Urinary Incontinence

Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from strokes, multiple sclerosis, and physical problems associated with old age.

Older women, more often than younger women, experience incontinence. But incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. You will need to overcome your embarrassment and see one of the doctors at Women’s Healthcare Associates to learn if you need treatment for an underlying medical condition.

Incontinence in women usually occurs because of problems with muscles that help to hold or release urine. The body stores urine-water and wastes removed by the kidneys in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.

During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body (see figure 1). Incontinence will occur if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.

Types of Urinary Incontinence

Stress Incontinence
If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause are common events that cause stress inconti¬nence. It is the most common form of incontinence in women and is treatable.

Pelvic floor muscles support your bladder. If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken. The incidence of stress incontinence increases following menopause.

Urge Incontinence
If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge inconti¬nence is inappropriate bladder contractions. Medical professionals describe such a bladder as “unstable,” “spastic,” or “overactive.”

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when someone else is taking a shower or washing dishes).

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, brain tumors, and injury-including injury that occurs during surgery-all can harm bladder nerves or muscles.

Mixed incontinence
Stress and urge incontinence often occur together in women.

Functional Incontinence
People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer’s disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women in nursing homes.

Overflow Incontinence
If your bladder is always full so that it continually leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra.

Transient incontinence
Transient incontinence is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.

How is Urinary Incontinence Diagnosed?

The first step toward relief is to see a doctor in Women’s Healthcare Associates who is well acquainted with incontinence to learn the type you have .

To diagnose the problem, we will first ask about your symptoms and medical history. You will be ask to keep a diary to record your fluid intake and the pattern of your voiding over 24- 48 hours. This diary should note the times you urinate and the amount of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim.

Women’s Healthcare Associates has a very sophisticated computerized urodynamic laboratory that enable us within a short time make the right diagnosis and based on these findings suggest the appropriate treatment.

How Is Urinary Incontinence Treated?

Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises.

Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, you stand and hold a cone shaped object within your vagina. You then substitute cones of increasing weight to strengthen the muscles that help keep the urethra closed.

Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Biofeedback
Biofeedback uses measuring devices to help you become aware of your body’s functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning ¬known as bladder training can alter the bladder’s schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

Medications
Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage.

Pessaries
A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage.

Implants
Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous natural tissue from cows) and fat from the patient’s body have been used. Implants can be injected using local anesthesia.

Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to deter¬mine whether you would have an allergic reaction to the material.

Surgery
Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success.

Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.

In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.

Catheterization
If you are incontinent because your bladder never empties completely (overflow inconti¬nence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.

Points To Remember
• Urinary incontinence is common in women
• You need not be embarrassed by incontinence.
• Diapers and absorbent undergarments are not the answer for incontinence.
• All types of urinary incontinence can be treated successfully at all ages.

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