bladder control problems

Accidental loss or leaking of urine is a very common but embarrassing bladder issue, believed to affect millions of people all over the world. Mr Simon Brewster, explains why people lose control of their bladder and what type of doctor you should visit to get the appropriate treatment.

What are the main causes of bladder control problems?

Bladder control problems are caused by involuntary contractions of the muscle in the bladder wall. This leads to the sensation of urgency to pass urine and sometimes people get "caught short" and leak a little urine while trying to get to a toilet or receptacle. This is called urge incontinence, which can be embarrassing and lead to the need to wear a pad inside the underwear.

These involuntary contractions, sometimes described as the overactive bladder, can be caused by any of the following:

• Urinary infection
• Inflammation disorders of the bladder
• Bladder stones
• Bladder tumours
• Obstruction to the bladder outlet from prostate gland enlargement or scarring
• Nervous system diseases like Parkinson's disease or multiple sclerosis (MS)

Some people find that certain stimulants, such as strong caffeinated drinks, cause their bladders to become overactive. Many patients notice an improvement in urgency and incontinence by switching to decaffeinated beverages (such as decaf tea, coffee & cola).

Bladder control can also be a problem when the muscular ring (known medically as the urethral sphincter) near the outlet of the bladder becomes stretched or damaged by childbirth, major surgery, radiotherapy or nearby disease, such as prostate cancer. Leakage of urine may then occur when people cough or do something strenuous because the pressure inside the bladder cannot be overcome by contracting the sphincter. This is known as stress incontinence.

Are bladder problems worse for people with MS?

Yes. MS and other neurological conditions, such as Parkinson's disease and some spinal injuries, can prevent calming signals from the brain reaching the bladder, leading to an overactive bladder.

What other symptoms indicate that something is wrong with my bladder?

A slow, intermittent, dribbly flow of urine is associated with either obstruction or under-activity of the bladder. Very low abdominal pain may be coming from the bladder, especially if the bladder is obstructed or inflamed.

Blood in the urine (known medically as haematuria) may be caused by infection of the bladder (cystitis) if it is associated with pain passing urine, or bladder cancer if it is painless.

Why does alcohol make bladder control worse?

This is partly because alcohol is a diuretic stimulating the kidneys to make extra urine and partly because alcohol is a direct stimulant of the bladder muscle.

What doctor treats bladder problems?

GPs and urologists most commonly treat bladder problems. Some specialist gynaecologists also have expertise in this area, especially treating incontinence associated with vaginal prolapse and childbirth.

Mr Simon Brewster is a consultant urological surgeon with over 25 years of experience. If you want to book an appointment with him, check his availability here.