Tissue Talk: The most estrogen-dependent tissue in the body

You might be thinking the uterus, ovaries, or mammary glands. But no, we're talking the urethra. Yes, that's right, the urethra. It is the most estrogen-dependent tissue in the body for both men and women.

The urethra depends upon sufficient estrogen levels to maintain proper lubrication, which is essential for normal functioning, especially in women. Women lack an internal urinary sphincter. Instead, the urethra must compensate through an adequate bladder neck angle (also called a urethral angle) and a process called coaptation. The urethral angle refers to the angle the urethra exits your bladder. Too small an angle may contribute to diminished flow. More common, too great an angle may contribute to incontinence. Coaptation means that the tissue must open and close in response to external (to that tissue, not to your body) stimuli. In order to do that, it requires sufficient lubrication provided by the mother of lubrication--estrogen.

Several of my menopausal and post-menopausal patients have found that a topical cream has been part of the solution to their incontinence. The cream does not carry the risks associated with oral hormone replacement therapy. You may benefit from the topical if you have low, or borderline, estrogen levels, have bladder issues and especially if your stream is affected (diminished, increased, spurting, etc).

The weighted bladder

Research shows that bladder dysfunction is affected by changes in body weight. Even a five pound increase in weight can adversely affect a bladder already experiencing symptoms. The good news? A five pound decrease in weight can lessen the stress on the organ and, hence, mitigate the experience of bladder symptoms.

But I have a small bladder.....

I'm amazed at how often I hear this and that this myth has survived in such an educated society. You never hear anyone say, "I can't do aerobic exercise because I have a small heart." It sounds ridiculous, right? But somehow when people say they have a small bladder, it goes unchallenged.

All species are born with organs of appropriate size for their bodies. My 8# Papillons have very small bladders. But when there has been occasion that I wasn't able to get home for 10 hours, they held it. They are continent through the night. Size is irrelevant; condition is everything.

It is true that the bladder, being a muscle, can atrophy, just like a heart can degenerate into unhealthy condition. The heart degenerated from not exercising and the only way to get it back in shape is to do aerobic exercise. The bladder atrophied from not drinking enough fluids and from urinating too frequently and the only way to get it back in shape is to drink more fluids and to urinate less frequently.

Next time someone laments that they have a small bladder, let them know that there is help for them and direct them here.

Popular myths surrounding incontinence or urinary leaking

The three things that most people do when they find that they are suffering from any sort of incontinence or urinary leaking are to decrease their fluids, increase their frequency of urination and to stop exercising.

They figure that if they're leaking fluid that they must be taking in too much or that decreasing intake will somehow make it less likely to leak out. They figure that if they have been urinating every three or four hours and leaking in between, then maybe they can stave off that leaking by going more frequently. They figure that if they have been leaking on impact when exercising, then maybe they should stop exercising. All of these are rational; all of them are wrong and set up the bladder for more incontinence.

If a bladder is already compromised, it may be that there are false signals relayed to the nervous system indicating an urge to urinate when the bladder is not full. Often this is from irritation within the bladder or from dyscoordinated neuromuscular activity of the bladder with other surrounding structures. In any case, the strategies of drinking less and urinating more are strategies of dehydration. This is never healthy systemically and actually makes the bladder worse off as it atrophies over time. The bladder has a muscular layer, the detrusor, and like any muscle, needs to be worked to stay healthy. Unlike other muscles, the detrusor is only worked when filled and stretched. The detrusor is stretched by the bladder filling up to functional capacity, by drinking fluids and urinating infrequently.

There are studies that show that any exercise done regularly, even if it doesn't address the pelvic floor itself, will improve the condition of the pelvic floor over time. If there is leaking on impact, the leaking is not caused by the impact; it is caused by the neuromuscular dyscoordination. One might consider switching to a low-impact exercise or wearing pads while continuing the higher-impact exercise.

So, counter-intuitive as it may seem, the best course of action when one starts leaking or experiencing any sort of incontinence is to drink more fluids, urinate less frequently and keep exercising (or exercise more). Work that bladder!

You might want to check out the List of Bladder Irritants in my Treasure Trove (tab in navigation bar).