The Bladder: Gender Differences & Problems Peeing

One of the funniest "vanity" license plates I've seen was owned by a urologist (doctor who specializes in bladder, prostate, and kidney issues). It read, "NOPCME." In other words, "No pee? See me!" I'll never forget that blue sports car (though in retrospect, it probably should have been yellow!)

Urinary issues (both difficulty getting urine out and keeping urine in) is one of the most common problems that we face, especially as we age. In fact, almost 40% of women report having an episode of urine leakage in the past year. So why do we have so much difficulty with our bladders?

The bladder is a very stretchy, muscular sac that sits in the bottom of the pelvis. The bladder muscles are stimulated to relax or contract by a complex of nerves that are controlled without our conscious knowledge. The bottom of the sac has a small sphincter (similar to the function of the anus) that relaxes and opens when we will it to do so.

The problem with this sphincter is that for women, it is not a complete circle. The nearby vagina takes up some of the space that the muscle could use, and so the sphincter is not as strong as it is for men. Women who have vaginal child birth may experience some further weakening of the bladder sphincter. For these reasons, women are more prone to bladder leakage.

Men have a unique anatomical difference that can cause problems with urination as well. The tube from the bladder to the exterior of the body happens to travel through a gland, called the prostate. When this gland is enlarged, it can narrow the passageway for the urine, causing a back up into the bladder and need to urinate small amounts frequently.

Since the bladder has a complicated nerve supply, there is a lot that can go wrong there as well. For a successful void, your bladder has to contract the outside muscle (like a shrinking balloon) while at the same time, relaxing the sphincter. This takes coordination from both the brain and spinal cord. If you have a brain or spinal cord injury, this process may get out of synch, resulting in a floppy bladder, or a lot of pressure in the bladder with a tightly closed sphincter – or anything in between.

There are gender differences in exit tube length – kidneys make the urine, then it travels to the bladder via two ureters, it is stored in the bladder, and then passes out the urethra (another tube). Women have relatively short urethras, and men have longer ones that pass through the prostate gland and all the way out of the penis to the exterior of the body.

This urethra length difference is important because bladder infections are ten times more common in women. It's a fairly short journey for bacteria to climb up into the bladder and multiply in the nice warm urine. Luckily, bladder infections can be treated quite easily with antibiotics, and women should contact their doctor at the earliest signs of burning and pain with frequent urination.

Finally, a few other anatomic differences between men and women can affect urination. Women who have had babies may experience some stretching of the ligaments that hold the uterus in place. Sometimes the uterus can slide downwards and obstruct the bladder exit, or in severe cases, even exit trough the vagina. Urologists or gynecologists can surgically repair such issues, and bladder slings are quite common.

Men, on the other hand, are prone to prostate cancer and sometimes undergo surgery to remove the gland altogether.  Sometimes they have difficulty controlling their urine after such procedures.

Bloody urine is concerning for possible bladder cancer, so if you see red blood in your urine, contact your doctor right away.

There are many medications that have side effects for the urinary tract – diuretics (or "water pills") intentionally increase the amount of urine produced in order to reduce blood pressure or blood volume. More urine means a need to void more frequently. Anti-depressants can cause a decrease in bladder contraction (resulting in a "floppy" bladder), and muscle relaxants may also relax bladder muscle. Of course, caffeine is a bladder stimulant, and sleeping pills may reduce your awareness of a full bladder, causing stretching while you sleep.

Tips to keep your bladder healthy:

1. Do not smoke. I know that sounds strange and perhaps unrelated, but smoking greatly increases the risk for bladder cancer.
2. Limit caffeine intake if you're experiencing frequency or incontinence.
3. Be aware that too much fluid intake (or diuretics) can make overactive bladders worse.
4. For men with enlarged prostates: Stop drinking fluids several hours before bedtime to reduce the need to get up frequently at night.
5. For women: Kegel exercises may strengthen the bladder sphincter. *
6. For women: Reduce urinary tract infection risk by urinating after sexual intercourse to flush bacteria from the urethra.**

The good news is that we have many fairly effective solutions for bladder problems. There are medications for "overactive" bladders, as well as bladder stimulant medications. There are surgical procedures to help with anatomical barriers, and of course, all kinds of over-the-counter incontinence pads that provide invisible protection from leakage.

If you have a chronic bladder problem that is not improving with input from your primary care provider, it's important to see a specialist to figure out what is triggering it so that the right treatment is prescribed. As you now know, the bladder (and the entire urinary system) is very complex, and the root cause of difficulty urinating (or frequent urination) could be anything from a brain or spinal cord problem, to an enlarged prostate, sphincter weakness, medication side-effect, or overly-sensitive bladder nerves. Specialists can look inside the bladder with a tiny camera, or perform "urodynamic testing" to see if bladder pressures and fluid capacity are normal.

If you or someone you know is having difficulty with urinating, just remember that urologist's license plate - NOPCME!

References

http://www.webmd.com/urinary-incontinence-oab/news/20050523/adult-incontinence-how-common-is-it
*http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283
** http://www.mdedge.com/jfponline/article/60079/womens-health/does-postcoital-voiding-prevent-urinary-tract-infections-young

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