Heart Disease is the #1 killer of men and women, worldwide.  The heart is a vital muscle that beats every minute of every day, morning
and night; we know we must eat healthy and exercise to care for it. I
myself spend a great deal of time and expense caring for my skin — it is part
of every first impression I make and is the largest organ of the body. But, the urinary bladder . . . it is a muscle that is largely ignored; taken for granted, until damage is done.  Billions of dollars each year are spent in the U.S. to treat bladder
disease, which can make a significant adverse impact on your quality of life.  If you think you needn’t concern yourself . . . "not in my lifetime", it's not a bet you're likely to win.

In 2010, experts in the field of urology met to define a consensus
statement toward the impact of Bladder Health on the overall health of an
individual, including emotional well-being, forming the first US public health
statement to address bladder health (Lukacz, E. S., 2011).  They agreed upon a number of
conditions/symptoms to be included in the heterogeneous group of approximately
1.9 billion people worldwide (>48% of people over 20 years of age, in 2008)
that live with an "unhealthy urinary bladder" or "Lower Urinary Tract
" (LUTS). 

Consequences of Urinary Bladder Disease
— considerable financial cost, born
by individuals and society for costs associated with personal protection
supplies (pads), at the low end, and in severe cases placement in nursing
homes.  Total costs in 2007 for
Overactive Bladder were estimated at $65.9 billion in the U.S. (Ganz, M.L.,
2010), whereas estimated costs of UTI were $1.6 billion in 2003 (Foxman, B.,
2003).  Among older men and women,
overactive bladder is associated with increased risk of falls and fractures
(Darkow, T., 2005).  LUTS is associated
not only with increased anxiety, but also impacts Quality of Life (QOL), which can
lead to depression, reduced productivity, decreased physical activity,
including sexual function.  I am
impressed that Trudy has already discussed ways to deal with each of these
issues, reclaiming her life from potential debilitating consequences of a
compromised urinary system.

 Healthy Bladder — did you know?:

  • In adults, capacity of bladder is 300-400 ml
  • Normal Frequency averages 8x daily (every 3-4
    hrs. + 1 or fewer trips at night)
  • Daily intake should average 2400 ml/day (US Food
    Science Board recommends fluid intake volume 0.5 oz./lb./24 hrs.)
  • The Urinary and G.I. tracts share neural
    signaling pathways (peripheral nerves) and may be the reason that constipation
    is associated with bladder disfunction (Coyne, K.S., et al., 2011)

The scope of this study
group did not specifically address the added complication of a neurogenic
component leading to symptoms (neurogenic bladder).  However, healthy bladder function is
dependent on signaling from the lining of the bladder to the pelvic floor
muscles that control urination at the urethra/neck of the bladder to relax, and
thus release the contents of the bladder, when it is nearing capacity.  Interruption of the signal could lead to many
of the symptoms discussed, as well as other symptoms of neurogenic bladder, such
as urine retention.  Maintaining a disease-free
bladder is that much more important for those already living with a dis-connect
between the neurological and urinary-muscular systems; it means one less strain
with which your body needs to cope.


Trudy — who works in the field of education, should find this particularly interesting:

the expert panel creating
the statement on a healthy bladder recognized that the health of the adult
bladder can be impacted by incidents from childhood, including access frequency
to bathroom facilities.  They hope that
by improving the understanding of normal toileting patterns and their potential
interruption by "environmental factors" including situations where
toilets become the scenes of bullying and thus lead to unhealthy "holding
behavior" (Vernon, S., et al 2003) —
potentially leading to subsequent damage to the bladder over time, is a
situation that can be averted.  Securing
bathroom privacy, safety and cleanliness for children in schools should be a
given, but can be achieved through proactive work on the part of educators and


for Improving/Maintaining
Healthy Bladder Function 

  1. Consume
    an adequate level of fluid per day to maintain a urination frequency period of
    every 3-4 hrs.
  2. Moderate
    consumption of food/beverages known to irritate the bladder (Dietary Considerations)
  3. Adopt
    a relaxed position for urination and allow time to empty the bladder
  4. Maintain
    muscle tone with pelvic floor muscle training and pre-emptive pelvic floor
    contraction (Knack maneuver) to improve and maintain bladder health
  5. Avoid/control
  6. Maintain
    a healthy weight (obesity can lead to compromised bladder function)
  7. Quit

 Dr. Emily Lukacz, (Assoc.
Professor of Reproductive Medicine,
UCSD), et al. believe that by supporting the guidelines of the International
Consultation on Incontinence — by educating and raising awareness amongst the
general population and healthcare providers — bladder disease can be
alleviated and in some cases prevented. 
Working to increase understanding and attention resulting in new public
health policy that recognizes the importance of a healthy bladder would
inevitably lead to more individuals seeking help earlier, and physicians better
equipped to recognize symptoms.

 Be proactive, spread the
word . . . Maintaining Bladder Health is a critical component of Healthy
!  Change starts with you.

 –Julia Parker

The Biosleuth



1: Lukacz ES, Sampselle C,
Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, Palmer MH. A healthy bladder: a
consensus statement. Int J Clin Pract. 2011 Oct;65(10):1026-36.            doi:
10.1111/j.1742-1241.2011.02763.x.                                PubMed PMID: 21923844; PubMed Central PMCID:

2: Coyne KS, Cash B, Kopp
Z, Gelhorn H, Milsom I, Berriman S, Vats V, Khullar V.  The prevalence of chronic
constipation and faecal incontinence among men and women with symptoms of
overactive bladder. BJU Int. 2011 Jan;107(2):254-61. doi: 10.1111/j.1464-410X.2010.09446.x.
    PubMed PMID: 20590548.

3: Darkow T, Fontes CL,
Williamson TE. Costs associated with the management of overactive bladder and
related comorbidities. Pharmacotherapy. 2005 Apr;25(4):511-9. PubMed
PMID: 15977912.

4: Foxman B. Epidemiology
of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon.
2003; 49:53-70. doi: http://dx.doi.org/10.1016/S0011-5029(03)90000-9

5: Ganz ML, Smalarz AM,
Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, Pashos CL. Economic costs of
overactive bladder in the United States. Urology. 2010 Mar;75(3):526-32, 532.e1-18. doi:
10.1016/j.urology.2009.06.096. Epub 2009 Dec 29. PubMed
PMID: 20035977.

6: Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence
estimates of lower urinary tract symptoms, overactive bladder, urinary
incontinence and bladder outlet obstruction. BJU Int. 2011 Oct;108(7):1132-8.            doi: 10.1111/j.1464-410X.2010.09993.x.                   PubMed PMID: 21231991.

7: Latini JM, Mueller E, Lux MM, Fitzgerald MP, Kreder KJ. Voiding frequency in a
sample of asymptomatic American men. J Urol. 2004 Sep;172(3):980-4. PubMed PMID: 15311017.

Lukacz ES, Whitcomb EL, Lawrence JM, Nager CW, Luber KM. Urinary
frequency in community-dwelling women: what is normal? Am J Obstet
Gynecol. 2009 May;200(5):552.e1-7. doi: 10.1016/j.ajog.2008.11.006. Epub
2009 Feb 27. PubMed PMID: 19249726; PubMed Central PMCID: PMC2695664.

9: Vernon S, Lundblad B, Hellstrom AL. Children's experiences of school toilets
present a risk to their physical and psychological health. Child Care Health Dev. 2003 Jan;29(1):47-53. PubMed PMID: 12534566.


Further Online Reading:

Stay current about Recommendations for Continence

Continence Promotion
(International Consultation on Incontinence)

Beverages To Moderate with Bladder Disease