Why Do I Have a Weak Bladder When Drinking Alcohol?

Have you enjoyed a glass (or three) of wine with your friends, felt the need to pop to the loo, when your friend grabs your hand and tells you to ‘sit down’ because if you wee you’re going to ‘break the seal’?

Well, guess what? Breaking the seal isn’t a real thing. When you drink alcohol you’ll need to pee more, whether you wee earlier on in the night or not. Crossing your legs and ignoring that tingling feeling can lead to health problems (more on this in a bit).

To be clear, alcohol doesn’t cause bladder leaks. However, if you already have a bladder problem, for example, you have stress urinary incontinence (SUI) or an overactive bladder, alcohol can make your symptoms worse ⁽¹⁾.

Do you feel drinking alcohol is affecting your day to day life? Are you waking up to find that you’ve peed in your sleep? Well, you’re not alone, and you don’t have to suffer in silence. There are things you can do, such as speaking to your doctor, drinking in moderation, and using INNOVO to help strengthen your pelvic floor muscles.

In this post, we’ll be covering the effect alcohol has on your bladder and how drinking too much can cause you to wet the bed. We’ll also take a look at what you can do to stop bladder leaks after drinking alcohol.

Alcohol incontinence issues

Alcohol is a diuretic, which means after you’ve had a drink you’ll produce more urine so naturally, you’ll need to wee more often ⁽²⁾.

When you drink plenty of water you’ll notice that your urine is clear or a pale yellow. When you drink lots of alcohol it can cause you to become dehydrated and you’ll notice that your wee turns darker in colour, becomes cloudy, and may smell unpleasant.

When wee sits in your bladder it becomes more concentrated and can cause irritation and inflammation in the lining of your bladder. This increases your chances of getting a urinary tract infection (UTI) which can sometimes lead to a kidney infection ⁽³⁾. This is why you should never resist the urge to urinate in order to “not break the seal”.

Make you go more often

Beer, wine, and spirits are bladder stimulants, which means the more you drink, the more you’ll find yourself on the loo. The urge to visit the loo happens because the detrusor muscles are contracting too much. If you’re diagnosed with having an overactive bladder, alcohol can make your bladder leaks worse ⁽⁴⁾.

Needing a wee can be frustrating on a night out or whilst travelling as taking regular trips to the toilet, or waiting in the queue when you’re bursting for a wee, can be a nightmare. If you have a physical impairment too, this may make it difficult for you to reach the toilet in time.

Bladder leaks in bed or public

Here comes the science bit: Alcohol suppresses the antidiuretic hormone (ADH). The role of ADH is to stop the kidneys from making too much urine, this then stops you from dehydrating. But when you drink alcohol, it suppresses the amount of ADH made, so your body makes more urine than it should ⁽⁵⁾.

So after a drinking session, your bladder fills up quicker than normal and if not emptied, will continue to balloon. If you’re asleep and don’t realise that you need the toilet, your body still has to release the pressure building up and you’ll wee while you’re sleeping.

Alcohol can also relax the bladder muscles. When you’re awake, this can leave you rushing to the toilet or wetting yourself.

Thinking you need the toilet when you don’t

Drinking a lot of alcohol can cause your brain to send impaired signals to your body, tricking you into thinking you don’t need to go when actually you do. If you’ve ever found yourself needing the toilet on a night out and then not being able to pee—this may be why.

How can I prevent a weak bladder when drinking alcohol?

If you’re experiencing leaks as a result of bladder weakness it’s important to speak to your doctor.

Bladder weakness can have multiple causes and it’s important to identify the root cause in order to treat your specific type of incontinence. By identifying and treating incontinence, you can reclaim control over some aspects of your life and have the confidence to be in crowded or awkward environments such as planes or trains, or even on a night out without worrying about going to the toilet as often.

If your leaks relate to when you have consumed alcohol, they’ll tell you to cut down on the number of drinks you’re having.

The daily recommended amount of alcohol for both men and women is 14 units a week if you’re drinking on a regular basis (6). Find out how much you’re drinking using the unit calculator.

