﻿Treating a Weak Bladder Without Surgery | Everyday Health

Treating a Weak Bladder Without Surgery

Q1. My father, age 81, has been diagnosed with a weak sphincter muscle (bladder). He does not want the recommended surgery to have a bag or drain off valve. Can he rebuild this muscle or have surgery to repair it? Can his diet or lifestyle have any effect?

— Dan, Florida

If your father has a weak sphincter, and has urinary incontinence as a result of the weak sphincter, then surgical procedures involving a sling or artificial injury sphincter may be effective to augment or substitute his normal sphincteric function.

If in fact his detrusor muscle has become overstretched and fails to contract at all, then there are no effective surgeries available to him right now that can restore his bladder contractility. It is also unlikely that diet or any other lifestyle choices will have any major effect on his bladder contractility. Such chronic damage to the bladder muscle can be treated with urinary diversion, catheter drainage, or intermittent catheterization where the patient self-catheterizes to drain the bladder intermittently.

Thus, the distinction between a weak bladder and weak sphincter muscle is very significant and would have very different treatment approaches. A urologist who performs urodynamic studies can determine the correct diagnosis for your father and recommend effective treatments for his specific issue as well as any urinary incontinence symptoms.


— Loretta, Ohio






Q3. I have a teenage daughter who has occasional trouble with incontinence. She is very healthy, and active in sports. About twice a month she seems to lose control of her bladder when laughing. I brought her to a specialist six months ago, who found nothing physically wrong with her. He suggested the leakage might occur when her bowels were abnormally full (which was indicated by X-rays). She's since been taking fiber in the evening to minimize this issue. Yet the incontinence persists. Is this at all normal? What else should we be looking at?

— Mary, Minneapolis

Your daughter appears to be suffering from a condition called giggle incontinence. You describe it well, namely, the insuppressible urge to urinate associated with laughter. This has been described in several reports in the medical literature. Although it is not associated with any significant underlying medical disorders, incontinence of even small amounts can be quite distressing to the individual. Thus, it would be difficult to consider this to be a "normal" condition. The mechanism of giggle incontinence is not entirely understood, but laughter may trigger a bladder contraction, which would lead to the urinary leakage. In the absence of incontinence in other situations, it is not typically necessary to perform extensive testing in such patients.

The long-term natural history of this condition is not well described, but as with other types of incontinence occurring in childhood and adolescence, young people with further development and maturation will often outgrow it. There are no specific treatments for giggle incontinence, although some researchers have advocated the use of antispasm medicines, based on the theory that the incontinence is caused by a triggered bladder spasm. However, this may lead to overtreatment and side effects associated with typical antispasmodic drugs, such as mouth dryness and constipation. Kegel exercises could be helpful in this situation, since this exercise (namely tightening the pelvic floor muscles) could interrupt a reflex bladder contraction.

Q4. I recently had a cystoscopy and found out that my bladder is weak, for which the doctor prescribed Vesicare. This past weekend my husband and I had intercourse two days in a row, and Monday morning my lower back and lower side hurt so bad that a heating pad wouldn't stop it. I also had a constant urge to urinate. Could the intercourse have caused my bladder pain?

The bladder pain you are experiencing may be related to a urinary tract infection. Sexual intercourse can introduce bacteria into the urethra, which could explain your lower back and side pain. A urinalysis is the best way for doctors to diagnose a urinary infection.

Alternatively, the medication that your doctor prescribed, VESIcare (solifenacin), may be causing some retention of urine, which, if severe, could lead to back pain. Given that you've had new symptoms develop shortly after starting a prescription drug, you should follow up with the prescribing physician. In addition to a urinalysis, simple in-office ultrasound tests that assess bladder emptying can be performed, which would verify whether you are suffering from urinary retention.

Q5. I have been diagnosed with a weak hypotonic bladder. As a result, I have had a very slow urine stream for many years. However, I have recently developed what feels like cramps or spasms in the area of my bladder. They seem to occur mostly when I am sitting or lying on my back. I am concerned about this recent development. What can be done to relieve this discomfort?

— Rick, Arizona

Carrying a diagnosis of a weak hypotonic bladder, these new symptoms may be related to more severe underlying urinary retention. The key question in patients with hypotonic bladder is: Does the bladder empty completely? If bladder emptying becomes incomplete, then urinary retention could lead to chronic over-distension of the bladder, worsening contractile function, and even kidney damage. If indeed you are retaining urine, this can be determined by ultrasonic imaging of the bladder after voiding (which measures the amount of residual urine after voiding). Measures may need to be taken to improve bladder emptying. If no surgically-treatable cause of obstruction is found, then the main approach to this problem would be to have the patient intermittently catheterize his or her bladder several times a day in order to drain out the residual urine. The symptoms you are experiencing may not be related to the urinary tract, and therefore a careful evaluation by a medical doctor is important.

Q6. I was diagnosed with an overactive bladder by my family doctor. I am 59. The urge was terribly strong and I went frequently (basically all the time). I took Detrol for several weeks but switched to Oxybutin, which I have been taking for the last three weeks. I had noticed some improvement, though slight, but the urge was improving. Last week, the urge came back and I was wondering if it means I'm back to square one or if this is typical of an overactive bladder medication. I really appreciate any information you can give me.

— Cheryle, Florida

The success of any treatment for overactive bladder may depend on the cause and severity of the symptoms. You have been given two common treatments for overactive bladder, Detrol and Oxybutinin. Detrol can be taken once a day with good efficacy, whereas most formulations of Oxybutinin need to be taken three times a day in order to be effective. It can take as much as four to eight weeks for the full effect of a treatment for an overactive bladder to be noticeable. And it is not unusual for symptoms to wax and wane.

In general, unless someone is experiencing dry mouth or other side effects, the adequate, recommended dose of Oxybutinin is 5 milligrams, three times a day. Because it's often hard to maintain this schedule, it is not uncommon for patients to be taking less of this medication than would be effective. The advantage of Detrol, as well as a number of other drugs, is that it may be taken less frequently and has fewer side effects than Oxybutinin.

The underlying cause of your overactive bladder will be an important consideration in determining the best course of treatment. Most middle-aged women experience bladder overactivity without other serious underlying problems. However, urgency may be a result of another condition, including bladder prolapse, an infection, a fibroid, or a neurological condition. If the treatment you're following under the care of your primary care physician is not effective, you need to see a specialist, such as a urologist. This doctor can perform more specialized tests to check that your bladder is emptying properly and that there is no other urologic problem that is confounding your treatment.


— Carol, New Jersey



Learn more in the Everyday Health Incontinence and Overactive Bladder Center.