For Women Who’ve Just Got To Go,
Common Bladder Problems Reviewed

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

The Chronicle Pavilion at Concord, California, is an outdoor performance venue about thirty miles east of San Francisco. The Pavilion hosts jazz musicians, vocalists, popular bands and a variety of international artists-much like Austin’s One World Theater-but on a much larger scale. It can accommodate audiences of eight thousand in reserved seating and another forty-five hundred on the lawn.

The Pavilion draws an upscale clientele. Despite its casual outdoor ambiance, the array of appetizing hors d’oeuvres, wines and beer cater to the adult palate.
I attended several shows at the Pavilion while living in the Bay Area, yet despite the awesome shows and great times, my most vivid memory of the Pavilion is the ladies’ restroom.

Located behind the stage at the apex of the amphitheater, you can enter the facility from either side. Straight ahead is a long thruway lined with sinks and hand driers. To the left and right of the central thruway, bathroom stalls line the walls for as far as the eye can see. There was no waiting to use the restroom. Women moved swiftly in and out of the many stalls with ease.

The architect who designed the Pavilion really understood the problem. Where there are lots of women, there must be plenty of bathroom facilities available. Many large theatres have only one or two ladies rest rooms for the entire building, with only three or four stalls in those restrooms. Women either leave shows shortly before the end of the first act to get ahead of the line, or miss the beginning of the second act waiting in line to use the facilities.

Women generally use restroom facilities more often then men. Women have to go-often, and immediately. There is nothing more frustrating than needing to go and having to wait. Why do women always have to go?

Many physiologic changes cause women to have bladder problems. Women urinate more often during their menstrual periods and during pregnancy because the uterus compresses the bladder reducing the amount of urine it can hold. After childbearing, many women have decreased pelvic muscle tone. They cannot hold a full bladder for very long. Hysterectomies change the internal arrangement of the pelvis sometimes contributing to bladder weakness. The hormonal changes of menopause alter nerve receptors within the pelvis and cause changes in urinary patterns.

There are many different types of bladder problems in women. Healthcare providers must determine the type of bladder problem and specifically direct treatment to it. Some of the more common problems are reviewed here.

Urgency is the constant urge to urinate, the inspiration for all the ads chanting, “Gotta go, gotta go right now!” Urgency describes the situation when the bladder receives signals to urinate even though there is minimal urine present. This results frequent urination (with minimal output). Incontinence, involuntary leakage of urine, may or may not accompany urgency. The International Continence Society defines overactive bladder as a syndrome consisting of urgency with frequency and nighttime urination. Incontinence may or may not be present.

Incontinence actually has three forms, urge incontinence, stress incontinence and mixed incontinence. In urge incontinence, as soon as the bladder detects urine within it, it sends a message to urinate and a woman may actually leak a bit of urine before she reaches the restroom. Stress incontinence is the involuntary leakage of urine with coughing, laughing or sneezing. The increased pressure on the lower abdomen causes small (or large) amounts of urine to escape. A woman has mixed incontinence when she has symptoms of both urge and stress incontinence.

Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder. The National Institute of Diabetes and Digestive and Kidney Diseases defines IC as urinary urgency with frequency, chronic pain in the pelvis upon urination, and pinpoint hemorrhages in the bladder tissue noted on direct visual examination.

Millions of women are suffering with urinary problems, with profound effects on quality of life. Fearing public accidents, many women limit their activities if they are unsure of the accessibility of facilities. Some protective undergarments, though effective, are uncomfortable or unacceptable in certain settings. Bladder problems can become marital problems when women avoid intimacy due to pain or fear of an accident.

Bladder problems, sometimes referred to as bladder weakness or bladder dysfunction, are not a normal part of aging, and you don’t have to “put up with them”. Treatments are available including pelvic muscle strengthening exercises, biofeedback, medications and surgeries. Because physicians often don’t ask and women typically don’t offer the information, it can take three to seven years to make a diagnosis and begin treatment.

The commercials end with, “And I don’t have to go right now.” But you do have to go right now-to the phone to call your healthcare provider for an appointment if any of this information describes symptoms you’ve been having.