Stop Running To The Bathroom!
Treatments For Bladder Problems

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

After completing last month’s column, I realized that I had presented medical problems without clear and complete information for consumers to make informed decisions. To complete the story, here is a review of the treatments for common bladder problems.

Let’s tackle the medications first. Medications used to treat overactive bladder, urinary incontinence and interstitial cystitis belong to a group called antimuscarinics. They alter the activity and interaction of neurochemicals and their receptors located in and around the bladder and in others areas of the body. Antimuscarinics relax the smooth muscles of the bladder walls, decrease the spastic contractions and alleviate urinary urgency frequency and incontinence. The smooth muscles of the bladder work in opposition to the muscles that control the urethral opening. When bladder muscles contract, the muscles around the urethra relax so you can empty your bladder. When the bladder muscles are relaxed, the muscles around the urethra contract and your bladder is able to fill and hold urine. Currently, Detrol, Ditropan, VESIcare, Sanctura and Enablex are antimuscarinics approved by the US Food and Drug Administration for the treatment of bladder problems. Although these medications all belong to the same family, they have different activities and side effects. If one particular medication fails to help correct the problems, it is reasonable to try one of the other medications.

Muscarinic receptors are all over the body, and current medications cannot target the bladder receptors alone. As a result, some unpleasant side effects occur with the use of antimuscarinic medications. Side effects include dry mouth, dry eyes, blurred vision, constipation and in severe cases, fecal impaction. The drugs cannot be used in people who have bladder outlet problems (such as enlarged prostate) or narrow angle glaucoma, and they have to be used cautiously in the elderly and in people with decreased kidney function.

Proper treatment of bladder dysfunction also requires behavioral therapy. Colleen Basler, is a licensed physical therapist and registered massage therapist in North Austin who specializes in pelvic pain and incontinence therapy. While her patients are primarily women, she also treats men.

Basler first performs a thorough assessment of her patients. She reviews voiding and diet diaries and medical histories. She performs a pelvic exam to check for scarring, thinning, tears or other obvious physical causes of bladder dysfunction. She checks the strength of the muscles of the abdomen, pelvis and perineum before prescribing exercise so that the exercise is of optimal intensity.

Using computer-assisted biofeedback Basler teaches patients how to effectively contract and release muscles, training them to work in an organized fashion to coordinate bladder function. The computer program allows patients to see their muscles contracting on the screen while feeling the contraction at the same time.

Basler teaches bladder retraining as a treatment for urge incontinence showing patients how to gradually extend the amount of time between voids. When urgency arises, patients use a series of distraction techniques and to put pressure on muscles surrounding the urethra to try to complete the voiding interval. Diet therapy is an important component of urge incontinence treatment since many foods act as bladder irritants and diuretics that cause increased urinary frequency and urgency.

Electrical stimulation is a very effective treatment that Basler uses for stress and urge incontinence. A sensor is placed in either the vagina or rectum and small electrical pulses are delivered to the muscles in the area. Patients learn what a muscle contraction feels like and how to contract specific muscles of the pelvis and perineum to reduce stress and urge incontinence. This use of electrical stimulation is also very effective against urinary frequency, and many patients are able to sleep through the night or at least awaken less frequently to go to the bathroom following muscle stimulation. Electrical stimulation is an ongoing therapy, and often not covered by insurance, so patients typically purchase the devices personally.

Finally, there is exercise. When dealing with bladder dysfunction, any exercise that strengthens the core (abdomen, hips, lower back and pelvis) will aid continence. Core stability training on the large exercise balls is an excellent exercise modality. Yoga, Pilates and swimming also strengthen the core muscles and aid in improving bladder function. Ideally, women should engage in some form of core training in their youth and especially through the child bearing years-when the pelvic floor suffers the most trauma. But if the damage has been done and rehabilitation is in order, the aforementioned activities are extremely beneficial, especially when coupled with medication and physical therapy.