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Bladder issues causing social anxiety? UAE doctors urge residents to seek help

Women don’t have to shoulder the burden alone as there is a treatment option for every condition

Bladder control issues are affecting a large number of women in the UAE, but the emotional burden and embarrassment are barriers to seeking help, said a top doctor at Cleveland Clinic Abu Dhabi (CCAD).

Bladder control issues are not specific to a particular age group of women but can affect them at different life stages. Some of the most common bladder control conditions that are witnessing a growth in the number of reported cases are overactive bladder, neurogenic bladder, which stems from brain, spinal cord, or nerve problem, and urinary incontinence and frequency, which is the involuntary loss of urine.

According to a study by CCAD, the condition affects many women in the UAE, with around 42.2 per cent of the female adult population experiencing it at some point in their lives.

Dr Zaki Almallah, staff physician, in the Surgical Subspecialties Institute at CCAD, told Khaleej Times about the most common issues, their causes, and symptoms, and stressed that women don’t have to shoulder the burden alone as there is a treatment option for every condition.

Understanding overactive bladder

“Overactive bladder is characterised by the frequent urge to urinate, often leading to involuntary leakage or ‘urge incontinence’. This condition arises from the sudden contractions of the bladder muscles, even when the bladder is not full. Women with overactive bladder may experience urgency, frequency, and nocturia (nighttime urination), disrupting their sleep patterns and daily routines.”

Common causes and risk factors of overactive bladder can be attributed to a range of factors, including age, hormonal changes, and neurological conditions. The weakening of bladder muscles and pelvic floor tissues due to childbirth, menopause, or pelvic surgeries can contribute to the condition too. Obesity, urinary tract infections, and certain medications can also increase the risk of developing an overactive bladder.

Neurogenic bladder damage

“Neurogenic bladder occurs when there is damage to the nerves that control bladder function. This can result from conditions such as spinal cord injuries, multiple sclerosis, or diabetes. Neurogenic bladder can lead to either an inability to empty the bladder or involuntary leakage, depending on the severity of nerve damage.”

Dr Almallah highlighted that a neurogenic bladder is often a consequence of underlying neurological disorders that disrupt the communication between the brain and the bladder. Spinal cord injuries, strokes, and certain autoimmune diseases can damage the nerves responsible for regulating bladder function. While it cannot be cured, it can be managed. Treatment options include medications, use of catheters, and lifestyle changes.

What is urinary incontinence?

Dr Almallah pointed out that urinary incontinence is one of the most common conditions that affect women but is riddled with misconceptions. Women mistakenly think that urinary incontinence is the dribble that occurs after finishing urination.

“Urinary incontinence is the experience of uncontrollable urine leakage, and it encompasses several types. Two main types are stress and urge incontinence. Urge incontinence, which is caused by an overactive bladder, involves the involuntary loss of urine due to a sudden urge to urinate, while stress incontinence occurs when pressure is exerted on the bladder, causing leakage.”

Dr Almallah said urinary incontinence can be a result of various factors, including hormonal changes during pregnancy and menopause, pelvic floor muscle weakness, and chronic health conditions such as obesity and diabetes. Childbirth and pelvic surgeries can also weaken the pelvic floor, leading to urinary incontinence.

Psychological implications

Dr Almallah said that bladder control issues not only cause physical discomfort but also carry a significant emotional burden.

“The anxiety, embarrassment, self-consciousness, and frustration associated with these conditions can affect a woman's self-image and mental health, impacting the overall quality of life.”

Frequent trips to the bathroom, coupled with the fear of sudden leakage, or experiencing difficulties in controlling urination or fully emptying the bladder can drive women to develop social anxiety and may also lead them to avoid social activities or situations that trigger their condition. Many women often suffer in silence, unaware that effective treatments and management strategies are available.

Treatment and management

Dr Almallah noted that different factors should be considered while creating a treatment plan for bladder control conditions, especially urinary incontinence and overactive bladder. There are three main types of treatment for incontinence: medications, lifestyle changes, and surgery.

“Your doctor can discuss medications that are suitable for your condition and recommend the best lifestyle changes, upon which some women notice improvements without the need for further treatment. The most effective lifestyle changes you can adopt to help improve incontinence include maintaining a healthy body weight, doing regular Kegel exercises that help strengthen your pelvic floor muscles, and practising bladder training to help stretch out the amount of time between each trip to the bathroom. The goal in bladder training is to practice delaying urination each time the urge is felt to build strength.”

Dr Almallah pointed out that if medication and lifestyle changes are not enough to manage the condition, invasive treatment options ranging from simple injections to surgeries are recommended. “Some injections help increase the size of the urethra’s lining in case of stress incontinence while others are injected into the bladder to help relax the muscles, helping with urge incontinence. Surgeries include sling procedures where either a synthetic material or a strip of a woman’s tissue is typically used to support the urethral channel. Another surgical procedure includes implanting neuromodulation devices under the bladder that stimulate the nerves to improve control.”

Dr Almallah added: “Overactive bladder, neurogenic bladder, and urinary incontinence are common conditions that can have far-reaching effects on a woman's life. Understanding their causes, risk factors, and symptoms are essential for early intervention and effective management. Seeking medical advice, adopting lifestyle changes, and exploring treatment options can empower women to regain control over their lives and alleviate the psychological toll these conditions can take on them.”

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