Maintaining Bladder Health

Known bladder irritants include caffeine (coffee, tea, dark sodas, some herbal teas, cough medicines) and alcohol (liquor, wine, beer). Some people report problems with other foods, including acidic foods or fruit juices (oranges, grapefruit, lemon, lime, mango, pineapple, tomatoes), spicy foods, sugar (sweeteners, honey, fructose), and milk products (cheese, yogurt, ice cream).

To begin to identify the causes of irritation, remove all bladder irritants for one week and drink only water. Keep a diary to note the changes in your urinary habits. Then add one food item back at a time for three days.

Watch for changes in your bladder diary, and slowly eliminate what you feel to be causing problems. Pelvic muscle exercises, also known as Kegel exercises, work the pelvic floor muscles, which normally tighten around the urethra to prevent leakage.

The exercises are named after Dr. Arnold Kegel. At the time Dr. Kegel conceived of this therapeutic protocol, the therapy included biofeedback and pelvic floor physiotherapy to ensure the pelvic floor myscles were being properly exercised. Strictly speaking, the term "Kegel" refers to the integration of biofeedback therapy.

To practice pelvic muscle exercises, squeeze the muscles quickly, then relax. Do this three times with a 10-second rest in between, and repeat for 10 to 15 minutes twice a day. You can either sit, or lie down with your knees up, to practice pelvic muscle exercises. Because the rectum and urethra are right next to each other, bacteria can easily enter the urethra and establish a urinary tract infection (UTI).

Prolapse and sexual activity can increase the risk of UTIs. Certain contraceptives, including spermicide, nonlubricated condoms, and diaphragms, may also put you at an increased risk.

Although the following are healthy habits, it does not appear that these can significantly reduce the risk of recurrent UTIs: voiding habits (including frequent emptying and emptying after intercourse); personal hygiene habits (e.g., wiping front to back, using tampons instead of pads, and wearing cotton underwear); and fluid consumption (including drinking more water, avoiding caffeine, and drinking unsweetened cranberry juice).

Factors that can put premenopausal women at a greater risk for recurrent UTIs include heredity, a history of childhood UTIs, and sexual activity. Factors that can put postmenopausal women at greater risk include incontinence, prolapse, atrophie vaginitis, and prior UTIs. For elderly or institutionalized women, catheters, incontinence, dementia, and antibiotic exposure can increase the risk.

Medication can be prescribed for women with recurrent UTIs, allowing them to start treatment themselves when they recognize symptoms to prevent them from worsening. There is also medication available that can be taken daily or immediately after intercourse.

2005 NAFC. This article is reprinted with permission from the National Association For Continence (NAFC). If you would like more information on causes, prevention, diagnosis, treatment, and management alternatives for incontinence, please contact NAFC at 1-800-BLADDER (toll-free) or visit its Web site at www.nafc.org.

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By Betsy Omeis, R.N., B.S.N. and Ross Rames, M.D.

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