What can you do to limit your alcohol intake ^{(5, 7,8, 9)}?

• Switch to a 5. 5% wine instead of the usual 12 -14%
• Stop using your favourite giant novelty wine glass (we’ve all got one)
• Don’t mix your drinks with caffeine and fizzy drinks, as these can irritate your bladder
• Pace yourself and don’t drink too late into the night
• Go to the toilet right before you climb into bed
• Set an alarm and go to the toilet during the night
• Strengthen your pelvic floor muscles using Kegel exercises

Control your weak bladder with INNOVO

Kegel exercises are the first-line treatment your doctor will recommend to stop your bladder leaks. Knowing that you can take immediate action is empowering, but doing Kegels can be boring, time-consuming, and tricky to get right. That’s where INNOVO can help.

INNOVO is a pair of shorts that you wear for 30 minutes a day, 5 days a week, whilst relaxing (preferably without a glass of wine in your hand). INNOVO does 180 perfect pelvic floor exercises for you, taking the guesswork out of those Kegels. Find out how INNOVO works and how it can treat your bladder leaks—Cheers to that!

Sources

1. National Association for Incontinence. Could Alcohol Be Causing Your Bedwetting Problem? Accessed September 2021.
2. NHS. 10 Ways To Stop Leaks. Reviewed November 2019.
3. Hartmann. Alcohol & The Impact It Has on Your Bladder and Bowels. August 2018.
4. NHS. Urinary Incontinence: Causes. Reviewed November 2019.
5. Cleveland Clinic. Do You Wet the Bed After a Night of Drinking? Here’s Why. Accessed October 2021.
6. NHS. Alcohol Units. Reviewed April 2018.
7. Healthline. Do You Really ‘Break The Seal’ When You Pee After a Drink? Published December 2019.
8. Drinkaware. Low Alcohol Drinks. Accessed October 2021.
9. Mayo Clinic. Overactive Bladder. Published March 2020.

Alcohol & The Impact It Has on Your Bladder and Bowels

Causes | Incontinence


Alcohol and The Impact It Has on Your Bladder and Bowels


Everyone enjoys an alcoholic drink or two. Whether it’s wine with dinner, whiskey with friends, or sweet, cold champagne on New Year’s Eve, most of us enjoy a tipple (or two or three!) every now and then. The problem with alcohol is not that we drink it; rather, it’s how much we actually drink.

And when excess alcohol is consumed over an extended period, its negative consequences can be devastating to our health and well-being.

Everyone knows how bad alcohol is for your health – that’s a fact. What you might not be aware of, though, is the effect it can have on your bladder and bowel movements too.In this guide, we detail the impact that alcohol can have on your bladder, bowels and your entire elimination system, even leading to incontinence.

Alcohol & The Impact It Has on Your Bladder and Bowels | HARTMANN


• Alcohol and The Bladder

• Alcohol and urinary tract and kidney infections

• Alcohol and bladder control issues

• Alcohol and Your Bowels

• Alcohol and diarrhoea

• Alcohol consumption and constipation

• Alcohol and Bowel Conditions

Alcohol and The Bladder

You’ve probably experienced this at the pub after drinking a few pints: your urge to use the toilet ramps up quickly.

Normally you empty your bladder 4 to 6 times per day. When you drink alcohol, however, excess urine production can lead to dehydration and much more concentrated urine. It is not uncommon for this urine to appear dark yellow, or even brown in colour.

Alcohol and urinary tract and kidney infections

What’s the problem with concentrated urine?

It wreaks havoc on your urinary tract. Concentrated urine sits in the bladder, and it can cause irritation and inflammation in the lining of your bladder. You are far more likely to develop a urinary tract infection (UTIs) if your urine is concentrated, which can also spread to your kidneys.

UTIs cause burning, pain, or pressure when you urinate; frequent urination; and an urge to urinate right away. Cystitis is one of the symptoms of a bladder infection and is causes the inflammation and swelling of the lining in your bladder. You might feel sharp pain, see blood in your urine, and experience increased urgency or frequency.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, urinary tract infections are one of the most common bacterial infections in women.

