WHERE DOES THE WATER GO?

Most of us have heard that water makes up 65% of the body and is vital to our survival. While we can live without food for a month, we can only live without water for a week! Maybe that’s how the expression “dying of thirst” came about. We need water to dilute the nutrients we eat in our food and help carry energy all over our bodies. Water is necessary for the biochemical reactions that our cells use to function, grow and repair themselves. How does your body process the water and remove what’s not needed? Let’s follow a molecule of water on its path from your mouth all the way through your body:

We’ll start with a cool glass of iced tea (mostly water) that you might drink at lunch on a hot summer day. As you swallow, the tea washes down your esophagus into the stomach. Your stomach starts the process of digestion, breaking food into smaller and smaller units that can be easily absorbed into the bloodstream to provide energy. The iced tea mixes with the food you have eaten, and after a few hours, the contents of your stomach pass into the small intestines – which take up most of the area of your abdomen. The nutrients from food, along with some water from the tea, are absorbed by the cells of the small intestines and passed into the blood stream. Most of the remaining water is absorbed by the cells in the large intestines and passed into the bloodstream.

Once water gets into your bloodstream, it begins a number of essential tasks for your body. The water bathes the cells that make up your blood. New supplies of water replace any lost as a result of sweating. In addition, water is taken up by the cells to be used for the complex process of turning nutrients into energy.

Lastly, water helps remove waste and toxins from the body. These wastes, which are mostly nitrogen compounds formed as a byproduct of the cell’s energy use, are filtered out of blood by the kidneys, which reabsorb most of the water and send it back into the bloodstream, preventing dehydration. The mixture of water and toxins, what we know as urine, collects in the center of the kidneys and then passes down through the ureters, small muscular tubes connecting to the bladder. When the bladder becomes full, your brain signals that you need to find a bathroom. Once you get to a bathroom, you relax the muscles holding the urine in. This voluntary relaxation of the muscles triggers a reflex contraction of the bladder muscle, and the urine, produced from that glass of iced tea you had for lunch, passes from your body. More detail about the normal workings of the bladder and kidneys follows.

WHAT IS THE BLADDER SUPPOSED TO DO?

The bladder has two basic functions. First, it stores the urine from the kidneys. The bladder fills up without any intentional thought on your part. Most women, first sense urine in the bladder when there are about 4 ounces collected. As the bladder fills and stretches, bladder nerves carry messages to the brain informing us that it is time to find a bathroom. This usually happens when there are about 10 ounces in the bladder. All this is accomplished while the bladder painlessly expands and collects urine. At the point the bladder is entirely full, containing about 15-20 ounces, you will feel uncomfortable, in need of relief, and will want to quickly find a bathroom.

The bladder’s second function, releasing stored urine, is usually a conscious, voluntary act. When you get to the bathroom, you relax the muscle near the opening of the bladder, called the sphincter. At the same time that the sphincter

relaxes, a reflex signal from the brain causes the bladder muscle to contract, and the urine is pushed out. The co-ordination of this system that keeps us dry is complicated, but we do all this with barely a thought. We learn this control when we are children, and it becomes second nature to us. The problem of incontinence arises when urine leaks out when we don’t want it to.

DO YOU REALLY NEED TO DRINK ALL THAT WATER?

We don’t know exactly how everyone got so concerned about drinking lots of water, but it seems to have come from the theories that extra water keeps your kidneys functioning well, keeps you from overeating and keeps your skin healthy. Not surprisingly, the International Bottled Water Association promotes these ideas aggressively. However, your kidneys are designed to work without a flood of water, and there is no medical evidence that more water helps them work any better. Some women think that drinking a lot of water helps curb the appetite, but studies show that drinking lots of extra water does not lead to a decreased total of calories people eat in a day. There are no studies that show that water helps with weight loss. Let’s face it- no one’s appetite is satisfied just drinking water. There is also no evidence to show that drinking a lot of water helps keep your skin moist and healthy. Dermatologists suggest that if your skin seems dry, you should apply lotion, not drink extra water.

Your body is well designed to tell you exactly how much fluid you need in a day – this mechanism is called thirst! Your brain very accurately senses when there is not enough water in your system and then tells you to drink. If you are dehydrated from sweating, your thirst tells you to drink what you lost. If you drink when you are thirsty, you’ll get the right amount. Around four 8-ounce glasses of fluids a day, all told, is enough. In fact, most people get enough water

in the foods they eat during a normal day to satisfy the body’s need for fluids. Fruits, vegetables, meat, fish, poultry, and dairy products all contain lots of water.

Ida and Pearl’s Problems with Water

     Ida and Pearl are sisters and long-time patients in our practice. Pearl, age 60, came in for a checkup but spoke more about her sister than she did about herself. “My big sister Ida is extreme in everything, and when it comes to her health, she’s a fanatic. If you tell her eating spinach once a week is good, she’ll eat it ten times a week. Now she’s on a water kick. She read drinking 8 glasses of water is good for your health, so she’s drinking 12 glasses of water a day! I don’t even know how she can get it all down. Is drinking all that water bad for her?”

     We assured Pearl that while Ida’s new water drinking habit was extreme, it wouldn’t injure anything. Nonetheless, drinking excessive amounts of water puts an unnecessary strain on the bladder and might cause Ida to lose control occasionally. Pearl was relieved but vowed to “set Ida straight and make sure she stops this craziness.”

     Two months later Ida, age 62, came in for her regular checkup. She told us she was feeling fine but shyly added that there was “one small problem.” She explained that she was “simply following the instructions in all the magazines about the importance of drinking lots of water but am embarrassed because I wet my pants quite a bit.”

     We talked about exactly how much water is really needed each day. Ida told us she was drinking” a bit more than that”. We suggested she cut back her consumption and let us know if the incontinence resolved.

     Three weeks later Ida called with the good news that she is always dry. “My sister Pearlie drives me crazy. But the truth is, she’s usually right. My marathon water drinking is over.”

• HOW OFTEN SHOULD YOU NEED TO GO TO THE BATHROOM?
• HOW MUCH URINE SHOULD YOU PASS?
• IS IT NORMAL TO GET UP AT NIGHT TO GO TO THE BATHROOM?
• IS LEAKING NORMAL?
• IS BULGING OR DROPPING OF THE BLADDER OR RECTUM NORMAL?
• WHAT DO THE KIDNEYS DO?
• WHAT DOES THE BLADDER LOOK LIKE?
• WHAT DOES THE INSIDE OF THE BLADDER AND URETHRA LOOK LIKE?
• HOW DO YOU NORMALLY CONTROL YOUR BLADDER?
• CAN ANY OF THESE AREAS MALFUNCTION?
• HOW ELSE DOES THE BLADDER NORMALLY PREVENT URINE FROM LEAKING OUT?
• WHAT DOES THE FUTURE HOLD?

Edited Excerpts from our book
The Incontinence Solution

By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker

Order The Incontinence Solution directly from Amazon.com.

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