Underactive bladder
Related Terms
Bladder disorders, bladder infection, bladder irrigation, epidiymitis, frequency-urgency-dysuria syndrome, neurogenic bladder, orchitis, painful bladder syndrome, pelvic inflammatory disease, PID, underactive bladder, urethral inflammation, urethritis, urine acidification, urinary retention, urinary tract defects, urinary tract infection, UTI.
Background
Genitourinary disorders are illnesses that occur when the urinary organs and genital organs are not functioning properly. These disorders may be the result of aging, illness, or injury.
There are many organs involved in urination, including two kidneys, two ureters, the bladder, two sphincter muscles, and the urethra.
The kidneys, a pair of organs located on the left and right side of the abdomen, are an essential component of the urinary tract. The kidneys are responsible for removing toxins, chemicals, and waste products from the blood.
Urine then leaves the kidneys and travels down two tubes called ureters. The muscles in the ureter walls constantly tighten and relax to bring urine into the bladder. Small amounts of urine enter the bladder approximately every 10-15 seconds.
The bladder is a hollow muscular organ. The bladder stretches until it is full with urine. Healthy adults can hold up to 16 ounces (two cups) of urine in their bladders for two to five hours. Muscles, called sphincters, prevent urine from leaking out of the bladder.
When the bladder is full, nerves send a message to the brain, which then causes the patient to feel the urge to urinate.
During urination, the brain signals the muscles in the bladder to contract and the sphincter muscles to relax. This causes urine to empty out of the bladder.
Examples of genitourinary disorders include interstitial cystitis, neurogenic bladder, kidney stones, pelvic inflammatory disease (PID), prolapsed uterus, urinary incontinence, and urinary tract infection (UTI). In addition to causing urinary problems, many of these conditions may also affect the reproductive organs including the uterus, cervix, fallopian tubes, and vagina in women and the testicles, epididymis (tubular organ where sperm collect after leaving the testis), prostate gland, and penis in males.
Treatment of genitourinary disorders depends on the specific type and severity of the disorder. If left untreated, some disorders, including pelvic inflammatory disease (PID), may lead to infertility. Therefore, patients who have symptoms of genitourinary disorders should visit their healthcare providers as soon as possible.
Signs and symptoms
Interstitial cystitis: Symptoms of interstitial cystitis vary among patients. Individual patients may also experience changes in the severity of symptoms over time. For instance, stress, menstruation, allergies, and sexual activity may worsen symptoms.
Common symptoms include a frequent urge to urinate and passing small amounts of urine many times a day. Patients with severe interstitial cystitis may urinate more than 50 times in one day. Patients may experience pain in the pelvis or perineum (area between the anus and genital organs). Some patients may experience pain during sexual intercourse. Males may also experience pain when they ejaculate.
Some patients may experience either pain or frequent urination. However, most patients experience a combination of both symptoms.
Kidney stones (renal calculi): If the kidney stone is small, patients do not experience any symptoms of the condition. However, if the stone is large enough to block the tubes inside the kidney, patients may experience an intense pain that often comes and goes. Pain may last anywhere from five to 15 minutes at a time. The pain usually begins in the lower back. As the stone moves from the kidney toward the bladder, the patients may feel pain near the abdomen, groin, or genitals. Additional symptoms may include blood in the urine, cloudy or foul-smelling urine, nausea, vomiting, and constant urge to urinate.
In some patients, the kidney stone may cause an infection. Symptoms of an infection include fever and chills.
Neurogenic bladder: Damaged or defective nerves may send signals to the bladder at the wrong time, causing the muscles to spontaneously contract. This causes the bladder to become overactive. Symptoms of an overactive bladder may include frequent urination, persistent urge to urinate, and spontaneous emptying of the bladder that cannot be controlled (incontinence). Urine may occasionally leak out in small amounts throughout the day.
Other patients with neurogenic bladders may have underactive bladders. This happens when the nerves do not receive the message that the bladder is full or the message is too weak for the bladder to be completely emptied. When the nerves do not function properly, urine builds up in the bladder (urine retention). An overfull bladder may empty without warning. If the bladder is too full, it may back up and put pressure on the kidneys. Urine retention may also lead to an infection of the bladder or kidney.
Pelvic inflammatory disease (PID): Common symptoms of pelvic inflammatory disease (PID) include pain in the lower abdomen and pelvis, irregular menstrual bleeding, foul-smelling vaginal discharge, lower back pain, fever, fatigue, diarrhea, vomiting, pain during intercourse, and difficulty or pain during urination.
Prolapsed uterus: Symptoms of a prolapsed uterus vary depending on the severity of the condition. Mild cases may not cause any symptoms. Common symptoms may include a feeling of fullness or pressure in the pelvis, lower back pain, sensation that something is falling out of the vagina, difficulty urinating or moving the bowels, and difficulty walking.
Urinary incontinence: Patients with urinary incontinence are unable to control their bladders. Urine may leak out when the patient laughs, coughs, exercises, or lifts heavy weights. Small amounts of urine may leak out periodically throughout the day or night. Some patients may experience a sudden urge to urinate followed by an uncontrolled emptying of the bladder. Some patients may be unable to empty their bladders completely. As a result, urine may build up in the bladder until it cannot hold any more fluid. When this happens, the bladder spontaneously releases the urine. Some patients, especially children younger than seven years old, may be unable to control their bladders during sleep.