If you notice these symptoms, see your doctor right away!

These issues can really damage your quality of life, and prevent you from travelling, socialising, and a healthy sex life. The best prevention for urinary tract infections is to drink plenty of water and clear fluids; you should also avoid the excessive consumption of alcohol.

Alcohol and bladder control issues

• Increased frequency

If you suffer from any kind of bladder control issue, it is a good idea to watch your alcohol intake. Beer, wine, spirits and all other alcoholic beverages can act as a bladder stimulant, and ultimately lead to incontinence.

Your over stimulated bladder will make you need to urinate far more often than usual; for people with incontinence paired with other physical issues, they may not be able to make it to the toilet in time.

• Unintentional leakage

Although alcohol is defined as a “depressant,” most people who drink in moderation consume it more for relaxation and its stimulant effect. But this can become problematic when it comes to urinary incontinence, as alcohol can also lead to the relaxation of the bladder muscles, thereby possibly inducing unintentional leakage.

This can really be a problem if you usually get up in the night to use the toilet – if you have consumed a lot of alcohol and ‘passed out’ you likely won’t get the signal that wakes you. It’s not uncommon for people with bladder leakage problems to wet the bed if they go to bed after having many drinks. If this is the case, you should certainly cut down on their drinking, and use incontinence pads at night time.

Learn more how urinary incontinence can develop and the causes of urinary incontinence

• Impaired signals

Alcohol consumption can also cause the brain to send impaired signals to the rest of the body, confusing you as to when you need to go. This might mean that you think you need to use the toilet only to get there and find you don’t, but it is much more likely that you won’t get the warning you need to prevent an accident.

Alcohol and Your Bowels

Alcohol can cause either constipation or diarrhoea in different people, and sometimes one right after another for others!

Learn more about it in Bowel incontinence guide

Alcohol and diarrhoea

Drinking alcohol can be a wonderful way to relax and unwind with your friends. But if you suffer from chronic diarrhoea, you may want to cut back on the wine.

Alcohol consumption causes irritation and inflammation in the gut, which can in turn cause diarrhoea. Not only does diarrhoea make you feel exhausted and terrible, it can really damage your stomach lining and sap your body of important nutrients.

Alcohol irritates the delicate nature of your digestive tract, and can worsen your diarrhoea. It has been proven that this phenomenon most often occurs with wine, which can destroy the helpful bacteria found in the intestines. We’re not suggesting that you give up your beloved glass of red wine with a fine meal, but don’t overindulge on a regular basis.

Do you find that alcohol affects you more when you have not eaten a solid meal? This makes complete sense.

When you drink while eating food, the alcohol has a buffer. When the alcohol and food reaches your stomach, it is absorbed into your blood via the walls of your stomach. The food slows down the intoxicating effects of the alcohol. However, if you haven’t eaten any food with your alcohol, the booze travels immediately to your small intestine and then passes more quickly into your bloodstream. This is why you feel much more intoxicated at a much quicker rate.

After most or all of the alcohol has been absorbed into the bloodstream, you will then excrete the rest through defecation and urination. When you defecate, your colon muscles move and spasm (peristalsis) in order to push the stool from the body. Alcohol causes these contractions to speed up, preventing your colon from absorbing water, resulting in watery diarrhoea.

Alcohol consumption and constipation

• Dehydration

Dehydration doesn’t just mean you’re thirsty. It’s a dangerous condition that can lead to serious health problems if you don’t drink enough fluids to replace what you lose in your urine and bowel movements.

Although alcohol is mostly water, it can dehydrate you because it messes with your body’s water levels. Alcohol stimulates your kidneys to produce more urine, which means you’re losing more fluid than usual through urination and bowel movements.

You might think that drinking beer or other alcoholic beverages would help prevent dehydration, since they contain water. But as we’ve already learned, alcohol prevents your pituitary gland from producing ADH (anti-diuretic hormone), which prevents you from urinating. So even though beer is mostly water, when you drink it you’ll still end up with less water in your body than before because the alcohol prevents your body from reabsorbing the water through urination like it normally would.

