Ever Since I Had My Baby

by Roger Goldberg

  HYDRATING RIGHT

  Not too wet. For better or worse, we’re living in a water-bottle culture, where sleek marketing has transformed our least expensive resource into a costly craze. Thousands of years from now, the relics of our era will be excavated not as mosaic-tiled floors and Doric columns but in the form of countless sixteen-ounce plastic sport bottles. For some women, life in the water-bottle culture translates into excessive water intake; those on weight-loss diets, in particular, are likely to overhydrate. Drowning it with fluid will challenge even a very strong bladder and should be avoided if you have incontinence or other urinary symptoms.

  Not too dry. Dehydration, on the other hand, is also a problem. Women who are concerned over a loss of bladder control often develop a habit of drinking less to reduce their odds of an accidental leak. Intentional dehydration is not a healthful habit. Chemicals in the urine can become highly concentrated and irritating, leading to spasms of an overactive bladder and sometimes even worse incontinence.

  Just right. Good hydration usually means a basic goal of six to eight glasses each day, and more in hot weather or during exercise. Prefer a more mathematical guideline? If so, aim for a half ounce of water per pound of body weight each day. If your symptoms tend to flare at night, try restricting your fluid intake starting around two to four hours before bedtime. Urine color is a very reliable indicator of whether you’re ahead or behind with your daily fluids. A pale straw appearance usually indicates that you’re in a healthy balance.

  THE BLADDER DIET

  If you have bladder symptoms, take a close look at the foods and drinks you choose each day. Irritants in the diet can lead to symptoms that feel just like cystitis, cause patterns that mimic an overactive bladder, or even make incontinence suddenly worse. A bladder diet can have the opposite effect, helping to prevent infections, relax an overactive bladder, and reduce incontinence. For starters, take a look at Table 1, which lists most of the foods and drinks that could irritate the bladder. Foods that acidify the urine are often the biggest offenders, but as you can see, a number of other substances may also spell trouble. You’ll notice that the table lists most of the world’s healthiest foods and beverages. Don’t worry—you won’t be asked to avoid them all. Though some of these items might be contributing to your symptoms, the vast majority are not.

  Step #1: Scan the list. First, take a look at the foods on the list, then write down any of the items that have been a regular part of your diet. You’re creating a suspect list. Next take a look at the drinks. Again, list any that have been a regular part of your diet.

  Step #2: Make a change. Once you’ve scanned the bladder diet, it’s time to look back at your suspect list and start your investigation. Try eliminating one possible offender at a time for a week, keeping track of your symptoms during that time, and reassess for any changes. If things felt better—for instance, less urinary frequency and urgency, better control, more restful nights—then keep this food or drink out of your routine. If the dietary change made no difference, then add the item right back.

  Tweaking your bladder diet may take several weeks or months, but if you’re lucky enough to find a genuine trigger, you’ll have made a small investment of time for a rich payoff. Just don’t abandon a fully balanced diet for daily meals of Pop-Tarts and water with the hope of doing some good for your body. Your task is to seek out one or two bad apples, not to throw out the whole bushel.

  The Bad: Dietary Suspects

  Spicy and sweet. Chilies, chocolates, corn sweetener, honey.

  Fruits and veggies. Apples, cantaloupes, citrus, cranberries, grapes, lemons and limes, guava, peaches, pineapple, plums, strawberries, tomatoes.

  Juices. These acidic drinks may help to decrease your risk of bladder infection, but what’s not often realized is that they can also act as bladder irritants, causing urinary frequency, the urge to urinate, and discomfort or pain within a sensitive bladder.

  Cranberry, orange, and tomato juices are acidic and may spell trouble. In addition to being acidic, grapefruit juice is a mild diuretic—in other words, a substance that causes the body to excrete water. That is one reason why the grapefruit diet became so popular several years ago, and also why it can over-whelm an overactive or irritated bladder. As a rule of thumb, opaque juices (tomato, grapefruit) are generally more irritating than clear ones (apple).

