Your bladder and you

1
Your bladder and you

• Thought about your aging bladder

2
Objectives

• To have a better understanding of bladder
  function
• To be familiar with the role of aging, childbirth
  lifestyle on bladder function
• To have experience with pelvic floor exercises
• To be able to act as an advocate for care

3
What are your thoughts about bladder health?
4
A cautionary tale.
5
How did Tycho die?

• Dont hold your bladder too long!!!
• In 1601 he either
• let a party game get out of hand
• was excessively polite

6
What is his legacy?
7
Take the quiz...

• 1. What percentage of the Canadian population
  knows what the word "incontinence" means?
• 2. True or false - constipation has nothing to
  do with incontinence.

8
Take the quiz...

• 3. True or false - Kegel exercises are pelvic
  tilts.
• 4. True or false - Once you have a loss of
  bladder control, it is too late to do anything
  about it.

9
Take the quiz...

• 5. True or false - Incontinence is a womens
  issue.
• 6. True or false - Incontinence is a normal part
  of aging.

10
Take the quiz...

• OAB quiz

11
How to assess incontinence
12
What does it look like?
13
What is involved?

• The brain
• pontine micturition centre
• frontal inhibitory centres
• Spinal cord
• sympathetic trunk
• Sacral nerve roots
• Bladder
• cholinergic and adrenergic receptors

14
How does the bladder work?

• Filling phase
• relaxation of detrusor muscle
• tightening of sphincter
• Emptying phase
• contraction of detrusor with
• coordinated relaxation of sphincter

15
What does it look like?
16
More views of the innards...
17
More views of the innards...
18
More views of the innards...
19
More views of the innards...
20
More nasty pictures
21
What are things to avoid?

• Having 12 children!
• Developing diabetes
• Reduce cardiovascular risk factors
• Stay slim
• Empty your bladder regularly
• Minimize medications
• Keep your bowels regular

22
What are things to avoid?

• Dont overuse caffeine !
• Watch out for genital atrophy
• Avoid surgeons

23
What happens with aging?

• Smaller bladder capacity
• increased bladder irritability
• decreased bladder emptying
• genitourinary atrophy
• concurrent conditions
• stroke, dementia, PD, BPH, DM

24
Preventing infection

• Minimizing large bladder residuals
• Treating atrophy
• Cranberry juice?
• Abstinence?
• Diabetic control
• Minimize instrumentation

25
How to treat atrophy in 2003

• Oral estrogen
• local estrogen
• cream
• estradiol tablets
• estradiol vaginal rings
• non-hormonal lubricants/moisturizers
• lifestyle factors

26
Treating the OAB

• Behavioural strategies
• Environmental strategies
• Pharmacological options
• oxybutinin (XL)
• tolteridine (XL)
• flavoxate

27
Whats old is new again as usual
28
Treatment options to consider...
29
Dont forget the world of bladder products
30
Dont forget the world of bladder products
31
Dont forget the world of bladder products
32
Dont forget the world of bladder products
33
Dont forget the role of health professionals!

• There is more to incontinence than urologists and
  gynecologists
• nurse continence advisors
• CNS
• physiotherapists
• family physicians
• geriatricians

34
And now time to exercise..
35
Please go to the bathroom.. now...