Urinary tract infection (UTI): Common symptoms of a urinary tract infection (UTI) include a constant urge to urinate, burning sensation during urination, blood in the urine (hematuria), cloudy or foul-smelling urine, and frequently passing small amounts of urine.
If the bladder becomes inflamed the condition is called cystitis. Symptoms of cystitis may include pelvic pressure, pain in the lower abdomen, and painful and frequent urination.
If the urethra becomes inflamed (urethritis), patients may experience a burning sensation during urination. Men with urethritis may experience penile discharge.
If the epididymis becomes inflamed in males, symptoms may include scrotal pain, tenderness in one or both testicles, tenderness in the groin, painful urination, painful intercourse or ejaculation, blood in the semen, and swelling of one or both testicles (orchitis).
Diagnosis
Interstitial cystitis: A potassium sensitivity test is the standard diagnostic for interstitial cystitis. During the procedure, a flexible tube, called a catheter, is used to fill the bladder is with distilled water. Then, the bladder is filled with a potassium solution. After each solution is instilled into the bladder, the patient rates how much pain and urgency to urinate they feel. If the patient feels more pain or urgency to urinate with the potassium solution than with the water, the patient is diagnosed with interstitial cystitis. Although researchers are unsure whether the potassium solution indicates increased bladder permeability or hypersensitive sensory nerves, patients with interstitial cystitis have been shown to be sensitive to the solution. Healthy patients do not notice any different between the two solutions.
Kidney stones (renal culculi): Imaging studies, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan may be performed if kidney stones are suspected. These tests take pictures of the kidneys, allowing healthcare providers to detect kidney stones.
Neurogenic bladder: If it is suspected that the patient has a neurogenic bladder, tests are performed to evaluate the bladder and nervous system.
Tests may be performed to determine how much water the bladder can hold and whether it is able to empty completely and efficiently.
Imaging studies, including X-rays, CT scans, and MRI scans, may be performed to take pictures of the urinary tract and nervous system. The images may show abnormalities that indicate nerve damage.
A healthcare provider may perform a test called an electroencephalograph (EEG) to detect abnormalities in the brain that may be causing the condition. During the procedure, small electrodes are taped to the patient's forehead. The electrical signals from the brain are transmitted to a small monitor. If the signals are abnormal, a positive diagnosis is made.
An electromyography (EMG) may also be performed to test the muscles and nerves of the bladder. During the procedure, a needle electrode is inserted through the skin and into the bladder muscle. The electrical activity detected by the electrode is displayed on a screen.
Pelvic inflammatory disease (PID): Pelvic inflammatory disease (PID) is diagnosed after a pelvic examination, cervical cultures, and/or analysis of the vaginal discharge. During a pelvic exam, a small instrument called a speculum is inserted into the vagina and the healthcare provider is able to examine the vagina, cervix, and uterus. The reproductive organs, including the uterus, will appear inflamed during a pelvic exam. Cervical cultures and/or analyses of vaginal discharge are performed to detect the presence of bacteria that are known to cause PID. If bacteria are present, a positive diagnosis is made.
Prolapsed uterus: A prolapsed uterus is diagnosed after a pelvic exam. Imaging studies, such as CT scans or MRI scans, are often needed to determine the severity of the condition.
Urinary incontinence: Patients who experience urinary incontinence should visit their healthcare providers to determine the underlying cause. Since it is common for children younger than seven years old to wet the bed, they usually do not require a medical diagnosis. Several tests may be performed to diagnose the patient. A healthcare provider may ask the patient to record fluid intake, time of urination, and number of incontinence episodes over the course of several days.
A sample of urine may be collected from the patient to check for an infection.
A sample of blood may be taken from the patient to check for medications or chemicals that may be causing incontinence.
A postvoid residual (PVR) measurement test may be performed to determine if the patient is able to empty the bladder. Patients urinate into a container that allows the healthcare provider to measure the amount of urine that is excreted. Then, the healthcare provider inserts a soft, thin tube into the urethra and bladder to drain any remaining urine. If there is a lot of urine left in the bladder, this may indicate that there is an obstruction (such as at tumor) or a problem with the muscles or nerves.
A pelvic ultrasound may be performed to detect abnormalities in the urinary tract. During a pelvic ultrasound in females, a probe, called a transducer, is inserted into the vagina. The transducer sends pictures of the pelvic organs to a nearby camera. During a pelvic ultrasound in males, a transducer is inserted into the rectum, and pictures are taken of the pelvic organs, including the prostate and seminal vesicles.
Urodynamic testing may also be performed to measure the pressure inside the bladder when it is empty and when it is filling. A catheter is inserted through the patient's urethra and into the bladder. The bladder is then filled with water. The pressure inside the bladder is monitored. This test allows the healthcare provider to measure the strength of the bladder muscle.
A cystoscopy may be performed to detect possible abnormalities in the urinary tract. During the procedure, a thin tube with a camera, called a cystoscope, is inserted into the urethra and into the urinary tract. The cystoscope projects images of the urinary tract onto a screen.