  Miscellaneous and hidden triggers. Carbonation, artificial sweeteners (Nutrasweet and saccharine), vinegar, mayonnaise, and soy sauce. Watch out for salad dressings, marinates, ketchup, and tomato-based sauces.

  The Really Bad: Prime Suspects

  Coffee and tea. You’re probably well aware from personal experience that coffee and tea can rev up a bladder like almost nothing else. For postreproductive women already struggling with control, the hours after the morning brew might present a clear and present danger. Why? For one, caffeine is a strong diuretic. Even without the caffeine, the chemical texture and acidity of coffee and tea can be highly irritating to the bladder’s inner lining, making it less likely to behave.

  Because coffee and tea can undermine your control over both bladder and bowels, women with certain postreproductive symptoms are often advised to quit the habit cold turkey. For many a soul, that’s easier said than done. If you’re like me and find it hard to start your day without the company of Earl Grey or Juan Valdez, here are a few tips that may help you maintain better control while satisfying your craving:

  Decaffeinated coffee or tea. The chemical texture of decaf can be almost as irritating to some bladders as the regular stuff, but at least caffeine’s diuretic effect won’t be a problem. It’s worth a try.

  Low-acidity coffee beans. In general, for any coffee, a darker roast means lower acidity. Specially marketed low-acid coffee beans may be better tolerated by sensitive bladders. Freshness of the beans also matters—try to avoid that wicked truck-stop blend in your office percolator, especially after it’s been sitting for a while.

  Coffee substitutes and grain or malt-based drinks. Kava (instant, low-acidity), Postum, Pero, Roma, Cafix, Breakfast Cup.

  Non-citrus herbal teas.

  Hot water. Try it with a lemon.

  Cranberry juice. The juice from those little red berries just might be the most underused and overused home remedy for the female bladder. As you’ve undoubtedly heard, cranberry juice is a great means for prevention of some postreproductive conditions; for other conditions, as you might not know, it’s the pits. When it comes to its effect on your bladder, cranberry can play both Jekyll and Hyde.

  Countless women over the years have sworn by cranberry for preventing cystitis. It does appear to reduce the amount of bacteria in the bladder by keeping the urine more acidic and preventing bacteria from sticking to the bladder’s inner surface. One study of postmenopausal women in The Journal of the American Medical Association concluded that a ten-ounce daily dose of cranberry-juice cocktail reduced the amount of bacteria in the urine by up to 40 percent. Another, smaller study, this one of sexually active younger women, showed a reduced risk of infections over a six-month period. So remember—ten ounces each day just may keep the bugs away. If juice therapy entails more fluid and calories than you can afford, consider these alternatives:

  Unsweetened cranberry juice. Available at some natural-food stores.

  Artificially sweetened juice. Keep in mind that synthetic sweeteners can act as bladder irritants themselves.

  Dried cranberries, or fresh cranberries ground with honey. Another option for those of you who have a little extra time and a bit of Martha Stewart in your blood.

  Cranberry extract or capsules. Can help you achieve the same effect as juice, minus the fluid load.

  Don’t assume that cranberry is a panacea. Acidifying the urine—with the help of juice, tablets, or extract—is great for preventing bladder infections and stopping symptoms in their tracks (see chapter 12). But if you’re dealing with an existing infection, an active inflammation, or an overactive bladder, acidifying
might make your bladder feel much worse.

  Your bladder on booze. You know all about the dizzying effects of alcohol up above, but what about its effects down below? For at least a few reasons, liquor can present a real challenge to your postreproductive body. Alcohol in any form causes the kidneys to draw water out of your body and flush it into the bladder. If a brisk diuresis leaves you suddenly more full than usual, it may create a recipe for leakage. Also, the chemical texture of alcohol can directly irritate the bladder lining. This can trigger an overactive bladder, urge incontinence, even stress incontinence—and require some quick thinking! So before you pop that cork or cap, be prepared for the consequences.