• Peristalsis

We have already mentioned the contractions in your small intestine and bowel that cause you to have a bowel movement. Peristalsis is necessary in order to effectively propel food through the digestive track. As alcohol is a depressant, it dampens the nerves needed to cause the process to happen. Chronic drinkers will find that they will experience constipation far more often than those who avoid overconsumption.

When you are drinking you are often more tempted to treat yourself with fatty fried foods, high carb meals and decadent sweets – all of which can lead to constipation (and/or diarrhoea) on their own. If you are planning to have a few drinks, make sure you eat a healthy meal beforehand. A stomach full of wholesome food will prevent the alcohol from absorbing too quickly into your bloodstream. Ideally, it will also prevent you from pigging out on junk food!

• The bacteria in our gut

Our gut bacteria may be miniscule, but they are incredibly important when it comes to how you look and feel. While some alcohol can have positive effects on pathogenic bacteria (wine can combat and kill H. pylori, it also destroys the positive bacteria as well. Without a solid amount of good bacteria, you end up with gut problems, soft tissue inflammation and poor digestion. Even a small amount of alcohol can throw these levels off, and lead to chronic constipation.

Alcohol and Bowel Conditions

For those with irritable bowel syndrome (IBS), Crohn’s Disease or ulcers, alcohol can cause a huge uptick in symptoms. Alcohol is particularly nasty for people with diarrhoea caused by IBS, and it can trigger an attack that can last for days. The body views the alcohol as a caustic substance, and for those with IBS the results can be prolonged and painful.

In addition to causing problems for people with existing bowel and bladder problems, alcohol greatly increases one’s risk of developing bowel cancer. One of the most commonly diagnosed cancers in the UK, almost 42,000 people were diagnosed with bowel cancer (also known as colorectal cancer) in 2014 alone.

While causes and factors that can lead to a diagnosis of bowel cancer are varied, increased alcohol consumption is one of the most commonly cited causes. If you are a heavy regular drinker, you are putting yourself at risk of cancer.

Summary

In the final analysis, it’s very important to keep active and eat a healthy diet. It’s just as important not to overdo it with alcohol. Simple changes could make all the difference to your life.

Also interesting

Overactive bladder – symptoms, causes, signs and methods of treatment of OAB in adults in the “SM-Clinic”

This disease is treated by a Urologist

• About the disease
• GMP classification
• Symptoms of overactive bladder
• Causes of GMF
• Diagnosis of overactive bladder
• Expert opinion
• Treatment of OAB
• Prophylaxis
• Rehabilitation
• Questions and answers
• Doctors

About the disease

OAB is a widespread syndrome. According to the International Society for Urinary Containment, 17% of adults in Europe have symptoms. It should be noted that OAB without urinary incontinence (“dry OAB”) is observed in 7.6% of women, and OAB in combination with urge urinary incontinence – in 9.3%. Currently, there is a trend towards an increase in cases of OAB with urinary incontinence in women from 12% under the age of 60 to 20% at the age of 65 years and older. In general, this is more pronounced in women after 44 years, and in men – after 64 years. There are no unambiguous data on the prevalence of OAB in Russia, but it is generally accepted that it is similar to that in European countries.

Although OAB is more commonly diagnosed in the elderly, its symptoms also occur in other age groups. The largest number of patients was observed at the age of over 40 years. In men over 60 years of age, there is a clear trend towards an increase in the incidence, and in women – to a decrease. Thus, OAB is a fairly common clinical syndrome that occurs in different age groups and leads to physical and social maladjustment.

GMF classification

Depending on the frequency of urination, urgency and episodes of urinary incontinence, doctors distinguish three degrees of overactive bladder.

