When Bathroom Runs Rule the Day (and Night)

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Personal Health

I have only one regret about not having been born a male, and it concerns plumbing, namely how easy it is for men to eliminate liquid waste, whether by avoiding long bathroom lines or being able to relieve themselves discreetly when no facility is available. My male envy grew after I contracted poison ivy on unmentionable parts when nature called during a hike in the woods.

Urination has long been a vexing problem for women. In a recent online questionnaire of 1,666 women age 18 and older living in the 50 states (conducted for Astellas Pharma U.S., which makes drugs for bladder control), 87 percent admitted to peeing somewhere other than in a bathroom, and more than half said they’d used a men’s room when the women’s line was too long.

Another tactic with which I can identify: 46 percent of those surveyed said they’d purchased something from a store or restaurant, and 25 percent posed as a hotel or restaurant guest, to gain access to a restroom.

Now imagine the extent of distress among the approximately 51 million adults in this country with an overactive bladder, who face frequent, sudden urges to urinate, or who have urinary incontinence and cannot delay urination when an urge occurs.

Those with an overactive bladder usually must urinate eight or more times a day, often awakening two or more times a night to use the bathroom.

(Still others are plagued with stress incontinence; they leak urine involuntarily when they cough, sneeze, laugh or exert themselves physically.)

Of course, women are not the only ones with life-disrupting urinary concerns. Men are susceptible to many of the same conditions that increase a woman’s risk of bladder problems, and older men who develop an enlarged prostate (60 percent of men in their 60s, rising to 90 percent by age 80) are especially at risk of urinary urgency and incontinence.

The National Overactive Bladder Evaluation, a study that assessed the prevalence of this problem in the United States among 5,204 representative adults, found in 2003 that it caused incontinence in 16 percent of men and 16.9 percent of women.

As disturbing as the symptoms of overactive bladder and urinary incontinence can be, Dr. Ekene Enemchukwu, a urologist at Stanford University Medical Center, told me that, on average, men wait four years and women wait six and a half years before consulting a doctor about difficulties in getting to the bathroom in time.

Although the problem is more common among older adults, experts like Dr. Enemchukwu say it is not a normal part of aging. Rather, conditions that tend to develop later in life, including arthritis, dementia and Parkinson’s disease, and medications taken for disorders like high blood pressure, can make it more difficult to control the urge to urinate.

Under normal circumstances, as the bladder fills, nerve signals sent to the brain gradually alert you to the need to urinate and typically give you enough time to find an appropriate facility before bladder muscles contract to release stored urine.

Sometimes, however, a person’s bladder muscles start to contract involuntarily and create an urgent need to urinate. This can happen even when the bladder is not full, for example, when the bladder is irritated by excessive consumption of caffeine or alcohol or compressed by stored stool when a person is constipated.

In men, the urethra, the tube that carries urine from the bladder, passes through the doughnut-shaped prostate gland and can be squeezed when the gland enlarges. This can cause the wall of the bladder to thicken, making it overactive, or decrease the efficiency of contractions, keeping it from emptying completely and causing more frequent urges to urinate, Dr. Enemchukwu said.

In women, pelvic organ prolapse may prevent complete bladder emptying when muscles that hold the bladder in place are weakened by childbirth or surgery.

Even when an underlying disorder is not present, the risk of developing an overactive bladder increases with age for reasons medical science has yet to determine, the doctor said. However, she added, just because you’re getting older or your mother had the same problem doesn’t mean you have to put up with it. There is a host of remedies that diminish the risk and often eliminate it entirely.

The American Urological Association says effective treatment should start with a thorough evaluation to help pinpoint the exact nature of the problem and factors that contribute to it. Before consulting a doctor, the Mayo Clinic recommends keeping a bladder diary for a few days, “recording when, how much and what kinds of fluids you consume, when you urinate, whether you feel an urge to urinate, and whether you experience incontinence.”

Also, make a list of the medications and supplements you take and be prepared to relate any and all underlying medical conditions, like diabetes, and prior pelvic surgeries.

Possible tests include measuring the amount and speed of voiding and pressure in and around the bladder as it fills. If the doctor suspects incomplete emptying of the bladder, an ultrasound scan may be done to measure residual urine after you void.

Whatever the cause, it is best to start with behavioral remedies, experts say. Strengthening pelvic floor muscles by regularly doing Kegel exercises, which may benefit both women and men, can reduce involuntary contraction of bladder muscles, though it can take up to two months to notice the benefit. If you are obese and have stress incontinence, losing weight may eliminate this problem.

When, what and how much you drink is of major importance. Avoid caffeine, alcohol and artificial sweeteners, which can be bladder irritants. Consume most fluids earlier in the day, drinking little in the evening to reduce nighttime voiding needs. If incomplete bladder emptying may be a cause, try voiding twice: Wait a few minutes after urinating, then try again to empty your bladder.

Many find it helpful to void on a schedule rather than wait for an irrepressible urge. For example, you might urinate every two to four hours at the same times each day. You might also try to gradually extend the time between voidings to increase your bladder’s capacity and ability to control an urge.

There are also more than half a dozen medications that help to reduce urge incontinence. As with all drugs, they can have side effects, most commonly dry eyes and mouth and constipation. Severe cases of incontinence may be treated with injections of Botox to partially paralyze bladder muscles.