  TABLE 1

  DIETARY TRIGGERS

  FOODS Fruits and veggies: Apples, cantaloupes, citrus, cranberries, grapes, lemons and limes, guava, peaches, pineapple, plums, strawberries, tomatoes

  Sweets: Chocolate, artificial sweeteners, honey, corn sweetener

  Spicy: Chilies, peppers

  BEVERAGES Coffee and tea: Even decaffeinatedAcidic juices: Cranberry, orange, tomato, grapefruitCarbonated Beverages

  MISCELLANEOUS Vinegar, soy sauce, marinates, salad dressings, ketchup and tomato-based sauces

  The Good: Dietary Substitutes

  Try olive oil and garlic on your pasta instead of red sauce. Pears, apricots, and watermelon are a good alternative to other, more acidic fruits. Papaya is low in acidity but may have a diuretic effect.

  THE LOW-OXALATE DIET

  Oxalate is a chemical found in plant products, including green vegetables, wheat bran, coffee, tea, and chocolate. It’s been proposed that dietary oxalate can trigger bladder irritation and vulvar symptoms. As a result, a low-oxalate diet is sometimes recommended to women with unexplained complaints in those areas.

  Avoid: Coffee, tea, beets, beans, peppers, celery, berries, grapes, nuts, tofu, peanuts and peanut butter, chocolate, spinach, orange and lemon peel, celery

  No Problem: Bananas, cherries, grapefruit, peaches, melon, plums, onions, peas, avocado, bread, pasta, white potatoes, rice, beef, fish, pork, poultry, cauliflower, mushrooms

  Consider: Calcium citrate (Citracal), a chemical that neutralizes oxalate in the bladder; may be taken after meals in the case of diet-sensitive bladder symtpoms

  THE NOT-SO-WONDERFUL DEVICES: PADS AND ABSORBENT PRODUCTS

  Despite the number of fancy, flashy, and high-tech treatments and cures available, there will still be times when women need temporary protection. For some, stress leakage might occur only at specific times, such as during pregnancy or on the tennis court. Others may have more regular incontinence but simply haven’t addressed the issue with a physician. As we’ve seen, these symptoms can be effectively treated or cured in a number of elegant ways. But if protection rather than cure is your present strategy, then understand a few aspects of this multimillion-dollar absorbent-product industry to help minimize your fear of embarrassment and maximize your quality of life.

  PADS, SHIELDS, AND LINERS

  Far too often, postreproductive women make a transition from menstrual pad to incontinence pad, considering it a normal aspect of life during their postchildbearing and perimenopausal years. Postreproductive women who worry about daily control over their bladder or bowels can easily spend hundreds of dollars each month on pads, shields, and liners. Here are a few guidelines that may keep things more effective and affordable:

  Don’t economize by using homemade substitutes. Some women use folded paper towels or tissue paper in their underwear; others use newspaper, once they discover that it can reduce the odor of urine. These solutions may be cheap, but they’re not very effective. Their absorbency is limited, compared with specialized pads and liners. Occasionally, chemicals and dyes in these materials may irritate the vulvar skin.

  Choose the right product. Incontinence liners and full-size pads (Serenity, Dignity, Depends, Poise) have a plastic backing, with absorbency capacities varying by pad thickness and design. Very light leakage may require a simple thin liner, which is barely visible even through sport clothing. Moderate leakage may require a thicker pad, with layers designed to pull moisture away from the surface and toward the core. Heavier-duty pads are lined with chemical additives that absorb urine and react with it to form a gel. This process stores urine in a drier form and prevents moisture from accumulating. The absorbent gel also allows pads to remain relatively thin, easily concealed beneath regular underpants yet able to absorb many times their weight in water. Their typical absorbent capacity ranges from 100 to 350 milliliters.

  Adult diapers and briefs (Depends, Attends, Surecare, Promise) may be a bit more challenging to conceal underneath clothing, but they can absorb the equivalent of several pads (1,000 to 2,000 milliliters). Recent improvements have made them far less bulky and conspicuous; some are nearly identical in appearance to regular underpants. Products designed for the most severe leakage combine undergarment briefs with gel-containing pads capable of absorbing large amounts of urine, in both daytime and overnight forms.