Degree of disease	Number of urinations per day	Number of imperative calls per day	Number of episodes of incontinence per week	Volume of urine at a time	Bladder volume
Light	Less than 10	No more than 1	No more than 1 time	80-100 ml	250-300 ml
Medium	10-14	2-4	More than once a week	60-75 ml	200-220 ml
heavy	15 or more	5 or more	Several times a day	50-60 ml	200 ml or less

Dry and wet forms of GMF are also distinguished. In the first case, the patient has no episodes of urinary incontinence, in the second – there are.

Symptoms of overactive bladder

The main signs of an overactive bladder are:

• frequent urge to urinate;
• periodic imperative urge to empty the bladder;
• passing urine in small portions;
• reduction in bladder volume.

Most patients also develop urinary incontinence. The urge to urinate and bouts of incontinence can occur both on their own and against the background of external stimuli. Often the provoking factor is the sound or sight of flowing water. In some patients, after urination, there is a feeling of discomfort in the urethra.

Causes of OAB

The main cause of urgent and frequent urination are special changes in the detrusor (muscle membrane of the bladder), leading to its involuntary contractions. In patients with OAB, the nerve endings located in the bladder are in a state of chronic irritation, randomly transmitting signals to the brain. This prevents the bladder from adequately storing urine and leads to involuntary bladder contractions during filling, resulting in urge incontinence.

This can occur on the background of neurological diseases (multiple sclerosis, diabetic or alcoholic neuropathy), spinal cord injuries, taking certain medications, as well as pathologies that are accompanied by edema (chronic heart failure, etc.). Risk factors are also:

• difficult labor accompanied by tissue rupture;
• operations on the organs of the urinary system and / or genitals;
• depression;
• over 75 years of age;
• overweight;
• abuse of alcohol or caffeine.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 777-48-49

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Why SM-Clinic?

1

Treatment is carried out in accordance with clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

9000 2 4

High level of service and balanced pricing policy

Diagnosis of overactive bladder

Patients require a baseline evaluation to rule out urological and other conditions that can cause urinary urgency and frequency. Diagnosis of OAB can be successfully performed on an outpatient basis and in most cases does not require special examination methods.

As a rule, patients with frequent and urgent urination, in order to exclude other diseases, evaluate the frequency of urination, urinalysis, ultrasound of the kidneys, bladder, prostate, determine the volume of residual urine.

Urination diary data is also important and helps to recognize an overactive bladder.

Expert opinion

The significance of the problem of OAB lies in the pronounced negative impact on the quality of life of patients. GMF becomes the cause of social maladaptation and serious psychological problems, leads to the abandonment of the usual way of life, for example, due to a significant impact on professional activity.

Complete complex treatment of OAB gives the patient the opportunity to return to normal life without the restrictions associated with frequent urination or incontinence. The main thing is to seek help in time and carefully follow the recommendations of a specialist.

Danilov Alexander Olegovich

Urologist-andrologist, Ph.D.

Treatment of OAB

The choice of treatment for overactive bladder in men and women depends on its cause, severity of symptoms, and individual characteristics of the patient’s body. In mild forms, non-drug methods come to the fore.

Behavioral therapy in the treatment of OAB is aimed at the formation of a new pattern of urination or restoration of the previous one, in which this process again becomes controlled for the patient.

By analyzing the urination diary data together, the doctor should look for episodes with the longest time interval between urination, the patient determines the minimum time interval that must be observed between urination, for example, every 2 hours, not earlier. This regimen is observed for 2 weeks, then, if this condition is successfully met, the interval between urination is extended every week by 15 minutes, until a 3- or 4-hour interval is reached.

Drinking mode correction. Suffering from urinary incontinence and / or frequent urination, the patient often limits the amount of fluid taken, thus trying to reduce involuntary loss of urine. To reduce the frequency of urination at night, it is necessary to limit fluid intake at least 4 hours before bedtime. The nature of the fluid taken is an important factor in increasing the intensity of urgency and the amount of urine produced. So, caffeine-containing liquids (coffee, tea, Coca-Cola, etc.) not only have a weak diuretic effect, but also increase urination. These drinks should be limited to 1-2 cups per day.

