Bladder control problems or urinary incontinence is not something we want to talk about, but it is extremely common. Millions of people -young, old, male, female- experience incontinence. Women experience incontinence twice as often as men. And women with fibromyalgia are even more likely to experience bladder control problems. Bladder symptoms may include urinary frequency, incontinence, urgency and interstitial cystitis (bladder pain).
In one research study titled “Pelvic Floor and Urinary Distress in Women with Fibromyalgia“, women with fibromyalgia were found to report significantly bothersome pelvic floor and urinary symptoms. In general, when FM impact was worse, pelvic and bladder symptoms were also worse.
Another study focused on the association of overactive bladder (OAB) and Fibromyalgia in adults aged 40 and over. The association between FMS and severity of OAB was significant. The study concluded that OAB is associated with FMS. Furthermore, FMS increases with severity of OAB.
The frequency of bladder symptoms in patients with fibromyalgia has led to the development of a sensory rating tool. The tool is known as the Fibromyalgia Bladder Index. It helps doctors and patients assess bladder symptoms that are not related to urinary tract infections. The rating tool allows doctors to understand the symptoms the patient is experiencing and helps to track information about the progression or development of bladder problems in patients with fibromyalgia.
TYPES OF BLADDER CONTROL PROBLEMS LINKED TO FIBROMYALGIA
Urinary incontinence is an involuntary loss of urine. It occurs because of problems with muscles and nerves that help hold or release urine. Bladder symptoms depend on the type of urinary incontinence you have.
You might leak urine when pressure is put on your bladder by coughing or sneezing. You might have sudden, intense urges to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night.
One in five women with fibromyalgia also experience unexplained bladder pain and pressure, with a frequent need to urinate and increased pain during urination.
The types of bladder control problems that tend to affect people with fibromyalgia include:
- Stress Incontinence – Stress incontinence is the most common type of bladder control problem. Bladder leakage can occur when you exercise, laugh, cough, sneeze or any time pressure is put on your bladder. It is caused by weakened pelvic muscles. Pregnancy and childbirth can stretch and weaken the pelvic muscles. The lack of estrogen after menopause can cause your pelvic muscles to weaken. Being overweight and taking certain medications can also lead to stress incontinence.
- Urge Incontinence – Urge incontinence is also called overactive bladder (OAB) or irritable bladder. With this type of bladder control issue, you have the urgent need to go to the bathroom. And you may not get there in time. Abnormal nerve signals cause the bladder to spasm and empty. Any condition that affects the nervous system can lead to urge incontinence. Infections, bladder stones, and certain medications can also cause it.
- Overflow Incontinence – Overflow incontinence is when you can’t fully empty your bladder. Causes include weak bladder muscles, nerve damage, constipation and certain medications. It can also be caused by conditions that block the flow of urine such as tumors or an enlarged prostate in men. So, if you can only dribble urine, you need to get treated. When you can’t empty your bladder, it can lead to infections and other problems.
- Mixed Urinary Incontinence – This means you have two types of incontinence happening at the same time. Many women have both stress and urge incontinence.
- Interstitial Cystitis (IC) – This is a condition resulting in discomfort or pain in the bladder or pelvic area. Symptoms can range from mild discomfort to intense pain in the bladder or pelvic area which may change as the bladder empties or fills up. In addition, there may be urgent or frequent needs to urinate. The condition may also be referred to as Painful Bladder Syndrome (PBS). IC often occurs in women with fibromyalgia and Irritable Bowel Syndrome.
The cause of urinary incontinence with fibromyalgia may be due to fatigue or weakened bladder muscles. Or possibly abnormal nerve signals that cause the bladder to spasm. Many women with fibromyalgia tend to have chronic urinary tract infections which can cause incontinence. Also, there are many medications that can cause incontinence or make it worse. These medications include high blood pressure medications, diuretics, antidepressants, narcotic painkillers, sleep medications and oral estrogens.
TREATING BLADDER CONTROL PROBLEMS
Talking about bladder control problems is not easy. You may feel embarrassed to tell your doctor. But talking about it is the first step to finding a solution. Your doctor will likely offer several treatment options based on the type of incontinence you have, the severity, and the underlying cause of the problem.
Some treatments your doctor may suggest include:
- Lifestyle Changes – If you have stress incontinence you may need to limit your intake of fluids. With urge incontinence, you may need to avoid spicy foods, caffeine and carbonated drinks which can irritate the bladder.
- Pelvic Floor Exercises – Pelvic floor exercises also called Kegels are recommended for women with stress, urge, or mixed incontinence. Kegel exercises consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. You can do kegel exercises lying down, sitting or standing up. The trick is to squeeze the right muscles. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends doing kegel exercises three times a day.
- Bladder Training – Bladder training can be used for stress and urge incontinence. It involves voiding on a fixed schedule while gradually increasing the time between emptying your bladder. The goal of bladder training is to:
- Lengthen the amount of time between bathroom trips
- Increase the amount of urine your bladder can hold
- Improve your control over the urge to urinate
- Medications – There are no medications approved for stress incontinence. But if you have urge incontinence or overactive bladder there are medications to prevent bladder spasms. Examples of these medications are Oxytrol, Detrol, Ditropan XL, Enablex, Myrbetriq, and Vesicare. Oxytrol is available without a prescription. Also, Botox can be injected into the bladder muscle to relax the muscle and increase it’s storage compacity.
- Pessary Device – A pessary is a plastic device that is inserted into the vagina. It can help prevent urine leakage by supporting the neck of the bladder. A pessary is most useful for stress incontinence.
- Electrical Nerve Stimulation – Electrical stimulation of the nerves that control the bladder can improve symptoms of urge incontinence as well as problems emptying the bladder. This treatment is usually offered when medications do not work. At first, a device outside your body is used to deliver stimulation through a wire implanted in your skin. If the treatment relieves the symptoms, your doctor may want to have a permanent device implanted, much like a pacemaker.
- Surgery – If other treatments fail, your doctor may suggest surgery to improve bladder control. Surgery only helps stress incontinence. It doesn’t help urge incontinence. Most stress incontinence problems are caused by the neck of the bladder dropping down toward the vagina. To correct the problem, a ribbon-like sling or a web of strings is attached to the muscle or bone. The sling will hold up the bottom of the bladder and the top of the urethra to stop leakage.
- Catheterization – If your bladder does not empty as a result of nerve damage, you might have to use a catheter. A catheter is a thin tube that you insert through the urethra into the bladder to drain the urine. You may use a catheter once in a while, a few times a day or all the time.
Even though bladder control problems are common with fibromyalgia, it’s important to seek medical advice. Don’t let embarrassment get in the way. In most cases, urinary incontinence is easily treated. But sometimes, loss of bladder control may indicate a more serious underlying condition.