Bladder issues commonly affect women of all ages. What’s also common is not seeking care for these problems, which often means suffering in silence. Whether it’s problems with bladder control (incontinence) or urinary tract infections (UTIs), there are lifestyle changes and treatments that can improve bladder problems at any age.1 

How the bladder works

The bladder is a hollow muscle that stores urine created by the kidneys. The average adult female bladder can hold about 2 cups of urine. However, a woman might start feeling the urge to urinate when the bladder is holding about a cup of urine. As the bladder fills, it stretches, triggering a message to the brain that you should start planning a bathroom break in the next half hour.2 

When it’s time to urinate, nerve signals sent to the brain coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra. Pelvic floor muscles physically support the bladder and open and close the urethra, the tube that carries urine from the bladder to outside the body. The muscles of the bladder tighten and push urine out of the body.3 

The many types of urinary incontinence

Urinary incontinence – the loss of bladder control – ranges from occasionally leaking urine when you cough or sneeze (stress incontinence) to such a sudden and strong urge to urinate that you can’t get to the bathroom in time (urge incontinence). 

Overflow incontinence is defined as the frequent or constant dribbling of urine because the bladder doesn’t empty completely, whereas functional incontinence is when physical or mental impairment prevents a person from getting to the bathroom in time. Mixed incontinence means having more than one type of urinary incontinence – most often urge and stress types.4

Different life stages can lead to urinary incontinence:4

  1. Pregnancy. Hormonal changes, increasing weight of the fetus, and pressure on the bladder can cause stress incontinence.
  2. Childbirth. Vaginal delivery can sometimes damage bladder nerves and supportive tissue or weaken the muscles that control the bladder. This can lead to a dropped (prolapsed) pelvic floor – when the bladder, uterus, rectum, and/or small intestine drop from their usual position and protrude into the vagina. This protrusion can lead to incontinence.
  3. Aging. As a woman ages, the bladder muscle also ages, decreasing its ability to store and hold urine. In addition, involuntary bladder contractions become more frequent with age, causing incontinence. 
  4. Menopause. After menopause, women produce less estrogen, a hormone that keeps the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.

Improving incontinence 

For some women, simple behavioral strategies might help improve their symptoms. For others, conservative treatments might not work so medical support is needed. For example, some medications can strengthen muscles and tissues in the urethra and vaginal areas and significantly improve overactive bladder symptoms. 

Strengthen the pelvic floor. Regularly performing pelvic floor exercises, commonly called Kegels, can strengthen the muscles that control urination. To perform, squeeze the pelvic floor muscles – as if trying to stop the urine stream – for three seconds. Relax for a count of three and repeat several times.3,5  

Not sure you’re doing Kegels correctly? Some health-care professionals use biofeedback as a tool to help patients effectively perform Kegel exercises. It involves placing sensors near the pelvic muscles that transmit exertion levels to a computer, which displays the activity on the screen. This immediate feedback often helps a woman master Kegel exercises more quickly because the system shows whether she is using the correct muscles.3 

There are also innovative products that teach how to properly do Kegels from the comfort of home. An Internet search will reveal Kegel exercise systems designed to help strengthen the pelvic floor with real time biofeedback via an interactive app.

Using vaginal weights is a time-tested approach to strengthen pelvic floor muscles. A user inserts a weight into the vagina, then contracts the pelvic floor muscles to keep the weight from falling out. Typically, vaginal weights come in sets of increasing weight to help build strength.3 

Learn more about the pelvic floor and Kegels here: What to Know About the Pelvic Floor.

Try bladder training. Bladder training, or retraining, involves adjusting habits. Try going to the bathroom on a set schedule, with the time between urination gradually increasing. This allows the bladder to fill more fully and provides more control over the urge to urinate.3

Avoid irritants. This includes coffee, tea, carbonated beverages, alcohol, acidic fruits and fruit juices, spicy foods, tomato-based foods, and chocolate. To test what might be causing a problem, eliminate these foods for about a week, then add one back every one to two days to see if it triggers incontinence. Sometimes, just cutting down on eating a single irritant can make a difference.3 

Watch the fluids. Drinking large amounts of fluid too quickly can cause a person to urinate more often and create a strong sense of urgency. Instead, drink smaller amounts throughout the day. For example, drink 16 ounces at mealtimes and 8 ounces between meals. Consume most of your fluids in the morning and afternoon to avoid having to go to the bathroom frequently at night.3

Maintain a healthy weight. Losing weight can ease symptoms by relieving pressure on the bladder.3

Mind your bathroom habits. Going too frequently before getting an urge can make the bladder overly sensitive, leading to more frequent emptying. On the flip side, ignoring the urge to urinate for hours can make the body less sensitive to the sensation of having to go and result in an overextended bladder that eventually doesn’t empty all the way. Squatting over a toilet in a public restroom to avoid seat contact can also prevent complete emptying of the bladder. Instead of hovering, opt for a seat cover instead.2 

Understanding UTIs

Urinary tract infections typically occur when bacteria – commonly Escherichia coli (E. coli) – bypass the body’s natural defenses and enter the urinary tract through the urethra. The bacteria multiply and cause inflammation in the bladder (cystitis) or the urethra (urethritis).6   

Women are more susceptible to UTIs than men. That’s because the distance from the urethra to the anus (where bacteria are usually found) and the distance from the urethral opening to the bladder are shorter in women than in men. This means bacteria can more easily enter a woman’s body and cause infection.5

Sexual intercourse can sometimes lead to UTIs, which is commonly called “honeymoon cystitis.” This tends to be more common in younger women, but older women with an active sex life are also susceptible. 