Physical therapy is also important. These are, first of all, exercises aimed at strengthening the muscles of the pelvic floor. They are especially relevant for women. With the regular implementation of the complex, 2/3 of the patients notice an improvement within 4-6 weeks. With insufficient effectiveness of conventional gymnastics, electrical stimulation of the pelvic floor muscles is prescribed.

When non-drug therapy is not effective, drugs are used to relax the muscles of the bladder. If necessary, antidepressants are prescribed.

Surgical treatment is prescribed in the absence of the effect of conservative therapy. Currently, a minimally invasive technique is coming to the fore, involving the introduction of drugs based on botulinum toxin into the sphincter or detrusor of the bladder.

Doctors can also sever the nerves that cause overactive bladder or, conversely, stimulate the nerve trunks with electrical impulses. If the volume of the bladder is significantly reduced, its plastic surgery or temporary creation of an alternative way of outflow of urine (epicystostomy, pyelostomy) is performed.

Prevention

Methods for preventing the development of an overactive bladder include:

• proper nutrition;
• sufficient physical activity;
• decrease in body weight with its excess;
• refusal of alcoholic beverages, nicotine;
• timely detection and treatment of diseases that can lead to OAB;
• taking drugs only as prescribed by a doctor.

In addition, it is very important to consult a specialist when the first symptoms of an overactive bladder appear and take measures to eliminate the disorder.

Rehabilitation

The duration of the rehabilitation period after surgical treatment of OAB depends on the type of intervention. Before tissue healing, the patient must limit physical activity, avoid hypothermia or overheating. Correction of nutrition, control of fluid intake, as well as compliance with all preventive measures are also important, since they help to avoid relapse.

Questions and Answers

Answer the following questions.

• Do you have frequent urination (>8 times during the day, >1 time at night)?
• Do you have imperative (sudden) urges that are difficult to control?
• Do you have involuntary urination?
• Do you use urological pads?
• Do you have neurological or other diseases that can affect the function of the bladder (sequelae of stroke, neuropathy due to diabetes, osteochondrosis, herniated discs)?
• Have you had brain/spinal or pelvic surgery?
• Do you have inflammatory diseases of the urogenital area that are difficult to treat with antibiotics?
• Is there discomfort or pain in the bladder, genitals, perineum?

If you answered yes to 2 or more questions, you should contact a specialist.

The use of folk remedies for the treatment of an overactive bladder is inappropriate. In an attempt to find the optimal remedy, you will lose precious time. As a result, the disease can become more severe.

Yu.O. Lyubarskaya, V.A. Atduev Hyperactive bladder // Remedium Privolzhye. 2014. No. 5 (125).

Trapeznikova M. F., Dutov V. V., Bychkova N. V., Golovchenko K. V. Epidemiology and treatment of overactive bladder // Almanac of Clinical Medicine. 2005. No. 8-1.

Karpov E.I. Treatment of an overactive bladder: expanding horizons // MS. 2016. No. 10.

Sayapova D.R., Sitdykova M.E. Overactive bladder and its conservative treatment // Medical Bulletin of Bashkortostan. 2015. No. 3 (57).

Sosnovsky Stanislav Olegovich, Kheifets Vladimir Hononovi, Kagan Oleg Feliksovich On the diagnosis and treatment of overactive bladder in men // Urological journals. 2015. №2.

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Urinary incontinence: causes and treatments

How rehabilitation can help with urological problems

The topic of urinary incontinence is considered taboo, many are ashamed of the problem and put off visiting a doctor. At the same time, incontinence negatively affects important aspects of life – from the emotional state to the ability to leave the house and travel.

There are various causes of incontinence, such as post-surgery stress, stroke, spinal cord injury, and other nervous system disorders. In this text, we will analyze in detail the causes of incontinence, as well as effective methods of treatment and rehabilitation.

Causes and risk factors for urinary incontinence

One of the most common risk factors for urinary incontinence is older age. Women over 60 report daily urinary incontinence in the range of 9% to 39%, men over 65 experience this problem half as often – from 2 to 11%. Urinary incontinence in the elderly is statistically associated with a decrease in strength and overall muscle tone, especially in the pelvic floor muscles.

