Five experts, five tips: How to maintain good urological health

Robert McConkey

Advanced Nurse Practitioner Urology,University Hospital Galway

Many conditions of the urinary system (kidneys, ureters, bladder and urethra) are not harmful yet they can dramatically impact all areas of an individual’s life. Although often associated with women, the most common problems of the urinary system affect men and women. These include stress incontinence (the unintentional loss of urine) which is due to weakening of the muscles of the pelvic floor. It is more common after pregnancy in women, or after prostate surgery in men.

Other common urinary problems are urinary tract infections, kidney stones and interstitial cystitis (also called painful bladder syndrome), a condition of chronic inflammation which causes bladder pain and the frequent need to urinate. An overactive bladder, which also results in a frequent and sudden urge to urinate day or night, can cause urinary leakage.

You can improve your overall urinary health by drinking plenty of plain water, maintaining a healthy diet and weight, taking regular exercise, reducing caffeine intake, and quitting smoking. Pelvic floor exercises and/or bladder training may be recommended for incontinence or overactive bladder. And medication or surgery may be required if symptoms persist. Your GP should be your first point of contact for urinary symptom assessment to rule out any more serious condition.

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Liz Boyce

Urology clinical nurse specialist, Children’s Hospital Ireland at Crumlin

Urinary incontinence is a common condition in children and is often associated with constipation. To help prevent constipation, children should have a healthy diet, drink plenty of water and take physical exercise.

Understanding how the bladder works helps parents understand their child’s coping strategies and ease stress and feelings of guilt. The bladder needs to fill to capacity and empty effectively at routine times throughout the day. This filling and emptying cycle helps to stretch the bladder so that it can hold urine comfortably.

Quite often, day and night-time wetting and simple urinary tract infections are caused by not filling up and emptying the bladder during the day. So, encourage children to drink at every meal and snack time and to go to the toilet regularly at home and at school. Children will need to pass urine about six times during the day and have at least three soft stools per week.

Children should drink between one and a half and two litres of water-based drinks at routine times throughout the day. Caffeine and sugary/fizzy drinks should be avoided and milk limited to two glasses a day. Drinking less to avoid wetting is not a good idea.

Make sure the child can sit comfortably with their feet supported and be relaxed (not rushed) when on the toilet. Use a toilet seat and footstool if needed. Children should avoid postponing going to the toilet when playing. It’s important to go to the toilet with a comfortable feeling, not at bursting point. To begin solving night-time wetting, some children need to work on their daytime drinking and toileting habits first.

Helen Keeble

Specialist pelvic health physiotherapist

One in three women experience urinary incontinence following childbirth and one in five first-time mothers experience severe pelvic floor muscle injury after a normal pregnancy and delivery. So, learning how to do pelvic floor exercises correctly is crucial to post-partum recovery. Formerly called the secret exercises (because nobody should be able to tell you are doing them by looking at you), pelvic floor exercises should be done once a day to prevent urinary leaks or three times a day to treat urinary leaks.

Start by tightening and lifting your anus on its own, making sure nothing else moves. Then take a deep breath in and out to relax the pelvic floor muscles. Repeat 10 times. Then tighten and lift your anus and hold for 10 seconds before letting go and taking a deep breath to relax the pelvic floor. Repeat five to 10 times. It’s a good idea to start doing these exercises lying down, gradually building up to sitting (within about six weeks) and then do them when standing (approximately another six weeks later). See a pelvic health physiotherapist if you are unsure how to do them or you do not see any improvement after six weeks.

Dr David Galvin

Consultant urologist at the Mater and St Vincent’s Hospitals, Dublin and principal investigator in the Irish Prostate Cancer Outcomes study

Urologists look after four of the most common cancers in Ireland which are prostate, bladder, kidney and testis cancers. Of these, prostate cancer – which is the most common cancer in men – makes up 75 per cent of our work. Prostate cancer can affect men from age 40 onwards. The prostate blood test (PSA) can be used to assess if further tests are needed (eg MRI) and it should be checked with your GP at the age of 45, and then periodically after that, especially if a man’s father, brothers or uncles have been affected.

The presence of blood in the urine is alarming and always requires urgent assessment, as it may be due to bladder cancer or more rarely to kidney cancer. Both of these conditions affect men and women. Ninety per cent of bladder cancers are caused by smoking which is another good reason for people to quit smoking. In young men (aged 15-44), testicular cancer is the most common cancer, but due to the development of excellent treatments, it is now one of the most curable cancers. Any man who notices a new lump in a testicle should have it checked out by his GP immediately.

Dr Rónán O’Caoimh

Geriatrician at Mercy University Hospital, Cork

and Marie Condon

Physiotherapist at Cork University Hospital, Cork

“One in seven older adults in Ireland experience urinary incontinence and it is up to three times more common in older women. While causes are often similar to those for younger people, pelvic floor muscle weakness, overactivity of bladder muscles and in men, prostate problems, increase markedly with age.

Chronic conditions such as dementia, frailty, stroke and Parkinson’s disease and several medications including diuretics, sedatives and antidepressants, predispose older people to incontinence.

Although urinary incontinence is common, it is not a normal part of the ageing process. It can have a significant negative impact on quality of life and can result in social isolation. Many older people do not seek help. Encouraging older people not to be embarrassed about incontinence and to seek help is important.

The causes should be investigated as effective therapeutic options are available from GPs, specially trained nurses and chartered physiotherapists. A medication review should be completed to remove or substitute suspected classes of medications which contribute to continence issues. Chartered physiotherapists can advise on bladder retraining, bladder calming, behaviour modification and pelvic floor exercises.

Tips for better bladder control as we age include reducing caffeine, avoiding going to the toilet “just in case”, drinking fluids by day, taking your last drink 2-3 hours before bed, and emptying your bladder before bedtime. As we age, bowel health is also important to prevent stress on your bladder. Tips for a healthy bowel include avoiding constipation by eating high fibre foods, keeping hydrated and remaining physically active.

Five experts, five tips
- GPs
- Heart health
- Musculoskeletal
- Digestion
- Respiratory health
- Urological health
- Reproductive health