Caitlin Whyte (Host): Welcome to another enlightening episode of WakeMed Voices, where today we're diving into the realm of bladder health. I'm your host, Caitlin Whyte. Joining us is Dr. Katy Reines, a urologist at WakeMed. Dr. Reines specializes in diagnosing and treating a range of bladder-related conditions, improving the quality of life for her patients. Well, doctor, thank you so much for joining us on the show today. To start off our conversation, can you tell us, what are some of the most common bladder conditions that you see in patients?

Dr. Katy Reines: Yeah, thanks for having me. I'm excited to talk everything bladder health. Some that come to mind, one is bladder outlet obstruction, or BPH, or any type of prostate enlargement, and particularly in older men whose prostates may be blocking their bladder. So, the prostate sits at the opening of the bladder and can cause either a partial or a total blockage of their bladder depending on the shape and size of their prostate. And this can manifest as a weak urine stream, feeling like you can't empty all the way, or having to urinate very frequently during the daytime or the nighttime.

Another condition would be urinary tract infections. This is when bacteria enters into the urinary tract and causes an infection. And some symptoms of that include frequent urination, burning during urination, and even blood in the urine. Importantly, though, just because you have these symptoms doesn't mean that you have an infection, and just because you have bacteria in your urine doesn't necessarily mean that you need antibiotics to treat an infection.

Another one is overactive bladder, and this is when the bladder contracts before it's actually full, and that can give you a sensation again of having to go to the bathroom all the time or feeling the sudden urge to urinate but you can't make it to the bathroom in time.

And then, the last one that comes to mind is bladder cancer. And this is a cancer that originates in the cells that line the bladder called the bladder mucosa. It's the fourth most common cancer in men and the ninth most common cancer in women. The biggest risk factor for bladder cancer is smoking, and men are about three times more likely than women to get bladder cancer. So, those are some of the most common bladder conditions that we see as urologists.

Host: Well, on the other end of the spectrum, what are some signs that your bladder is healthy and doing its job?

Dr. Katy Reines: Yeah, great question. Your bladder is an organ, and the whole job of a bladder is to store urine before it's excreted out of the body. It's connected to the urinary system, which includes your kidneys, your ureters, and your urethra. And the kidney filters all the blood in your body and creates urine as a waste product of that process. And so, the urine flows down from the kidneys through the ureters into the bladder. So when the bladder is healthy and doing its job, you should really hardly notice it. The bladder expands like a balloon to hold about 400 to 600 cc's of urine in adults. And it's that stretching sensation of holding urine that then lets your brain know that it's time to urinate. And in a working system, your brain then signals to the muscle of the bladder, which we call the detrusor muscle, to contract, and your sphincter muscles to relax, and that should allow urine to pass through your urethra out of the body.

Host: Well, how often is normal for someone to urinate then?

Dr. Katy Reines: Like most things in medicine, I would say normal is more of a relative term, and it can be a bit different for everyone. But, in general, most people urinate about four to eight times a day, and that can vary based on a number of factors. For example, hydration is probably one of the most frequently talked about things when it comes to how frequently you urinate, because the more fluid you drink, the more that you're going to urinate.

There are also certain medicines that can cause people to urinate more. So, things like diuretics given to people who have heart conditions like heart failure, high blood pressure, and they purposely make you urinate more often. The body in general is trying to constantly regulate how much fluid is in your body. And urinating is the main way that we rid our bodies of fluid.

Host: And what role does exercise play in maintaining a healthy bladder?

Dr. Katy Reines: A few things come to mind. First is strengthening your pelvic floor muscles. And so, the pelvic floor, I like to think about it as a hammock that provides support to your bladder, your rectum and, in women, the uterus. And the muscles of the pelvic floor help control urination, particularly your ability to hold in your urine and not leak, especially during things like coughing or sneezing or going from sitting to standing. So, exercise can help keep those muscles strong and functioning.

 Another way that exercise can play a role in a healthy bladder is just overall weight management. So, maintaining a healthy weight reduces the pressure on your bladder. And having excess weight can strain your bladder and your pelvic floor muscles because they're needing to work extra hard and that can lead to things like urinary incontinence or overactive bladder.

And then, a third thing that exercise can help with is constipation. And constipation is actually very intimately related to bladder health, because your bowel health and your bladder health are kind of hand in hand. So if you're constipated and you hold a lot of stool in your colon and your rectum, this will definitely impact your bladder's ability to expand and contract normally because there's a finite amount of space in your pelvis. And so if you have a lot of stool sitting around, it'll impact your bladder's ability to also store urine. So, exercise is one of the best ways to keep your bowels regular and, in turn, keep your bladder functioning as well as it should.

Host: So, can what you eat or drink play a part in maintaining a healthy bladder?

Dr. Katy Reines: Yes. Diet actually plays a huge role in how your bladder behaves. First off, as we previously discussed, but just to reiterate the point, hydration is extremely important. It's so important that if you're experiencing any issues with the bladder whatsoever, the first thing we think about is how much water you're drinking on a regular basis and what time of day you're drinking it. So, drinking enough water is crucial to bladder health. It helps dilute toxins in your urine, which are supposed to be there because they're being excreted by your body. It reduces the risk of urinary tract infections and it promotes urinating on regular intervals. So, staying well hydrated keeps the normal cycle of bladder filling and emptying to overall keep your bladder working appropriately.

And then, there's a bunch of things that you can eat and drink that irritate the bladder. Probably the biggest culprit that many of us have on a daily basis is caffeine. So, coffee, tea, soda, energy drinks, all of those things can irritate the bladder and increase urinary frequency and urgency. So, I like to think about caffeine in general as a stimulant and It may not happen anymore because we're used to caffeine. But in general, caffeine can make you feel jittery or sort of on edge. And the same thing can happen to your bladder when you have caffeine. So, that detrusor muscle can become overactive with caffeine on board and contract before your bladder is full, giving you the sensation of having to go to the bathroom all the time or just being uncomfortable in your bladder. And other things that are also bladder irritants include alcohol, spicy food, acidic foods, so things like citrus or pasta sauces, carbonated beverages and, unfortunately, even chocolate can be a bladder irritant.

Host: Well, to wrap up our conversation today, Doctor, what signs or symptoms should someone never ignore when it comes to their bladder?

Dr. Katy Reines: I would say the first is if you're not able to urinate. So if we step back from the bladder itself, urinating is a reflection of how well your kidneys are working. And ultimately, you can't live without working kidneys. So, regular urination is proof that your kidneys are healthy and doing their job.

So if you're unable to urinate, there's something going on either with the kidneys themselves not producing urine or the urinary tract. So, any blockage from the kidneys to the outside of the body can ultimately hurt your kidneys in the long run. It's very similar to plumbing. You need all the pipes to be open and flowing or the system would shut down. So, first sign, not being able to urinate.

And then, second is blood in the urine that you can see. So, blood in the urine is a word that we call hematuria, and blood that you can see in the urine is called gross hematuria. And that's different than just blood that a test picks up in your urine. So, this is really blood that you can see, and there are a number of things that can lead to gross hematuria, like urinary tract infections or kidney stones. But bladder or other urinary tract cancers can also lead to blood in the urine that you can see. And it may be the only sign that there's something wrong or something there. So, we take blood in the urine very seriously.

Host: Thank you, Dr. Reines, for sharing your knowledge and insights on bladder health with us today. And thank you for tuning into this episode. I'm Caitlin Whyte and you've been listening to WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. For more information on urology and to connect with Dr. Reines, please visit wakemed.org. We'll catch you next time.