Fast facts about bladder care

Nutrition Health Review, Summer, 2004

Dr. Gary Lemack, an assistant professor of urology at the University of Texas Southwestern Medical Center at Dallas, says that it is not true for everyone, but for some people, products such as coffee, tea, chocolate, or carbonated beverages can cause bladder irritation.

"In patients prone to problems with urinary urgency and frequency, we do recommend they avoid what causes the problem," Dr. Lemack said. "It is hard to break people's routines, but if it is affecting your quality of life, it is time to consider changing your habits."

Caffeine is both a diuretic and a bladder irritant and therefore may result in increased urine production as well as enhanced bladder sensitivity. Other foods that might irritate the bladder include citrus fruits, spicy foods, and some cheeses.

Youngstown State University researchers in Ohio demonstrated the unique urinary health benefits of cranberries in 1984. Juice from the cranberry was found to inhibit bacteria from adhering to the walls of the urinary tract, thus reducing the risk of infection. They discovered that 15 ounces of cranberry juice cocktail significantly inhibited the adherence of Escherichia coli bacteria, which cause 80 to 90 percent of urinary tract infections.

Benign prostatic hyperplasia (enlargement of the prostate gland) is a common cause of urinary problems in middle-aged and older men.

Symptoms include the sudden urge to urinate, weak urinary flow, and a sense of incomplete urination. In the past, saw palmetto extract was used as a remedy for these symptoms.

In the medical journal Urology (2001;58:960-965), researchers tested the usefulness of saw palmetto extract in 85 men. All of the men were at least 45 years of age and had urinary problems.

For the first month of testing, all of the men received placebos. After that, 50 percent of the men were given 320 milligrams (mg.) of saw palmetto extract daily for six months, The other 50 percent continued taking placebo.

The men who received saw palmetto experienced a significant 26 percent decrease in prostate-related urinary problems. The men in the placebo group saw only a 14 percent improvement. The saw palmetto group also experienced a slight improvement in scores that measured their quality of life.

Urinary urge incontinence is a condition characterized by sudden, intense urges to urinate, followed by a loss of urine. A study published in the Journal of the American Medical Association (2003;290:426) involved 222 women, all older than 55 years of age.

One group received verbal behavior therapy with biofeedback; including a sensor that delivered computer images of bladder function for them to view. Another group received verbal behavior therapy only. The third group received behavioral therapy through a self-help book only. All of the behavioral therapies mentioned Kegel exercises to strengthen the urinary sphincter and pelvic floor muscles.

Incontinence episodes were reduced by 50 percent in the women who had the self-help book only, 63 percent in those who received biofeedback therapy, and 69 percent in those who had verbal behavior therapy alone.

Doctors at the Mayo Clinic say the test results are promising; however, they advise that behavior therapy requires significant motivation and discipline and that not every woman who encounters incontinence can be helped by this therapy.

Two popular drugs used for the treatment of overactive bladder have been evaluated. Results were published by the Mayo Clinic in June 2003.

Oxybutynin (Ditropan XL[R]) and tolterodine (Detrol LA[R]) were put through a multicenter, double-blind study that was supported by the manufacturers of Ditropan XL[R].

Researchers randomly assigned 790 women with overactive bladder one of two groups. One group of patients took 10 mg. of oxybutynin daily; the other took 4 mg. of tolterodine. After 12 weeks, the average number of urge incontinence episodes dropped from 37 to 11 in both groups.

The number of women who reported no incontinence episodes was slightly higher in the oxybutynin group, but oxybutynin recipients were more likely to report dry mouth than tolterodine group.

Both drugs showed reasonably similar results and side effects. Neither drug is available in a generic form.

Urinary incontinence consists of an unintentional leakage of urine. There are several causes, such as urinary tract infections, strokes, pregnancy, obesity, neurological disorders, and other age-related problems.

Stress incontinence is a type of urinary incontinence in which a person cannot hold urine during a sneeze, cough, laugh, or other sudden movement that puts stress on the bladder. Stress incontinence can be treated.

Kegel exercises, behavioral treatment involving charts and diaries, biofeedback, pelvic floor electrical stimulation, and even surgery are all proven therapies.

(Source: Journal of The American Medical Association, 2003; 290:426.)

Respiratory and urinary tract infections are associated with increased risks for myocardial infarction and stroke.

(Source: New England Journal of Medicine, 2004;351:2611-2618.)