  Boutique incontinence garments are available from specialty vendors, combining washable briefs with built-in pads holding up to 200 milliliters of urine. Specialty swim suits, fitted with similar systems, can also be found.

  About one of every three menstrual pads is used for urinary incontinence rather than menstruation. But often they are not the optimal product. First, they have much lower absorbent capacities than gel-containing incontinence pads. Second, the chemical additives in menstrual pads, when mixed with urine, can cause skin irritation around the vulva and vagina. Switching to incontinence pads may prove to be not only more economical but also more comfortable.

  Disposable and washable bed pads can be used for nighttime leakage. If the vulvar skin is irritated, sleeping underwear-free is often recommended. A bed pad can allow your skin to better breathe and heal.

  Obey the laws of good skin care. The wetness and rough chemical texture of urine can spell hard times for skin, which can become irritated if you’re not careful. The use of poorly absorbent pads and shields can worsen matters by trapping moisture against the skin. Whatever product you choose, remember to change pads as often as necessary to keep the skin dry. Try going pad-free at night, using a bed liner if necessary, to allow your skin some time to breathe.

  Shower with nonperfumed hypoallergenic soaps, avoid overly aggressive scrubbing of the area, and steer clear of perfumed or medicated creams. Barrier creams can help protect raw areas from the chemical irritation of urine, providing a second skin. Try cocoa butter, zinc oxide, lanolin, parafin, Balmex, Carlesta, or A&D emollient cream.

  Consider cost. Absorbent products aren’t usually covered by insurance. Be sure to weigh their cost and inconvenience against that of medications, devices, physical therapy, and operative treatments. A curative approach may cost far less than pads and diapers over the long run. Consider, for instance, a woman using just two pads each day—that’s fourteen per week, 730 per year, and thousands of dollars over each decade devoted to pads rather than movies, books, restaurants, and vacations. Finding a long-term solution for your problem may prove to be a wise financial investment.

  Kick the habit once you can. Though it may seem odd, many women who use pads for years have a very difficult time breaking free of these security blankets, even after their incontinence has been cured. Doctors will sometimes beg and plead with patients to give up their pads long after they’ve made it to dry.

  HIDDEN TRIGGERS: EFFECTS OF OTHER MEDICATIONS ON BLADDER CONTROL

  A wide range of postreproductive symptoms may be affected and even caused by medications you’re taking for totally unrelated medical conditions—and the connection might not be obvious at first. Take a close look at your medicine chest, both prescription and over-the-counter products. Just remember, don’t start or stop any medications without first checking with your doctor.

  ANTIHISTAMINES, COLD MEDICATIONS, DIET PILLS, DECONGESTANTS

  As already mentioned, several over-the-count
er pills (such as Sudafed, Alka-Seltzer Plus Cold, Dristan, Sinarest, TheraFlu, NyQuil, Afrin). can occasionally improve mild stress incontinence. But since part of their effect is to promote retention of urine, they can occasionally cause the bladder to overfill, leading to overflow incontinence. Difficulty passing urine or frequent urges may be the first indications of this problem and should be mentioned to your doctor.

  BLOOD-PRESSURE MEDICATIONS

  Beta blockers (Propranolol, Inderal). These are very common medications used for treating high blood pressure, which can occasionally make urinary incontinence worse. They can also diminish sex drive.

  Alpha blockers (Prazosin, Minipress, Hytrin, Cardura, Aldomet). Another family of blood-pressure medications that can aggravate incontinence by overrelaxing the urethra and its surrounding muscles. Women who become incontinent after starting one of these medications may sometimes be switched to another.

  Ace inhibitors (Vasotec, Zestril, Monopril, Lotensin). These blood-pressure medications have no expected effects on urinary control. Just one potential concern regarding your pelvic-floor symptoms: on rare occasion, ace inhibitors can cause a chronic cough. If this side effect happens to arise, the physical stress associated with coughing may place you at greater risk for incontinence and even progression of prolapse over time.