Understanding the Bladder

  • When caring for someone with urinary incontinence, you may find it useful to have a rudimentary understanding of how the bladder works. This will be very helpful in your discussions with healthcare professionals.

    The urinary system consists of two kidneys, the ureters, the bladder and the urethra. The kidneys lie in the back, in front of the lower rib cage on either side of the spinal cord. Urine, which is made by the kidneys, is transported to the bladder by the two ureters where it is stored until you go to the toilet.
    The purpose of the bladder is to store and then empty itself of urine in a controlled fashion and is connected to the skin just at the top of the vaginal opening in women and the tip of the penis in men by another tube called the urethra.
    In men, the prostate gland surrounds and the wall of the urethra, just below its connection with the bladder.

    How a normal bladder works

    The kidneys filter your blood and collect waste products which your body then needs to eliminate. It does this by producing urine which runs down the tubes called ureters from the kidneys into the bladder, where it is collected. The bladder has two main functions, to store urine and then to get rid of it. Your body gets rid of urine from the bladder by using a muscle in the abdomen to squeeze the bladder to empty it when it needs to. At the lower end of the neck of the bladder a tube called the urethra allows urine to empty out of the bladder, this tube is surrounded by sphincter muscles which keep it closed until you are ready to go to the toilet.
    Nerves carry messages from the bladder to the brain to tell it when the bladder is beginning to feel full. In response, your brain will let you know that you need to start thinking about going to the toilet and at the same time it will tell the muscles to remain closed until you get there.

    A normal bladder empties 4 - 7 times each day depending on how much you drink and holds up to 0.5 litres of fluid. It usually starts to tell you that you will soon need to go to the toilet when half this amount is in your bladder but also gives you enough time to find a toilet. A normal bladder empties completely every time you pass water and does not leak.

  • Healthy Bladder

      There are a number of things the person you are caring for can do to try to keep their bladder healthy. These include:
    • Maintaining a healthy fluid intake
    • Eating healthily and avoiding constipation
    • Regularly practising pelvic floor exercises

    Healthy fluid intake

    How much is healthy?

    It is very important that they drink enough fluid each day – this is essential to keep the bladder healthy as the bladder works at its best with the optimal fluid intake. If they don't drink enough, their bladder will get used to holding smaller amounts of urine and can become over-sensitive, if they drink too much they will need to go to the toilet more often and the risk of accidents will increase.
    They should try to drink at least 1.5 - 2 litres (or 6-8 glasses) of fluid each day. If the person you are caring for currently drinks less than this, you should try to increase the amount they drink gradually. It is easier to get them to drink fairly small quantities at any one time and to ensure they do this frequently throughout the day.
    People suffering from urinary incontinence are often tempted to reduce their fluid intake believing that it will help with their symptoms; however, this is not true. In the short term it may well seem to make the problems worse, but this will only be temporary. In the longer term, the bladder will learn to hold more urine and will become less sensitive, irritable and less prone to infection.

    What to drink

    The best fluids to drink to maintain a healthy bladder are water, fruit juice, herbal teas and cordials. Some research suggests Cranberry juice may help relieve the symptoms of those who suffer from frequent urinary infections. Drinking 1 or 2 glasses (250 to 600ml) every day can help but make sure the juice content is high, as many Cranberry juice products are very diluted – you should look out for a juice content of 20 to 25%. People with diabetes should check with their doctor or healthcare professional before drinking cranberry juice.

    What not to drink

    Drinks containing caffeine and fizzy drinks, especially those containing artificial sweeteners, should be avoided as they can make their problems worse. Alcoholic drinks, especially spirits, can also irritate the bladder.
    It may help to keep a diary of exactly what the person you are caring for drinks and to record which type of fluids tend to make things better or worse – that way you'll find out which drinks to avoid.
    Anyone taking Warfarin or suffering with Diabetes should check with their Doctor before making any significant changes to what they drink.

    Eating healthily and avoiding constipation

    When the bowel does not empty properly it will swell up, push downwards and put pressure onto the bladder so it is important that the person you are caring for eats the right foods and avoids constipation. They can do this by following a healthy diet which is something that will help their general health as well.
    The person you are caring for should eat a balanced diet that is not too high in fat, includes plenty of fibre and aim to consume at least five portions of fruit and vegetables each day. Choosing wholegrain varieties of bread, pasta and rice will also help, as will introducing nuts, seeds and pulses to their diet. As well as helping prevent constipation, eating a higher fibre diet has also been shown to lower blood cholesterol levels and improve digestion. Being overweight can also make bladder problems worse in the long-term as the extra weight may put undue pressure on the pelvic floor muscles, weakening them and, in turn, leading to Stress Urinary Incontinence.

  • Pelvic Floor Exercises

    Pelvic floor exercises are important for the person you are caring for as they can help strengthen the pelvic floor muscles which can improve bladder control and improve or stop leakage of urine. Like any other muscles in the body, the more they are used and exercised the stronger the pelvic floor will become.