Urinary tract infection: A urine analysis is the standard diagnostic test for a urinary tract infection. A sample of the patient's urine is analyzed in a laboratory. If disease-causing microorganisms are present, a positive diagnosis is made. Puss and blood cells may also be detected in the urine, which suggest an infection.
Complications
Infertility: Patients with pelvic inflammatory disease (PID) may become infertile. Patients who wait to receive treatment have the greatest risk of becoming infertile.
Therefore, patients who experience signs and symptoms of PID should visit their healthcare providers as soon as possible.
Pain: Up to 50% of females with PID develop chronic pelvic pain that may last for months or years. PID may cause scarring in the fallopian tubes and other organs that may lead to pain during exercise, ovulation, and sexual intercourse.
Patients with interstitial cystitis may experience severe pain. This pain may worsen during sexual intercourse or ejaculation. This may affect sexual intimacy among couples. Medications are available to reduce these symptoms. Patients should regularly visit their healthcare providers to ensure that their treatments are effective.
Skin problems: Patients with urinary incontinency may develop skin rashes, infections, or sores.
Quality of life: Patients who experience urinary incontinence may also suffer from a decreased quality of life. Patients may be less likely to travel or participate in activities because they are worried about having accidents. Patients with incontinence should visit their healthcare providers to diagnose and treat the underlying cause.
Treatment
Antibiotics: Medications called antibiotics are used to treat urinary tract infections (UTIs) and pelvic inflammatory disease (PID). Antibiotics, which are usually taken by mouth, kill the disease-causing microorganism. Severe infections that have spread to the kidneys may require hospitalization and intravenous antibiotics. Commonly prescribed antibiotics include amoxicillin (Amoxil? or Trimox?), nitrofurantoin (Furadantin? or Macrodantin), trimethoprim (Proloprim?), trimethoprim/sulfamethoxazole (Bactrim? or Septra?). Symptoms usually start to improve after a few days of treatment.
Patients should take medications exactly as prescribed. Even if symptoms appear to go away, patients should take all of their medication because there may still be bacteria in the body. Stopping medication early may allow the infection to return. Also, stopping medication early may lead to antibiotic resistance. The few remaining bacteria in the body that survive most of the antibiotic therapy are the most difficult to kill. If the bacteria become resistant to treatment, the medications will no longer be effective if taken in the future.
Pentosan (Elmiron?): The only medication that is approved by the U.S. Food and Drug Administration (FDA) for the treatment of interstitial cystitis is called pentosan (Elmiron?). This drug may help fix the epithelium, which is the protective lining of the bladder. As a result, the drug may help prevent toxic substances from entering the bladder and causing irritation. Patients may experience reduction in pain after two to four months and decreases in urgency to urinate after about six months of treatment.
Side effects may include upset stomach and hair loss. Avoid if pregnant, possibly pregnant, or if thinking about becoming pregnant because pentosan may cause miscarriage.
Extracorporeal shock wave lithotripsy (ESWL): If patients with kidney stones are unable to pass their stones by drinking extra fluids, a procedure called extracorporeal shock wave lithotripsy (ESWL) may be performed. This is the most commonly used procedure to remove kidney stones. Sound waves (shock waves) are used to break the stone into smaller pieces.
Patients receive sedatives and/or anesthesia before the procedure. The patient will either be partially submerged in a tub of water or will lie on a soft cushion. Patients wear headphones because the shock waves are loud. High-energy sound waves then pass through the patient's body and break the stone into smaller pieces. The healthcare provider usually uses X-rays or an ultrasound to monitor the status of the stone. Treatment usually lasts for about one hour. Once the stone is broken into smaller pieces, it can be excreted in the urine.
Side effects of treatment include blood in the urine, bruising on the abdomen or back, bleeding around the kidney or nearby organs, and pain when the stone fragments are passed in the urine.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Patients with interstitial cystitis may take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin? or Advil?) to reduce pain and inflammation associated with the condition.
Tricyclic antidepressants: Patients with interstitial cystitis may take tricyclic antidepressants, such as imipramine (Tofranil?), by mouth to help relax the bladder. Although these medications are primarily prescribed to treat depression, they have also been shown to have muscle relaxant properties. As a result, tricyclic antidepressants may help reduce a patient's urge to urinate and minimize pain.
Side effects may include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, and weight gain or loss.
Cystoscopy with bladder distention: Some patients with interstitial cystitis may undergo a procedure called cystoscopy with bladder distention. Patients receive anesthesia so they will not feel any pain during the procedure. A thin tube, called a cystoscope, is inserted through the urethra and into the bladder. Then water is infused into the bladder to stretch the bladder. If successful, the treatment will temporarily reduce frequent urges to urinate. If the patient has a positive response to treatment, the procedure may be repeated in the future. This procedure is generally well tolerated.
Anticholinergics: Medications called anticholinergics may be used to treat patients with overactive bladders. These drugs help relax the muscles of the bladder and prevent urine retention. The U.S. Food and Drug Administration (FDA) has approved trospium chloride (Sanctura?), darifenacin (Enablex?), and solifenacin succinate (VESIcare?) for the treatment of overactive bladders. Medications, such as oxybutynin chloride (Ditropan? or Oxytrol?), tolterodine (Detrol?), hyoscyamine (Levsin?), and propantheline bromide (Pro-Banthine?), have also been prescribed to treat overactive bladders. These drugs are usually taken by mouth daily to reduce symptoms. They are also available as patches that are applied to the skin.