Regardless of age and gender, the risk of urinary incontinence is increased in people with diabetes and overweight. For young women, childbirth, gynecological and infectious diseases can become an additional risk factor – from 7 to 37% of women aged 20 to 39have been reporting this issue for years.

Urinary incontinence may be due to a stroke. In 32-79% of patients, incontinence occurs upon admission to the hospital and in 25-28% remains at discharge.

Normally, in order to prevent leakage of urine, the sphincters (muscle valves) of the urethra should be closed during the accumulation of urine in the bladder, and the muscle of the bladder should be relaxed.

When the bladder is full, signals from the bladder are transmitted to the spinal cord and then to the brain, after which the response signals follow the same path, causing the bladder to contract and the sphincters to open. As a result, urine flows out of the bladder.

Frequent urination after a stroke is associated with overactivity of the bladder muscle, which occurs due to impaired communication between the central nervous system and the bladder. Risk factors for urinary incontinence: paresis (decreased strength in any part of the body), depression, cognitive impairment, age over 75 years, dysphagia (impaired swallowing), loss of visual field and a large area of ​​\u200b\u200bbrain damage (lesion of the cortex and subcortical region) .

“Recently, a patient came to our clinic after a stroke with frequent false urge to urinate and episodes of urinary incontinence day and night,” says Ivan Kolbin, a neurourologist at the Three Sisters Clinic. – Before each physical therapy session, the patient goes to the toilet because he is afraid that involuntary urination will occur during the exercises. At night, a man does not get enough sleep, as he wakes up at least four times because of the desire to go to the toilet. All this greatly affects his quality of life and emotional state. But this is solvable. If you choose the right therapy, then after 2-3 weeks the symptoms will go away or significantly decrease.

The main functions of the bladder – the accumulation and excretion of urine – are also impaired in spinal cord injuries. It is not uncommon for patients with spinal cord injury to stop feeling bladder fullness and the need to urinate. It is also likely that the person will not control the work of the sphincter of the urethra.

“If the patient has damage at the cervical or thoracic level, then frequent urination and urinary incontinence is associated with a spastic bladder that does not hold urine when filled. Although the signals between the bladder and the spinal cord are passing, the signals between the brain and the bladder have disappeared, so the person does not feel the fullness of the bladder and cannot control urination. The bladder muscle and urethral sphincter in this case are hyperactive, in addition, the joint work of these muscles is disrupted, says Ivan Kolbin. – In patients with lesions at the lumbar or sacral level, the situation is the opposite: the tone of the bladder is reduced, there are no contractions, the bladder gradually overflows and incontinence from overflow occurs. Failure to completely empty the bladder can lead to problems. Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and prevent urinary tract and kidney complications. ”

Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and complications of the urinary tract and kidneys

a number of other cases.

“Prolonged use of a catheter can sometimes cause a nosocomial infection that can contribute to urinary incontinence. Hygiene and regular intermittent catheterizations are important to avoid inflammation of the urinary tract, because the longer urine remains in the bladder, the more likely bacteria will multiply and cause inflammation. It is also important that the bladder is completely emptied and that there is no residual urine left in it, which contributes not only to inflammation, but also to the formation of stones. An indwelling catheter should be changed regularly. During catheterization, it is important not to damage the urethra, as this also creates the prerequisites for inflammation.

Urinary incontinence, in both men and women, can be stressful. Stress incontinence in women is more often associated with birth injuries, hormonal disruptions, and surgeries. In men, stress incontinence in most cases occurs after a prostatectomy (surgery to remove all or part of the prostate for prostate cancer) and after a transurethral resection (surgery for a benign prostate tumor).

Incontinence after prostatectomy is also due to the fact that when the prostate gland is cut off from the urethra, its back wall is partially damaged. The function is restored, as a rule, within 6 months after the operation. The number of patients with persistent urinary incontinence after surgery can reach 11.9%.

