Bladder & Bowel Archive

Rising resistance to antibiotics driven by overprescription and overuse has led to a decline in the effectiveness of antibiotics in treating urinary tract infections. If your doctor wants to prescribe an antibiotic, be sure to ask if it’s necessary, and what alternatives there might be.

Some men with an enlarged prostate gland (benign prostatic hyperplasia, or BPH for short) eventually start to experience urinary incontinence, the involuntary discharge of urine. The incontinence can be related to overactive bladder, one of the changes in bladder function caused by BPH.

Normally, the brain says "time to go" when your bladder is only partially full. That gives you a fair warning to find a place to relieve yourself. When you decide to let go, a valve called the urinary sphincter opens to allow the bladder to drain. Muscles in the bladder wall squeeze inward to empty the storage tank.

Research we're watching

Infections — especially those in the urinary tract, known as UTIs — may raise the risk of a stroke, a new study finds.

Researchers examined the electronic medical records of more than 191,000 stroke patients to see if they'd been hospitalized or gone to an emergency room for an infection shortly before the stroke. They tracked infections of the abdomen, blood, respiratory tract, skin, or urinary tract.

News briefs

Here's some relief for people with urinary incontinence who don't want to take pills to treat the problem: behavioral therapy (bladder training) works better for urinary incontinence than medication, according to a study published online March 18, 2019, by Annals of Internal Medicine. Researchers reviewed 84 randomized trials of women (average age 55). The studies evaluated 14 categories of incontinence treatments, including pill-free therapy and medications such as anticholinergic drugs — for example, oxybutynin (Ditropan). Most of the strategies (except taking hormones or getting injections of a bulking agent near the urethra) were more effective than doing nothing to treat incontinence. But for both stress incontinence (the kind that makes you leak when you laugh) and urge incontinence (the kind that makes you rush to the bathroom), behavioral therapy was the most effective treatment, beating medications and neuromodulation (electrical stimulation of the nerves that control the bladder). The catch: it takes practice to make behavioral therapy effective. But it may be worth the effort, since medications for incontinence often have side effects.

Ask the doctors

Q. I am 89 years old, and several months ago I was plagued by frequent urinary tract infections. The infections were treated, but is there anything I can do to avoid experiencing this problem again?

A. Urinary tract infections, or UTIs, are common infections that can occur when urine pools in the bladder and bacteria start to grow. These infections can be more common in older women for several reasons, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, or difficulty with emptying the bladder completely. In addition, estrogen helps to maintain a healthy balance of bacteria in the vagina, which can protect against UTIs. But this natural protection may wane when estrogen levels drop after menopause. One of the best ways to prevent UTIs is to stay hydrated by drinking plenty of water. This flushes out potentially harmful bacteria before it can cause a problem. You'll know you are drinking enough if your urine looks clear or light yellow. Some other strategies include fully emptying your bladder when urinating, urinating after sexual intercourse, and wiping from front to back after using the toilet. Also talk to your doctor about replacing estrogen in the vagina with a cream, tablet, or vaginal insert. Your doctor may also want to examine you for pelvic organ prolapse.

Try simple measures first, like using a fiber supplement and treating underlying conditions.

Nobody wants to talk about or even imagine it. But loss of bowel control — known as fecal incontinence — is a problem for millions of adults in the United States, especially women.

"It becomes more common with age. It's socially isolating and takes away your dignity. You live in fear that you have stool in your pants and people can smell it. Some people won't even tell their doctors about it," says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

On call

Q. After I have a bowel movement I sometimes get quite weak and have to lie down until the feeling passes. Why does this happen and is it cause for concern?

A. The sensation you are describing is most likely due to a reflex called a "vasovagal reaction." Here's what I mean.

Ask the doctors

Q. I was recently diagnosed with a prolapsed bladder. The doctor said it could be due to too much exercise. I've been exercising for more than 40 years and wonder if this is more likely to be age-related. Should people worry about exercise causing this problem?

A. When the bladder drops down from the pelvis and protrudes into the vagina, it's said to be prolapsed. This condition, known as cystocele, is uncomfortable and can also cause urinary problems.

Ask the doctors

 Image: © Stratol/Getty Images

Q. Sometimes I urinate normally, but often I have to wait for the stream to start, or it takes much longer to finish. It may even stop and start, so I have to sit on the toilet much longer than in the past. I do feel that I empty my bladder, but it takes a while. Is this normal?

A. Urinary problems after menopause are common and may be related to age-related hormonal shifts or may have a separate medical cause. For this reason, it's always best to visit your doctor to discuss the problem. Difficulty starting or maintaining a stream of urine may be caused by many factors, including a blockage, an infection, certain medications, or a nerve problem that's affecting your brain's ability to get signals to the bladder, among others. Your doctor will likely recommend tests to search for the underlying cause and to customize your treatment.

News briefs

Older women: Take note of two new screening guidelines. One is for cervical cancer screening. Recommendations from the U.S. Preventive Services Task Force, published online Aug. 21, 2018, by the Journal of the American Medical Association, suggest that many women ages 30 to 65 can now approach cervical cancer screening in several ways: they can get a cervical cytology (Pap) test every three years; a test for human papillomavirus (which causes most cervical cancer cases) every five years; or they can get a combination of both tests every five years. If you're older than 65, the USPSTF recommends against screening unless you haven't had adequate tests before or you're at high risk for cervical cancer. The other screening guidelines are for urinary incontinence. They come from the Women's Preventive Services Initiative and were published online Aug. 14, 2018, by Annals of Internal Medicine. The guidelines recommend that women get screened for incontinence yearly, regardless of age. "I completely agree with brief annual screening for urinary incontinence for women. A simple question can be used to screen for it, such as, 'Do you have any bothersome urinary incontinence or urinary leaking during the day or night?' If the incontinence is treated early, in some cases, it will not progress and the patient will be able to avoid more invasive, costly, risky, or time-consuming treatment options," says Dr. May Wakamatsu, vice chair of gynecology services at Harvard-affiliated Massachusetts General Hospital.