Bladder & Bowel Archive

Also called painful bladder syndrome, this frustrating disorder disproportionately affects women.

Interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area, often accompanied by an urgent and frequent need to urinate — sometimes as often as 40, 50, or 60 times a day, around the clock. Discomfort associated with interstitial cystitis can be so excruciating that, according to surveys, only about half of people with the disorder work full-time. Because symptoms are so variable, experts today describe interstitial cystitis as a member of a group of disorders collectively referred to as interstitial cystitis/painful bladder syndrome. (In this article, we'll call it interstitial cystitis, or IC.)

Among the one to two million Americans with IC, women outnumber men by as much as eight to one, and most are diagnosed in their early 40s. Several other disorders are associated with IC, including allergies, migraine, irritable bowel syndrome, fibromyalgia (a condition causing muscle pain), chronic fatigue syndrome, and vulvodynia (pain or burning in the vulvar area that isn't caused by infection or skin disease).

Infections aren't the only conditions that can cause discomfort.

Certain urinary symptoms are quite common, particularly in women: painful burning with urination, an urgent need to urinate like you can't hold it (urinary urgency), and urinating frequently (urinary frequency).

These symptoms can be caused by any of the following conditions.

Ask the doctors

Q. I suffer from mild urinary incontinence. A friend suggested that I try bladder training. Is this a real treatment?

A. Yes, some women with urinary frequency and overactive bladder might benefit from bladder training. The idea behind bladder training is to teach your body to respond more appropriately to bladder signals.

Antidepressants and opioids are common offenders.

It's frustrating when you feel the urge to move your bowels but can't seem to go. Before blaming your diet, consider whether medication side effects are causing your constipation.

Possible suspects

Many medications can contribute to constipation, including the following:

Some men with an enlarged prostate gland (benign prostatic hyperplasia, or BPH for short) eventually start to experience urinary incontinence, the involuntary discharge of urine. The incontinence can be related to overactive bladder, one of the changes in bladder function caused by BPH.

Normally, the brain says "time to go" when your bladder is only partially full. That gives you a fair warning to find a place to relieve yourself. When you decide to let go, a valve called the urinary sphincter opens to allow the bladder to drain. Muscles in the bladder wall squeeze inward to empty the storage tank.

Research we're watching

Infections — especially those in the urinary tract, known as UTIs — may raise the risk of a stroke, a new study finds.

Researchers examined the electronic medical records of more than 191,000 stroke patients to see if they'd been hospitalized or gone to an emergency room for an infection shortly before the stroke. They tracked infections of the abdomen, blood, respiratory tract, skin, or urinary tract.

News briefs

Here's some relief for people with urinary incontinence who don't want to take pills to treat the problem: behavioral therapy (bladder training) works better for urinary incontinence than medication, according to a study published online March 18, 2019, by Annals of Internal Medicine. Researchers reviewed 84 randomized trials of women (average age 55). The studies evaluated 14 categories of incontinence treatments, including pill-free therapy and medications such as anticholinergic drugs — for example, oxybutynin (Ditropan). Most of the strategies (except taking hormones or getting injections of a bulking agent near the urethra) were more effective than doing nothing to treat incontinence. But for both stress incontinence (the kind that makes you leak when you laugh) and urge incontinence (the kind that makes you rush to the bathroom), behavioral therapy was the most effective treatment, beating medications and neuromodulation (electrical stimulation of the nerves that control the bladder). The catch: it takes practice to make behavioral therapy effective. But it may be worth the effort, since medications for incontinence often have side effects.

Ask the doctors

Q. I am 89 years old, and several months ago I was plagued by frequent urinary tract infections. The infections were treated, but is there anything I can do to avoid experiencing this problem again?

A. Urinary tract infections, or UTIs, are common infections that can occur when urine pools in the bladder and bacteria start to grow. These infections can be more common in older women for several reasons, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, or difficulty with emptying the bladder completely. In addition, estrogen helps to maintain a healthy balance of bacteria in the vagina, which can protect against UTIs. But this natural protection may wane when estrogen levels drop after menopause. One of the best ways to prevent UTIs is to stay hydrated by drinking plenty of water. This flushes out potentially harmful bacteria before it can cause a problem. You'll know you are drinking enough if your urine looks clear or light yellow. Some other strategies include fully emptying your bladder when urinating, urinating after sexual intercourse, and wiping from front to back after using the toilet. Also talk to your doctor about replacing estrogen in the vagina with a cream, tablet, or vaginal insert. Your doctor may also want to examine you for pelvic organ prolapse.

Try simple measures first, like using a fiber supplement and treating underlying conditions.

Nobody wants to talk about or even imagine it. But loss of bowel control — known as fecal incontinence — is a problem for millions of adults in the United States, especially women.

"It becomes more common with age. It's socially isolating and takes away your dignity. You live in fear that you have stool in your pants and people can smell it. Some people won't even tell their doctors about it," says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

On call

Q. After I have a bowel movement I sometimes get quite weak and have to lie down until the feeling passes. Why does this happen and is it cause for concern?

A. The sensation you are describing is most likely due to a reflex called a "vasovagal reaction." Here's what I mean.