Treatment and rehabilitation

Pelvic floor training

Regular exercise is said to make the pelvic floor muscles stronger and stronger. Classes are held under the supervision of a doctor or with a smartphone, which tell the patient when to contract muscles and when to relax. It takes an average of 20 weeks to achieve results.

Kegel exercises help strengthen your pelvic floor muscles. But they are not shown to everyone. For example, in men after a stroke, mostly neurogenic damage occurs, in which drug therapy is sufficient. Muscle tone is more likely to decrease in women, especially with additional risk factors such as childbirth.

Electrical stimulation

This method is effective for men with urinary incontinence after prostatectomy.

Electrical stimulation (ES) activates the pudendal nerve. This causes the pelvic floor muscles to contract and also keeps the urethral sphincter closed and reduces the urge to urinate.

Electrical stimulation can be anal – when a special probe is inserted into the anal canal, as well as percutaneous – when overhead electrodes are placed (for example, on the hamstring or in the sacrum).

Extracorporeal magnetic innervation

This technique is effective in the complex treatment of urinary incontinence and works on the same principle as MRI: a device that is built into the seat of the chair creates a magnetic field. Next to the chair is a power supply unit with which the doctor can adjust the strength of this field. The doctor selects an individual dose of magnetic radiation for the patient, which improves the conduction of the nerve impulse and stimulates the contraction of the pelvic floor muscles. Unlike anal electrical stimulation, this method causes less discomfort for the patient.

General advice for patients with urinary incontinence

It makes sense to consult with your doctor about some aspects of your life. Perhaps he will advise:

• Limit fluid intake, drink in doses (no more than 200 ml of water at a time), drink less after 18:00, and also empty the bladder before bedtime so as not to get up at night and get better sleep.

“These are temporary restrictions,” says Ivan Kolbin. “Once the bladder again accumulates and holds a large portion of urine, you can return to the usual way of life.”

• Avoid excessive consumption of caffeinated, alcoholic and carbonated drinks.

“Caffeine stimulates urination even in patients without neurogenic disorders and stroke. Therefore, it is better for patients with urinary incontinence to limit coffee and, if there is such a need, drink it in the morning. If the patient himself notes the relationship between the intake of caffeinated drinks and incontinence, then it should be completely excluded, ”Ivan Kolbin.

• Do physical exercises to strengthen the muscles of the pelvic floor.

“The intensity of exercise depends on the condition of the patient. In most cases, Kegel exercises are enough to do 30 sets 3 times a day, ”- Ivan Kolbin.

• Watch your weight – Being overweight can put pressure on your bladder and make you want to urinate.

Experience of the Three Sisters Clinic in helping people with urinary difficulty

Patients with urinary incontinence are most often admitted to the Three Sisters Clinic after stroke and spinal cord injury. In these cases, rehabilitation specialists work with them to strengthen the muscles of the pelvic floor. For example, Kegel exercises are recommended. The doctor supervises the exercises and teaches the patient to do them on their own so that they can continue exercising at home after discharge.

The main goal of rehabilitation is to regain control of urination and urinary retention. It is important that urination is voluntary and the patient, depending on the severity of the violation, has time to get to the toilet or other auxiliary means of rehabilitation.

If a person is holding urine, then the next goal is to increase the intervals between urination and work on control. For example, if an urge appears, the patient needs to learn how to hold urine so as not to interrupt the session and not immediately run to the toilet. The quality of rehabilitation and life in general depends on this.

Physicians also prescribe medication individually:

• Alpha-blockers, which are recommended for men because they help relax the sphincters and the prostate gland. This allows urine to pass freely, and alpha-blockers also help reduce the pressure in the bladder that occurs when urine passes.

• In addition to alpha-blockers, botulinum toxin preparations can be used to relax the bladder and sphincters. This method helps to reduce spasticity and hypertonicity of the bladder.

• Anticholinergics are given to people using intermittent catheterization. Anticholinergics relax the bladder and prevent contractions in the bladder muscle fibers that can cause urinary incontinence.

Text author: Polina Fomintseva, medical journalist, graduate of the School of Modern Journalism of the European University in St. Petersburg

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