Side effects may include dry mouth, blurred vision, constipation, increased heartbeat, and flushing (reddening of the skin).
Bladder training: Patients with underactive bladders may be able to control their bladders better with a type of therapy called bladder training. The patient records the amount of fluid intake, trips to the bathroom, and episodes of urine leakage every day over the course of several days to weeks. This record may have a pattern and patients may be able to avoid accidents by planning to use the bathroom at certain times of the day. Once patients gain control over their bladders, they may be able to increase the time between urination.
Kegel exercises: Patients may be able to reduce symptoms of urinary incontinence by strengthening their urinary sphincter muscles. These muscles help control urination. To do Kegel exercises, squeeze the muscles that are used to stop urine flow for about three seconds. Then release and repeat several times. Patients can perform these exercises any time during the day.
Urethral inserts: Urethral inserts are small, tampon-like disposable devices that females insert into the urethra. The urethra is the tube that releases urine out of the body. Therefore, urethral inserts help prevent urine from leaking out. These inserts, which are available by prescription, should not be used every day. Instead, they are usually used if a patient has predictable incontinent episodes. For instance, some patients may experience incontinence during exercise. When the females need to urinate, the device can be easily removed.
Pessary: Female patients with a prolapsed bladder or uterus that is causing urinary incontinence may be prescribed a pessary. This device is a stiff ring that is inserted into the vagina. The device holds up the bladder and helps prevent leakage. The pessary needs to be removed and cleaned daily in order to prevent infections.
Surgery: In severe cases of urinary incontinence, surgery may be considered. This treatment is usually reserved for patients who have not responded to other types of treatment. Surgery may be performed to enlarge the bladder. A part of the patient's bowel may be removed and added to the bladder to make it bigger. Although this surgery may improve symptoms of urinary incontinence, it may make it more difficult to empty the bladder. There is also a risk that the bladder may rupture, causing urine to leak into nearby tissues. Other potential risks include bladder infection and bladder/kidney stones.
Patients with a prolapsed uterus require surgery to either remove or repair the uterus. When discussing treatment options, patients should tell their healthcare providers if they want to have children in the future. Patients can only become pregnant if they have a uterus. Therefore, if the patient wants to become pregnant one day, the healthcare provider will first try to repair the uterus before removing it.
Protective pads and garments: Patients with persistent urinary incontinence may benefit from protective pads and garments. Most products available today are similar in size to normal under garments. They are not noticeable under clothing. These products are available at local drugstores, supermarkets, and medical supply stores.
Panty liners or pads may be worn inside of undergarments to collect urine. Adult diapers are also available.
Males who leak small amounts of urine throughout the day may use a drip collector. This is a small piece of padding that covers the penis.
Children who wet the bed may wear diapers, such as Pull-Ups?, during sleep. Children are able to take these diapers off like normal underwear, and they help keep bed linens clean and dry after an accident.
Catheter: If patients experience urinary incontinence because the bladder is unable to empty, a soft tube, called a catheter, may be recommended. The catheter is inserted into the urethra several times a day to drain the bladder. This helps prevent the bladder from spontaneously overflowing when it is full. It also helps prevent the urine from backing up and causing permanent kidney problems. Healthcare providers will show patients how to use catheters. Catheters will need to be removed and cleaned daily in order to prevent infections.
Integrative therapies
Good scientific evidence:
Chondroitin sulfate: Several studies have shown promise for using chondroitin for urinary incontinence.
Use cautiously if allergic or hypersensitive to chondroitin sulfate products and with shellfish allergy. Use cautiously with bleeding disorders and with blood-thinners like warfarin (like Coumadin?). Avoid with prostate cancer or increased risk of prostate cancer. Avoid if pregnant or breastfeeding.
Cranberry: Cranberries come from small evergreen shrubs with tart, red, edible berries. The berries are used in sauces, jellies, and drinks. There are multiple studies of cranberry (juice or capsules) for the prevention of urinary tract infections in healthy women and nursing home residents. While no single study convincingly demonstrates the ability of cranberry to prevent urinary tract infections, the sum total of favorable evidence combined with laboratory research tends to support this use. It is not clear what dosage is best. Patients should choose a juice that is made with 100% cranberry juice. Cranberry seems to work by preventing bacteria from sticking to cells that line the bladder. Contrary to prior belief, urine acidification (urine that is concentrated and has a lower-than-normal pH) does not appear to play a role. Notably, many studies have been sponsored by the cranberry product manufacturer Ocean Spray?. Additional research is needed in this area before a conclusion can be made.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
DMSO: DMSO (dimethyl sulfoxide) is naturally found in vegetables, fruits, grains, and animal products. DMSO is available for both non-medicinal and medicinal uses. A major clinical use of DMSO is to relieve symptoms of interstitial cystitis. Intravesical DMSO is U.S. Food and Drug Administration (FDA)-approved for interstitial cystitis when given by a qualified healthcare professional. DMSO may work when other treatments have failed.
