Most of your bladder control system lies inside your pelvis. Stand with your hands on your hips. The bones under your hands are the pelvic bones. Your pelvis is shaped like a big bowl. The bottom of this "bowl" is the area between your legs. The muscles across this area are the pelvic floor muscles.

Your bladder is another muscle. It is a balloon-shaped organ inside your pelvis, just below your belly button. Your pelvic floor muscles should be strong and tight to hold up your bladder in its proper place. Your bladder should stay relaxed when it is full of urine. But, when you go to the bathroom, the bladder muscle should tighten. This squeezes urine out of the bladder.

The sphincter (muscles are two muscles that surround the tube that carries urine from your bladder down to an opening in front of the vagina. The tube is called the urethra (. Urine leaves your body through this tube.

The sphincters keep the urethra closed by squeezing like tight rubber bands. The pelvic floor muscles also help keep the urethra closed. Urine stays inside your body when the pelvic floor and sphincter muscles are tight and the bladder is relaxed.

When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to go to the bathroom. Once you reach the toilet, your brain sends a message down to the sphincter and pelvic floor muscles. It tells them to relax. The brain signal also tells the bladder muscles to tighten up. That squeezes urine out of the bladder.

Bladder control means you urinate only when you want to. For good bladder control, all parts of your system must work together. Pelvic muscles must hold up the bladder and urethra. Sphincter muscles must open and shut the urethra. Nerves must control the muscles of the bladder and pelvic floor.

What causes bladder control problems?

Most bladder control problems happen when muscles are weak or too active. Problems may also happen when nerve signals don't work properly.

If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh, or lift a heavy object. This is called stress incontinence. It's the most common type of bladder control problem.

Stress incontinence often occurs when women are pregnant or after childbirth. The pelvic floor muscles stretch and weaken in pregnancy or childbirth. The same muscles become weak after a woman stops having periods (menopause). They weaken because they no longer get female hormones.

Sometimes, the bladder muscles become too active. Then you have a different problem. You may feel strong, sudden urges to go to the bathroom, even if your bladder has little urine. This kind of bladder problem is called urge incontinence.

Several things can cause your bladder to be too active:

• a bladder infection
• nerve damage (sometimes from childbirth)
• drinking alcohol (beer, wine, etc.) some medicines.

What is the treatment for bladder control problems?

Your treatment will depend on the type of bladder control problem you have. Some treatments are simple. Others are more complicated. Your health care team may suggest one of the following treatments:

• Pelvic muscle exercises. You can learn simple exercises that can strengthen the muscles near the urethra. These are called pelvic muscle exercises or Kegel exercises and take only a few minutes a day.

• Bladder training. You can train your bladder to hold urine better. Follow a timetable to store and release urine. You can also learn to decrease the urge to urinate.

• Weight loss. Sometimes extra weight causes bladder control problems. A good meal plan and exercise program can lead to weight loss.

• Food and drink. Some drinks and foods may make urine control harder. These include foods with caffeine (coffee, tea, cola, or chocolate) and alcohol. Your health care team can suggest how to change your diet for better bladder control.

• Muscle therapy

• Electrical stimulation. Certain devices stimulate the muscles around the urethra. This makes the muscles stronger and tighter.

• Biofeedback. This takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a TV screen. You watch the screen to see if you are exercising the right muscles. The therapist will help you. Soon you learn to control these muscles without the patch or screen.

Medical treatments

• Medicines. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles.

• Collagen injections. Collagen is a natural animal substance like fat. It can be injected into the tissue around your urethra to add bulk and keep your sphincter muscles tightly closed. One drawback to this treatment is that collagen breaks down after several months, so you may need to have injections repeated.
• Surgery. Some bladder control problems can be solved by surgery.

Many different operations can improve bladder control. The operation depends on what is causing the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder control muscles work better.

Soon, you will be able to buy new products. These products help control leaks. They do not cure the causes of bladder control problems.

Devices

• Pessary. Your doctor can place a special device called a pessary (in the vagina. The device will hold up the bladder to prevent leakage.

• Urethral inserts. Your doctor may give you a small device that goes directly in the urethra. You can learn to insert the device yourself. It's like a little plug. You remove the device when it is time to go to the bathroom and then replace it until it's time to go again.

• Urine seals. This is a small foam pad you place over the urethra opening. There it seals itself against your body to keep urine from leaking. When you go to the bathroom, you remove the pad and throw it away.

Dryness Aids

• Pads or diapers. Pads or diapers help many people. But diapers do not cure bladder control problems. See a doctor or nurse, even if diapers are working for you.

• Bedside urinal. Some people use a bed pan or a bedside chair urinal (or commode.

• Assistance. If you are disabled, health care workers can help you move more easily to a toilet. Your doctor or nurse may teach you to urinate on a schedule that prevents wetting.

• Renovations. Sometimes, you just need a carpenter to make changes to your house. Perhaps you need a hallway light. Or a downstairs bathroom. Another solution could be widening a bathroom door to fit a wheelchair.

Points to Remember

Many women have bladder control problems.

Bladder control problems do not have to be a normal part of aging. Many medical conditions can cause bladder problems.

Try not to let embarrassment about bladder control problems keep you from talking to your health care team. Most cases of poor bladder control can be improved greatly.

Ask your health care team for help.

For More Information

Agency for Health Care Policy and Research (AHCPR)

P.O. Box 8547

Silver Spring, MD 20907-8547

(800) 358-9295 or (410) 381-3150

American Foundation for Urologic Disease

The Bladder Health Council

300 West Pratt Street

Suite 401

Baltimore, MD 21201

American UroGynecologic Society

401 North Michigan Avenue

Chicago, IL 60611-4267

(312) 644-6610

National Association For Continence

P.O. Box 8306

Spartanburg, SC 29305

(800) BLADDER or (864) 579-7900

Information provided by the NIH and NKUD

MEDCEU Continuing Education Courses CEU for Nurses and Healthcare Professional

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