Decreasing levels of estrogen during perimenopause and menopause can lead to changes in the lining of the bladder. This causes a shift in the mix of bacteria and other microbes that populate the bladder. Diminishing levels of estrogen also cause a decrease in health-promoting Lactobacilli in the vagina.

Various species of Lactobacilli protect against infection by inhibiting other types of bacteria and pathogens. Lower levels of Lactobacilli also lead to an elevated pH (less acidic) level in the vagina. This combination of lower Lactobacilli and higher pH reduces the body’s natural defense mechanisms against UTIs.7 

How to treat (and avoid) UTIs 

To obtain relief from discomfort and to treat the infection, you will likely need an antibiotic prescription from a health-care professional.5 Most UTIs rarely lead to complications. However, left untreated they can turn into a kidney infection, which might cause permanent kidney damage. A pregnant woman with an untreated UTI has an increased risk of delivering a low-birth-weight or premature baby. 

Use over-the-counter treatments cautiously. Urinary pain relievers, such as phenazopyridine (AZO Urinary Pain Relief) and other products labeled “urinary pain relief,” do relieve some symptoms, but they don’t treat the infection and are only meant to be used temporarily.

Preventive steps that reduce the chance of getting a UTI include:

  • Wipe from front to back after a bowel movement to prevent spreading bacteria from feces into the urethra. 
  • Urinate immediately after sex to expel bacteria that might have gotten into the urethra. 
  • Empty your bladder when you feel the urge to urinate. This ensures urine is not sitting in the bladder for a long period of time and it flushes bacteria from the urinary tract before an infection can take hold.4   
  • Drink plenty of fluids, especially water. Water dilutes urine and leads to more frequent urination.4
  • If you are perimenopausal or postmenopausal and have recurrent UTIs, then talk to your health-care professional about vaginal estrogen. Vaginal estrogen can increase the presence of Lactobacilli in the vagina and decrease the recurrence rate of UTIs. Vaginal estrogen is available in forms such as creams, suppositories, and rings and is considered safe for most women.
  • If you have had breast cancer, current evidence does not show an increased risk for cancer recurrence with the use of vaginal estrogen.8,9 However, consult with your physician and oncologist to determine if vaginal estrogen is an option for you. 
  • There’s some indication that cranberry products, either in juice or supplement form, have properties that can fight a urinary infection. Researchers continue to study the ability of cranberry to prevent UTIs, but results vary. There’s little harm in drinking cranberry juice if it seems to help you prevent UTIs. Although quite tart, choose an unsweetened option if you want to avoid the sugar and calories. Don’t drink cranberry juice if you’re taking a blood-thinning medication, such as warfarin (Jantovin).10,11

If you have a bladder issue that continues despite your best efforts, then it’s time to see your health-care professional. Many women find bathroom issues embarrassing to talk about, especially when it comes to bladder control. Find hope in knowing you are not alone. Millions of women struggle with these same issues, and there are many available options and treatments that can help you find relief. 

A word from Thorne

You can support a healthy microbial balance in the vaginal and urinary tracts with a probiotic comprised of several strains of Lactobacilli.*

References

  1. Weiss C. Bladder issues common in women of all ages. Mayo News Network. https://newsnetwork.mayoclinic.org/discussion/bladder-issues-common-for-women-of-all-ages/. [Accessed February 5, 2023]
  2. Lucas P. The bladder owner's manual: What your bladder wants you to know. Mayo Clinic Press. https://mcpress.mayoclinic.org/women-health/the-bladder-owners-manual-what-your-bladder-wants-you-to-know/. [Accessed February 5, 2023]
  3. Bladder control: lifestyle strategies ease problems. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problem/art-20046597. [Accessed February 5, 2023]
  4. Urinary incontinence: symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808. [Accessed February 5, 2023]
  5. Ask the experts: What is cystitis? Urology Care Foundation. https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/fall-2021/ask-the-experts-what-is-cystitis-(uti). [Accessed February 5, 2023]
  6. Ilges DT. UTIs: Do you always need an antibiotic? Mayo Clinic Press. https://mcpress.mayoclinic.org/women-health/utis-do-you-always-need-an-antibiotic/. [Accessed February 5, 2023]
  7. Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric 2019;22(3):242-249.
  8. Anger J, Lee U, Ackerman A, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol 2019;202(2):282-289.
  9. Rosenblum N. Update in female hormonal therapy: what the urologist should know: NYU case of the month. Rev Urol 2020;22(4):182-185. 
  10. UTI: Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453. [Accessed February 16, 2023]
  11. Xia JY, Yang C, Xu DF, et al. Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis. PLoS One 2021;16(9):e0256992.