Avoid if allergic or hypersensitive to DMSO. Use cautiously with urinary tract cancer, liver disorders, or kidney dysfunction. Avoid if pregnant or breastfeeding.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. Many different techniques are used, including exercises, stretches, traction, electrical stimulation, and massage. A variety of techniques have been used to improve incontinence (loss of urinary control) such as pelvic-floor neuromuscular electrostimulation combined with exercises, pelvic floor muscle exercises alone (Kegel exercises), vaginal cones, and vaginal balls. Outcome measures studied have included bladder volume, vaginal palpation, and perceptions of improvement. Overall, short-term improvements have been seen with pelvic floor exercises and vaginal balls. Physical therapy appeared more effective than biofeedback techniques based on one trial, but higher-quality trials and comparisons with placebo are needed to confirm these results.
Vaginal balls should be thoroughly cleaned after each use. Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, complications are possible. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Vitamin C: Vitamin C may decrease the risk of developing urinary tract infection during pregnancy. Further research is needed to confirm early study findings.
Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.
Unclear or conflicting scientific evidence:
Acupressure, shiatsu: During acupressure, finger pressure is applied to specific acupoints on the body. Acupressure is used around world for relaxation, wellness promotion, and the treatment of many health problems. Early research suggests that acupressure may help treat bed-wetting in children. However, further research is needed to confirm these initial findings.
With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Acupuncture has been suggested as a possible treatment for enuresis (bed-wetting). However, additional long-term studies are needed to determine whether or not this is an effective treatment.
Early study in women suggests a reduced recurrence of urinary tract infection over six months and reduced residual urine (urine retained in the bladder after urination). Better-designed studies are needed.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Avoid if taking drugs that increase the risk of bleeding (anticoagulants). Use cautiously with pulmonary disease (such as asthma or emphysema). Use cautiously with a history of seizures, diabetes, critical illnesses, or if elderly. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
Bromelain: Bromelain is an herb that contains a digestive enzyme, which comes from the stem and the fruit of the pineapple plant. Additional research is needed to determine if bromelain can help treat urinary tract infections.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceaefamily. Use cautiously with a history of bleeding disorders, stomach ulcers, heart disease, liver disease, or kidney disease. Use cautiously two weeks before and immediately after dental or surgical procedures. Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.
Chamomile: Chamomile is an herb that has an apple-like smell and taste. The name chamomile is derived from the Greek kamai melon, which means ground apple. Chamomile is a common tea. Preliminary research suggests that the combination of chamomile baths plus chamomile bladder washes and antibiotics is superior to antibiotics alone for hemorrhagic cystitis (bladder irritation with bleeding). Additional research is necessary before a conclusion can be reached.
Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before and immediately after surgery or dental or diagnostic procedures that have bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is not enough reliable scientific evidence to ascertain the effects of chiropractic techniques in the management of nocturnal enuresis (bed-wetting).
Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease (osteoporosis), bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Chlorophyll: Chlorophyll is responsible for the green color of plants. It can be obtained from green leafy vegetables (e.g. broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae, wheat grass, and numerous herbs (e.g. alfalfa, damiana, nettle, and parsley). Based on historical use, chlorophyll has been suggested to improve bodily odor in colostomy patients. Despite empirical use, clinical research with chlorophyll supplements did not support these findings. Further research is warranted.
Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressants or anti-diabetes agents. Avoid if pregnant or breastfeeding.
Chondroitin sulfate: There is preliminary research administering intravesicular chondroitin in patients diagnosed with interstitial cystitis. Additional evidence is necessary before a firm conclusion can be drawn.
Use cautiously if allergic or hypersensitive to chondroitin sulfate products and with shellfish allergy. Use cautiously with bleeding disorders and with blood-thinners like warfarin (like Coumadin?). Avoid with prostate cancer or increased risk of prostate cancer. Avoid if pregnant or breastfeeding.
Cranberry: There is preliminary evidence that cranberry juice may reduce urine odor from incontinence or bladder catheterization. Well-designed human studies of cranberry for urinary tract infection treatment are currently lacking. Laboratory research suggests that cranberry may not be an effective treatment when used alone, although it may be helpful as an adjunct to other therapies such as antibiotics. Contrary to prior opinion, urine acidification does not appear to be the way that cranberry prevents urinary tract infections. More research is needed in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
DMSO: DMSO may relieve symptoms of inflammatory bladder disease. Further research is needed to confirm these results.
Avoid if allergic or hypersensitive to DMSO. Use cautiously with urinary tract cancer, liver disorders, or kidney dysfunction. Avoid if pregnant or breastfeeding.
Ginger: It is unclear if ginger can help treat urinary disorders in post-stroke patients.
Avoid with anticoagulation therapy. Avoid large quantities of fresh cut ginger with inflammatory bowel disease or a history of intestinal obstruction. Use cautiously prior to surgery and with gastric or duodenal ulcers, gallstones, cardiovascular disease, and diabetes. Use cautiously long-term and in underweight patients. Use cautiously if taking heart medications or sedatives and if driving or operating heavy machinery. Use cautiously if pregnant or breastfeeding.
