FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SMOKING HARMS NOT JUST LUNGS AND HEART, BUT BLADDER, TOO

Question: My doctor told me to stop smoking because I have a problem with urination. I must get up several times at night, and I also occasionally leak urine during the day. At other times I feel like I need to go but am then unable to do so. I know that smoking is bad for my lungs, and I should quit because of that -- but it is hard to do. Is my doctor just using my problems with urination as an excuse to encourage me to quit smoking, or does it really cause problems there, too?

Answer: An important concept of osteopathic medicine is that all parts of the body are interconnected. That is, a condition that affects one part of the body will have some impact on all other parts of the body. From this precept alone, you can correctly deduce that your doctor is giving you sound advice. He or she is not simply using "half-truths" to influence you to take better care or your health.

Urinary symptoms such as incomplete emptying of the bladder, frequent urination, leaking urine (incontinence) and urgency of urination can have several causes. Infection in the lower urinary tract, as distinct from the kidneys, can produce these symptoms and would be the most likely cause in a young person. In older individuals, problems related to increased mobility of the bladder or urethra (tube emptying the bladder to the outside), tumors, prostate enlargement, bladder irritation or bladder cancer would be viewed as more probable causes.

Smoking tobacco certainly causes respiratory problems, but it also increases the risk of other health conditions. Heart attacks and stomach trouble are two of the commonly recognized ones, but urinary tract problems can also be attributed to smoking. In the general population, cancer of the urinary bladder occurs at a rate of 28 per 100,000 men per year and 7 per 100,000 women. In those who had never used tobacco, the rate was three times lower, but, curiously, the gender difference in the frequency of this cancer remained the same. Among smokers, those who smoked the greatest amount for the longest period of years had the highest cancer rates. This sure does implicate tobacco as a significant bladder cancer risk factor.

The urinary symptoms you describe could be the consequence of bladder cancer or several other conditions, but it is more likely that they are the result of chemical irritation caused by smoking. The exact mechanism that produces this irritation isn't understood, just as the exact way in which it causes lung cancer isn't known. However, it is known that some of the tars and other chemicals found in smoke are eventually eliminated from the body by the kidneys. This "contaminated" urine then travels to the bladder where it may stay in contact with the bladder lining long enough to irritate it. What I don't understand is why the symptoms don't start with the first cigarette instead of taking years of regular smoking to develop.

Unfortunately, bladder symptoms caused by tobacco use don't promptly go away with cessation of smoking. They do slowly improve over a period of years, however. I'd advise you to stop smoking now -- for large a number of reasons.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.