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Bladder Problems

Incontinence, the inability to regulate urine from the bladder, is a widespread and severe health and social issue that affects approximately 13 million Americans - a figure that will expand along with the amount of aging baby boomers.

The bladder condition affects both sexes and all ages, but is diagnosed more in women than men (who mostly suffer from prostate disorders), and is rampant in the senior community. Approximately 15-30% of those 55+ who live at home are affected by urinary incontinence, as is 40% of the elderly in nursing homes. It’s not a predestined consequence of aging, but incontinence is one of the main reasons why seniors enroll in assisted medical or living facilities.

Most of those with the bladder disorder suffer social and public fluster, become disconsolate, and often impede their interactions away from home. They experience internal and external infections (such as bone fractures and skin irritation), and are inclined to falls and sleep disorders. Many are unaware of the access to medical and psychological assistance, feel awkward with health care providers, and instead, “just learn to deal with it."

Though incontinence is irreversible, there is indeed a workable way to “deal with it” in a very productive, sustainable and easily-adaptable manner. To better understand the condition, let’s take a closer look at the urinary system and process otherwise known as micturition.

The urinary system includes the kidneys, ureters, bladder, and urethra. The kidneys filter water and waste from the blood, and excrete urine (about 1 to 1 quarts or 1000-1500 mL in a 24-hour period), which travels through the ureters to the bladder, where the urine is housed until depletion.

The urethra is a narrow tube connecting the bladder with the opening when the urine exits the body. Surrounding the urethra are sphincter muscles, which partially regulate the urine’s release from the bladder and the body.

The bladder’s dimension, shape and position - in proportion to other organs - depends on the individual’s age and the amount of urine in reserve. But essentially, the bladder is a hollow, muscular organ with a smooth wall called the detrusor muscle. It’s able to accommodate about 600 mL of urine, but the impulse to urinate develops once the bladder harbors at least half of that amount. The bladder expands, and nerves within and surrounding the organ communicate with the brain, by way of the spinal cord. Once the bladder is full, the brain responds to the body with the instruction to urinate.

In general, people usually know when and how to urinate. But once a decision is made to do so, the nervous system takes over and the process becomes instinctive. Consequently, the detrusor contracts, and the sphincters loosen to accede urine to emanate. When the bladder is exhausted, the sphincters contract, and the detrusor relaxes. Halting or delaying urination is achieved by “squeezing” the external sphincter, which causes the detrusor to retreat. The urine is stored, and the “urge” is temporarily aborted. But as urine continues to be produced, the impulse increases.

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Dr. Aguirre
Dr. Aguirre is the Director of Aguirre Specialty Care, The Center for Female Pelvic Medicine. Dr. Aguirre is also a member of the Laser Vaginal Rejuvenation Institute of America.
The Laser Vaginal Rejuvenation Institute of America is founded and directed by Dr. David L. Matlock.

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