder problems occur naturally, incontinence can also be triggered by an event or situation in your life, such as a surgery, pregnancy or accident. Some of these situations can be short term but more severe accidents can leave people with lifelong incontinence.
If you suspect you have any of these conditions you should make an appointment to see your general practitioner (GP) or other qualified healthcare professional.
Visiting your GP
In order to make an accurate diagnosis, your GP will ask you questions about your symptoms and medical history to determine what bladder problem you have. For example, if you suspect you may be living with urinary incontinence, questions will be along the lines of:
- Does your urinary incontinence occur when you cough or laugh?
- Do you need the toilet frequently during the day or night?
- Do you have any difficulty passing urine when you go to the toilet?
You may also be asked to keep a bladder diary to record the frequency of which you go to the toilet, the sorts of liquids you drink, the amount of urine you pass and how many times you feel the urgent need to go to the toilet as well as the number of incontinence episodes you are experiencing.
It may help your GP if you note down ahead of your appointment the affect your bladder is having on your day-to-day life, such as those listed above.
In some instances you may be required to undergo a number of examinations, such as testing your urine for bacteria in order to rule out cystitis (the dipstick test), a physical examination where the doctor will examine your pelvic floor (female) or your prostate (male) for any abnormalities or damage that could be causing your incontinence, or a residual urine test, where doctors will carry out an ultrasound (a painless procedure using high frequency sound waves to create an image of part of the inside of your body) of your bladder to measure how much urine is left in your bladder after you go to the toilet (specifically for those with overflow incontinence).
Further tests, such as a cystoscopy (a thin fibre tube with a light and a camera at the end is inserted through the urethra, the tube which carries urine out of the body, into the bladder), can be carried out if the cause is unknown after the initial examination.
After receiving a diagnosis, your GP will recommend treatment for your bladder issue to improve symptoms.
How to treat bladder problems
Some issues, like mild cystitis, will improve when you follow simple lifestyle changes such as ensuring you drink a lot of water to flush out your system and, if recommended by your GP, take paracetamol/ibuprofen for the pain. Most incontinence problems, however, will require some form of treatment. Patients will initially be recommended to try non-surgical remedies which they can carry out themselves, such as lifestyle changes, pelvic floor muscle training (or 'Kegel exercises'), and bladder training.
Pharmacotherapy (the use of medication to help treat bladder issues) may be recommended by your GP. There are various types of medication available, you can read more about pharmacotherapy and bladder issues here.
Surgical treatments may be recommended in cases where non-surgical methods have been unsuccessful with some of the most common surgical treatments, all of which involve the lifting or supporting of the bladder to limit the risk of incontinence episodes.
For some bladder problems, catheters can be an effective treatment. You may be told you need a catheter for one of several reasons, such as:
- You have an obstruction in the urethra (the tube which carries urine from the bladder) – this can be due to scarring, an enlarged prostate or, in rare cases, due to kidney or bladder stones.
- During some types of surgery – to drain your bladder before, during or after surgery.
- During childbirth where you have delivered by caesarean section (C-section) or have had an epidural.
- To allow a person to urinate where you have bladder weakness (urine leaks from the urethra) or nerve damage (such as an injury to the spinal cord)
- A catheter may also be considered where other treatments for urinary incontinence have not worked, for instance, if a patient is particularly old or frail.
Catheterisation can be both a long term and short term treatment depending on the bladder issue. If you are required to use a catheter for a long period of time, you will usually be shown how to perform self-catheterisation and the appropriate measures you have to take to ensure your catheter remains clean, hygienic and free from infection. Long term catheterisation can cause discomfort at first, both physically and emotionally, with many experiencing feelings of embarrassment. Despite the distress catheterisation may cause, it is a treatment that can allow those with acute bladder problems the chance to live life outside the confines of their home.
In the case of incontinence, there are products that you can use which will make it easier to live with your condition. Although not a treatment which will lessen symptoms, incontinence products such as pads and incontinence pants can be useful for managing your condition and will allow you to carry out daily tasks without risk of an accident.
Living with a bladder condition
Living with a long term (chronic) bladder condition can be distressing and can in many cases cause social and emotional (psychological) problems. If you feel that your bladder problem is affecting you in this way it is important to discuss this with your doctor.
Sources used in writing this article are available on request.
Last revised: 13 October 2016
- Continence Issues: Catheters and their uses by Coloplast Ltd.
- Bladder Cancer by the talkhealth team
- Cystitis & Urinary Tract Infections by the talkhealth team
- Temporary Incontinence by the talkhealth team
- Total Incontinence: the loss of control by the talkhealth team
- Urinary Incontinence by the talkhealth team