Navigating Bladder Health: Understanding the Basics

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The bladder is a hollow, muscular sac located in the lower abdomen. It temporarily stores the urine made by the kidneys until it is released into a tube called the urethra, which transports the urine out of the body. When empty, the bladder is about the size and shape of a pear. The muscles of the bladder enable it to stretch and hold urine. A healthy bladder can hold 1½ to 2 cups of urine during the day and about 4 cups at night. When urinating, the muscles of the bladder contract, and two valves called sphincters open, allowing the urine to flow into the urethra and ultimately out of the body.

There are a number of disorders that can affect the bladder. Among them are urinary incontinence, overactive bladder, cystitis and bladder cancer.

According to the American Urological Society, as much as one-third of all adults in the US suffer from urinary incontinence, which is a loss of bladder control. There are several types of urinary incontinence including stress incontinence, urge incontinence, overflow incontinence and mixed incontinence.With stress incontinence, activities such as coughing, sneezing, heavy lifting, straining when using the bathroom and even laughing put pressure on the bladder, causing it to leak. Urge incontinence occurs when people feel the need to use the bathroom right away, but some urine leaks out before they can get there. Overflow incontinence occurs when people don’t empty their bladder completely initially, so it overflows with new urine and leaks. Some people have more than one type of incontinence. They may leak urine when coughing or sneezing and leak when they have a strong urge to use the bathroom. In these cases, the condition is called mixed incontinence.

Overactive bladder, or OAB, is a combination of symptoms that may include the need to urinate more frequently, increased urgency and incontinence. People may also feel the need to urinate often at night. An estimated 33 million Americans deal with OAB; about 17 percent are women. Weak pelvic muscles are a common cause of OAB, but it can also be caused by damage to the nerves that send signals from the brain to the bladder telling it to empty. Certain medications, infection, excess weight and an estrogen deficiency, such as what occurs after menopause, are other potential causes. People can lessen their symptoms by decreasing or eliminating foods and beverages known to worsen symptoms such as tea, coffee, alcohol, chocolate and caffeinated soft drinks. In addition, bowel regularity, maintaining a healthy weight and not smoking can help. There are also techniques for retraining the bladder so it holds and releases urine more efficiently.

Cystitis is inflammation of the bladder, most often due to a bacterial infection. It’s considered a type of UTI, or urinary tract infection. UTIs are one of the most common reasons patients visit their physicians. Estimates based on physician office and emergency department statistics suggest there are about 7 million episodes of acute cystitis reported each year. Common symptoms include a strong, persistent urge to urinate; a burning sensation when urinating; urinating frequently but only small amounts; blood in the urine; cloudy or strong-smelling urine; pelvic discomfort; a feeling of pressure in the lower abdomen; and a low-grade fever. People should see their doctor immediately if they experience back or side pain, fever and chills, or nausea and vomiting.Bacterial cystitis is the most common type. Other types include interstitial cystitis, drug-induced cystitis, radiation cystitis, foreign-body cystitis, chemical cystitis and cystitis caused by other conditions such as diabetes, kidney stones, an enlarged prostate or spinal cord injury.

Bladder cancer is the fourth most common cancer. The American Cancer Society estimates there will be more than 82,000 new cases in the country in 2023. That includes more than 62,000 cases in men. According to the ACS, there will be about 17,000 deaths from bladder cancer in 2023, about 12,000 in men. There are three types of bladder cancer that begin in the cells that line the bladder. They are transitional cell carcinomas, which start in the innermost tissue layer of the bladder; squamous cell carcinomas, which start in the thin, flat squamous cells lining the inside of the bladder; and adenocarcinomas, which begin in the glandular cells found in the lining of the bladder.

Blood in the urine is often the first sign of bladder cancer. Other signs and symptoms include the need to urinate more often than usual, pain or burning while urinating, an urgent need to urinate even when the bladder isn’t full, trouble urinating or having a weak urine stream, and frequent nighttime urination. Treatment depends on the stage, which is the extent the cancer has grown and spread. Treatments include surgery, radiation therapy, chemotherapy, immunotherapy and targeted drug therapy. In addition, new therapies are being evaluated in clinical trials. People may not be able to prevent bladder cancer, but there are steps they can take to reduce their risk and improve the overall health of their bladder. Some things that can be done to keep the bladder healthy include drinking an appropriate amount of water, avoiding constipation, maintaining a healthy weight, exercising regularly, eating a healthy diet and not smoking.