    What is the Pelvic Floor and where is it?

    The pelvic floor muscles are a group of muscles that extend from the tail bone (coccyx) at the back to your pubic bone at the front. They wrap around the underside of the bladder and rectum, supporting them in their correct position. In women the pelvic floor muscles also support the womb. In both sexes the muscles of the pelvic floor play an important role in ensuring the urethra (water pipe) and the rectum (back passage) close effectively.

    How the Pelvic Floor works

    The muscles of the pelvic floor are kept firm and slightly tense to stop leakage of urine from the bladder or faeces from the bowel. When you pass water or have a bowel motion the pelvic floor muscles relax. Afterwards they tighten again to restore control.

    Why do the Pelvic Floor muscles get weak?

      In both sexes pelvic floor muscles can become weak due to a range of factors including:
    • A general lack of exercise
    • Ageing
    • Repeated straining during bowel opening
    • Repeated heavy lifting
    • Chronic coughs
    • Obesity
    • Neurological damage e.g. after a stroke

    Women often find that pelvic floor muscles are damaged during childbirth which can contribute to both urinary and faecal incontinence.

    How Pelvic Floor exercises can help

    Pelvic floor exercises can strengthen these muscles so that they once again give support. This will improve bladder control and improve or stop leakage of urine. Like any other muscles in the body, the more they are used and exercised, the stronger the pelvic floor will be.

    Pelvic Floor exercises to treat Stress Urinary Incontinence

    There are two types of muscle fibres within the pelvic floor; slow twitch and fast twitch fibres and they respond in different ways depending on the type of activities you are carrying out during the day. It is important that you perform exercises that strengthen both types and that you do the exercises every day.
    It is vital that the correct muscles are exercised and you may be referred to a healthcare professional or physiotherapist for further advice on the exercises.

  • Pelvic Floor Exercises for Women

    Learning to Exercise the Right Muscles

      At first you will probably need to help the one you are caring for complete these exercises but you should soon try to get them to exercise independently. Ask them to follow the steps listed below;
    1. Sit or lie comfortably with the muscles of their thighs, buttocks and abdomen relaxed.
    2. Tighten the ring of muscle around the back passage as if they are trying to control diarrhoea or wind. Relax this muscle again. Practice this movement several times until they are sure they are exercising the correct muscles. They should try not to squeeze their buttocks or tighten their thighs.
    3. Now they should imagine they are passing urine and are trying to stop the stream. They should find themselves using slightly different parts of the pelvic floor muscles to the first exercise (the ones nearer the front). These are the ones to strengthen.
    4. The number of muscle squeezes they perform each day will depend on how well their muscles can move and how strong they are.
    5. They should find three to four regular times during the day to do the exercises e.g. after going to the toilet, when having a drink or when lying in bed. Tightening the pelvic floor muscles before getting up from a chair, coughing or lifting anything heavy will also help.
    6. In addition to the times set aside to do the exercises, they should try to get into the habit of doing exercises whilst going about everyday life.
    7. After several weeks the muscles will start to feel stronger. They should find they can squeeze the pelvic floor muscles for much longer without the muscles feeling tired.
    8. It may take up to 3 months to achieve the desired results. If they see little or no change, please contact a Healthcare Professional.

    More information on Pelvic Floor Exercises for women can be found on the Bladder and Bowel Foundation website www.bladderandbowelfoundation.org

  • Pelvic Floor Exercises for Men

    Learning to Exercise the Right Muscles


      At first you will probably need to help the one you are caring for complete these exercises but you should soon try to get them to exercise independently. They should follow the steps listed below;
    1. Sit or lie comfortably with the muscles of their thighs, buttocks and abdomen relaxed.
    2. Tighten the ring of muscle around the back passage as if they are trying the control diarrhoea or wind. Relax this muscle again. Practice this movement several times until they are sure they are exercising the correct muscles. They should try not to squeeze their buttocks or tighten their thighs. If their technique is correct they will feel the base of the penis move upwards slightly towards their tummy. They may also notice that the penis withdraws and the scrotum lifts.
    3. The number of muscle squeezes they perform each day will depend on how well their muscles can move and how strong they are.
    4. They should find three to four regular times during the day to do the exercises e.g. after going to the toilet, when having a drink or when lying in bed. Tightening the pelvic floor muscles before getting up from a chair, coughing or lifting anything heavy will also help.
    5. In addition to the times set aside to do the exercises, they should try to get into the habit of doing exercises whilst going about everyday life.
    6. After several weeks the muscles will start to feel stronger. They should find they can squeeze the pelvic floor muscles for much longer without the muscles feeling tired.
    7. It may take up to 3 months to achieve the desired results. If they see little or no change, please contact a Healthcare Professional.

    More information on Pelvic Floor Exercises for men can be found on the Bladder and Bowel Foundation website www.bladderandbowelfoundation.org

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