Horseradish: Horseradish (
Armoracia rusticana) is a hardy perennial plant of the Brassicaceae family, which includes mustard and cabbage. Several laboratory studies suggest that horseradish has antibiotic activity. Limited human study used a combination product made from horseradish root and nasturtium herb to treat common bacterial infections, including urinary tract infections (UTIs). Researchers found that the combination product was as effective as standard antibiotic therapy. However, further studies evaluating horseradish alone are needed.
Intravenous horseradish should be used cautiously. Use cautiously with bleeding disorders, high blood pressure, thyroid disorders, kidney disorders, gastrointestinal conditions, or ulcers. Use cautiously if taking anticoagulants, anti-platelet drugs, blood pressure drugs, anti-inflammatories, thyroid hormones, or if receiving cancer treatment. Avoid medicinal amounts of horseradish if pregnant or breastfeeding.
Hydrotherapy: There is currently insufficient evidence to determine the safety or effectiveness of hydrotherapy for treatment of pelvic inflammatory disease (PID). PID is a potentially serious medical condition that should be evaluated by a qualified, licensed healthcare provider.
Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, or saunas, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
Hypnosis, hypnotherapy: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions or to change behaviors. Studies have evaluated the effectiveness of hypnotherapy for the treatment of bed-wetting (nocturnal enuresis). However, results are inconclusive. Further research is needed.
Use cautiously with mental illnesses, such as psychosis, schizophrenia, manic depression, multiple personality disorders, or dissociative disorders. Use cautiously with seizure disorders.
Lingonberry: Cranberry juice is commonly used to prevent and treat urinary tract infections. One clinical trial using a combination of cranberry and lingonberry juice found that this was more effective. Higher quality research comparing lingonberry juice or cranberry-lingonberry juice to cranberry juice alone is needed.
Avoid if allergic or hypersensitive to lingonberry (Vaccinium vitis-idaea), its constituents, or members of the Ericaceae family. Use cautiously in male patients in couples who are trying to become pregnant. Avoid if pregnant or breastfeeding.
Magnet therapy: Magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Several small preliminary studies have been conducted using electromagnetic stimulation therapy in patients with urinary incontinence (including both stress and urge incontinence). The premise of this approach is that by seating individuals in a chair unit with a magnetic coil, electromagnetic pulses can be created that induce contractions of pelvic floor muscles. A course of therapy may involve up to two 20-minute treatments per day over eight weeks. The available studies have not been randomized, placebo controlled, or adequately blinded, and the number of involved patients has been small. Therefore, although the initial results are promising, better quality studies are necessary before a clear conclusion can be drawn. Nonetheless, patients with persistent incontinence who have not had success with other approaches and who have been evaluated by a urologist, may wish to pursue this approach with qualified healthcare professionals (who can explain the potential benefits and risks).
Avoid with implantable medical devices like heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions and should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with their qualified healthcare providers before starting treatment.
Moxibustion: Moxibustion is a therapeutic method in Chinese and Japanese acupuncture. The therapy involves burning an herb (usually mugwort) above the skin or on the acupuncture points to introduce heat into an acupuncture point and alleviate symptoms. It may be applied in the form of a cone, stick, or loose herb. It may also be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle. There is preliminary evidence suggesting that moxibustion combined with acupuncture may help reduce urological symptoms in women with urethritis (inflammation of the urethra resulting in painful urination). However, more studies are needed.
Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions, cramps, diabetic neuropathy, extreme fatigue, anemia, fever, or inflammatory conditions. Avoid over allergic skin conditions, ulcerated sores, skin adhesions, or inflamed areas or organs. Do not use over the face, genitals, head, or nipples. Avoid using immediately after exercise or taking a hot bath or shower. Use cautiously over large blood vessels and thin or weak skin. It is not advisable to bathe or shower for up to 24 hours after a moxibustion treatment. Avoid if pregnant or breastfeeding.
Peppermint: Peppermint is a flowering plant that grows throughout Europe and North America. Peppermint is most often grown for its fragrant oil. Peppermint tea added to other therapies has been used in the treatment of urinary tract infections. It is not clear if this is an effective treatment, and it is not recommended to rely on peppermint tea alone to treat this condition.
Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.
Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine and aid in digestion. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. Studies of
Lactobacillus preparations have had mixed results. Evidence suggests that a combination of
Lactobacillus rhamnosus GR-1 and
L.
fermentum RC-14 may reduce potentially harmful vaginal bacteria and yeast in healthy women. Other studies have found no benefit for women or pre-term infants. More studies are needed to determine the effectiveness of probiotics in the prevention of urinary tract infection.
Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behavior to help with problem solving. Preliminary evidence showed that psychotherapy may be more effective for bed wetting in children than either an alarm or rewards in terms of children failing or relapsing. In another study, psychotherapy and a placebo was just as effective as psychotherapy combined with the medications piracetam and diphenylhydantoin, suggesting that psychotherapy may be used before drugs. Further research is needed to determine if psychotherapy is an effective treatment for bedwetting.
People with urinary disorders such as unstable bladder (detrusor instability) or sensory urgency may benefit from psychotherapy. Early research suggests that psychotherapy may help reduce urgency, improve incontinence, and decrease nighttime urination, but probably not overall frequency. More research is needed.
Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
Reflexology: Some studies have suggested that reflexology may help prevent fecal soiling and bed-wetting (enuresis) in children. However, the research thus far in inconclusive. Research also suggests that reflexology may have beneficial effects in women with urinary incontinence. More studies are necessary to confirm the benefits of reflexology.
Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
Saw palmetto: There is currently insufficient evidence to recommend for or against the use of saw palmetto for the management of hypotonic neurogenic bladder.
Avoid if allergic or hypersensitive to saw palmetto. Use cautiously with a history of health conditions involving the stomach, liver, heart, or lungs. Use cautiously with hormone-sensitive conditions or bleeding disorders. Use cautiously if taking anticoagulants (e.g. warfarin), hormonal drugs (e.g. finasterid), or birth control pills. Avoid if pregnant or breastfeeding.
TENS (transcutaneous electrical nerve stimulation): TENS (transcutaneous electrical nerve stimulation) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Further research is needed to determine if TENS is an effective treatment for patients with urinary incontinence.
Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with seizure disorders or decreased sensation, such as neuropathy. Avoid if pregnant or breastfeeding.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract reduces urinary tract infection frequency and infection persistence. Further evidence is required before recommendations can be made.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking immunosuppressants or hormonal therapy. Avoid if pregnant or breastfeeding. Thymic extract increases human sperm motility and progression.
Uva ursi: Uva ursi (bearberry) is described as a small evergreen shrub with clusters of small white or pink bell-shaped flowers and dull orange berries. Uva ursi has long been used as a folk remedy to treat urinary tract infection (UTI). The active ingredients in the herb are believed to be ursolic acid and isoquercitrin. Additional study is needed to make a firm conclusion in this area.
Avoid if allergic or hypersensitive to uva ursi (Arctostaphylos uva-ursi) or to other members of the Ericaceae family. Avoid with a history of anxiety, high blood pressure, glaucoma, impaired cerebral circulation, benign prostate tumor (with residual urine accumulation), pheochromocytoma, Grave's disease, or kidney disease. Use cautiously with liver disorders, gastrointestinal problems, or gallstones. Use cautiously if taking diuretics. Avoid if pregnant or breastfeeding.
Fair negative scientific evidence:
Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Arginine has been proposed as a treatment for interstitial cystitis or inflammation of the bladder. However, most human studies have not found that arginine improves symptoms, such as urinary frequency or urgency.
Avoid if allergic to arginine, or with a history of stroke, liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin?) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
Cranberry: There is preliminary evidence that cranberry is not effective for chronic urinary tract infection prophylaxis.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice can affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
Prevention
Patients should drink plenty of water to reduce the risk of developing kidney stones.
Patients should empty their bladders when they feel the urge to urinate. Waiting a long time after the urge arises increases the risk of developing a urinary tract infection (UTI).
Patients should empty their bladders after intercourse. This helps reduce the risk of UTIs.
Children who wet the bed should avoid drinking fluids a few hours before bedtime.
Promptly treating sexually transmitted diseases (STDs), such as gonorrhea, helps reduce the risk of developing pelvic inflammatory disease (PID).
Patients who have been diagnosed with PID should ask their sexual partner to be tested and treated for STDs. This can help prevent the patient from developing PID in the future.
Patients should practice safe sex and use condoms or other protective barriers during oral, anal, and vaginal sex.
Author information
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Bibliography
Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol. 2007 Feb;177(2):450-6. .
Chancellor MB, Yoshimura N. Treatment of interstitial cystitis. Urology. 2004 Mar;63(3 Suppl 1):85-92. .
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). .
Natural Standard: The Authority on Integrative Medicine. .
Phatak S, Foster HE. The management of interstitial cystitis: an update. Nat Clin Pract Urol. 2006 Jan;3(1):45-53. .
Rosenberg M, Parsons CL, Page S. Interstitial cystitis: a primary care perspective. Cleve Clin J Med. 2005 Aug;72(8):698-704. .
Steele AC, McLennan MT. The painful bladder: urinary tract infection and interstitial cystitis in women. Mo Med. 2007 Mar-Apr;104(2):160-5. .
Common types and causes of genitourinary disorders
Interstitial cystitis: Interstitial cystitis, also called painful bladder syndrome or frequency-urgency-dysuria syndrome, is a long-term inflammatory condition that causes frequent urination and bladder pain.
In healthy individuals, the bladder will expand until it is full. Once this happens, the brain receives a message from the pelvic nerves, which causes patients to feel the urge to urinate. Patients with interstitial cystitis feel the urge to urinate more often than they should.
Although interstitial cystitis can affect anyone, it is most common among women.
The exact cause of interstitial cystitis remains unknown. Most experts believe that patients are born with a leaky epithelium, which is the protective lining of the bladder. If toxic or harmful substances enter the bladder through the epithelium, it may cause irritation and lead to cystitis.
It has also been suggested that the interstitial cystitis is the result of inheritance, infections, allergic reactions, or autoimmunity. Autoimmunity occurs when the immune system, which normally fights against disease and infection, mistakenly attacks body cells. However, further research is needed to verify these theories.
Neurogenic bladder: A neurogenic bladder occurs when the pelvic nerves do not function properly. This may lead to either an overactive or underactive bladder.
There are many potentially causes of a neurogenic bladder. Some of the most common causes include diabetes, infections, tumors, heavy metal poisoning, vaginal childbirth, stroke, multiple sclerosis, and brain or spinal cord injuries. Some patients are born with genetic nerve problems that cause the condition.
Kidney stones (renal calculi): Kidney stones, also called renal calculi, urolithiasis, or nephrolithiasis, usually develop when the urine becomes too concentrated (urine acidification). As a result, minerals and other substances in the urine form hard crystals in the kidneys. Over time, these crystals may combine to form a small, hard mass or stone. There are four types of kidney stones that can develop: calcium stones (calcium oxalate stones), struvite stones, uric acid stones, and cystine stones.
Calcium stones are the most common type of kidney stones, accounting for 80% of cases. Calcium stones develop when there are high levels of calcium (hypercalcemia) and oxalate in the blood. Patients who consume excessive amounts of vitamin D or have overactive thyroids may have high levels of calcium in the blood. Patients who consume large amounts of oxalic acid or undergo intestinal bypass surgery may have high levels of oxalate in the blood.
Struvite stones are usually caused by chronic urinary tract infections. The bacteria that cause these infections release enzymes that increase the amount of ammonia in the urine. This excess ammonia may form large, sharp stones that may damage the kidneys.
Uric acid stones form when there is excess uric acid in the urine. Uric acid is a byproduct of protein metabolism. These stones are usually caused by a cancer treatment called chemotherapy. It may also develop in patients who eat high-protein diets. Some patients are genetically predisposed to develop uric acid stones.
Cystine stones develop in patients who have an inherited disorder called cystinuria. This disorder causes the kidneys to release too many amino acids. The excess amino acids then form stones.
Pelvic inflammatory disease (PID): Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that causes pain and swelling. If left untreated, PID may lead to long-term pelvic pain. It may also result in infertility or complications during pregnancy.
PID usually develops when a sexually transmitted bacteria enters the uterus and reproduces in the upper genital tract. The most common bacteria that causes PID also causes the sexually transmitted disease (STDS) gonorrhea and chlamydia.
Prolapsed uterus: If the uterus collapses into the vaginal canal, the condition is called a prolapsed uterus.
There are many causes of a prolapsed uterus. Weakened pelvic muscles caused by aging may lead to a prolapsed uterus. Vaginal childbirth and medical conditions, such as such as chronic cough, straining from constipation, pelvic tumors, or an accumulation of fluid in the abdomen, may also cause the condition.
Urinary incontinence: Urinary incontinence describes the inability to control the bladder. The bladder spontaneously empties all or some of the urine.
Incontinence is a symptom of an underlying illness. Incontinence may be temporary or permanent, depending on the cause.
Most children, especially those younger than seven years old, experience nighttime incontinence, also called bedwetting or nocturnal enuresis. This may happen because the child's bladder is still developing and it cannot hold all of the urine that is produced during sleep. Very young children may be unable to recognize when they have full bladders. This is because the nerves that control the bladder take a long time to develop. Adults may also wet the bed. Other causes of bedwetting in children and adults may include stress, urinary tract infections, sleep apnea, diabetes, and chronic constipation.
In addition, alcohol, caffeine, dehydration, over-hydration, bladder irritation, medications (such as sleeping pills, antidepressants, or diuretics), urinary tract infections (UTIs), and constipation may lead to temporary incontinence.
Urinary incontinence may also be a long-term symptom of an underlying medical condition. For instance, pregnant women may experience incontinence because their bodies are going through hormonal and weight changes. Vaginal childbirth may damage the pelvic nerves and supportive tissues and muscles that are involved in bladder control. Aging is also associated with urinary incontinence because the bladder muscles become weaker over time. Also, elderly women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Other medical conditions, including inflamed prostate gland (prostatitis), enlarged prostate, prostate cancer, bladder stones, neurological disorders (such as Parkinson's Disease or multiple sclerosis), and tumors that block the urinary tract may lead to urinary incontinence.
Urinary tract infections (UTI): A urinary tract infection (UTI) is an infection of the urinary system. UTIs may affect any part of the urinary tract including the kidneys, ureters, bladder, and urethra. However, most infections involve the lower tract, which includes the urethra and the bladder.
Infections may cause swelling, especially of the urethra (urethritis), bladder (cystitis), epidiymis (epidiymitis), or one or both testicles (orchitis). When a UTI causes cystitis, the condition is sometimes called honeymoon cystitis. If bleeding occurs with an inflamed bladder, the condition is called hemorrhagic cystitis.
Infections typically develop when bacteria or viruses enter the urinary system through the urethra. Once inside the bladder, the disease-causing microorganism begins multiplying.
Females are more likely to develop UTIs than males. This is because the female's urethra is much closer to the anus than the male's. The anus harbors many disease-causing organisms that may cause UTIs.
Patients with UTIs typically experience a full recovery with treatment. However, if the patient does not receive treatment, the infection may spread to the kidneys where it can cause permanent damage.