Urinary incontinence

Urinary Incontinence 

 

What is incontinence?

Bladder problems are common. Many others have bladder problems, such as needing to go to the toilet more frequently and an urgency to go without leakage.

Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder (urinary incontinence).

Incontinence is a widespread condition that ranges in severity from ‘just a small leak’ to complete loss of bladder or bowel control. Incontinence can be treated and managed.  In many cases, it can also be cured.

Women leak small amounts of urine from time to time. Leakage of urine can occur with certain movements, or during pregnancy or times of stress. Some women find that they lose urine when they hear the sound of running water or when they have their hands in water. Others find that, at times, they feel the urge to urinate and are unable to control it. When leakage of urine becomes frequent or severe enough to become a social or hygienic problem, it is called urinary incontinence.

Often women are reluctant to tell their doctor about the symptoms of urinary incontinence. They may feel embarrassed, and may even withdraw from certain social or work situations. Other women have the false belief that urinary incontinence is a normal part of aging and that nothing can be done to correct it. But often urinary incontinence can be treated with success.

Any leakage of urine that you cannot control should prompt you to see your doctor. Proper diagnosis and treatment may correct these problems and ease the symptoms of urinary incontinence.

Normal Voiding

The urinary tract is made up of kidneys, which produce urine; tubes called ureters that carry urine to the bladder, a sac-like, muscular organ, where it is stored; and the urethra, a small, muscular tube about 2 inches long that channels urine from the bladder to the outside of the body.

Normal urination, or voiding, occurs when a woman is able to empty her bladder whenever she has a natural desire to do so. In normal voiding, the muscles around the urethra relax, the bladder contracts, and urine flows from the bladder to the urethra and out of the body. When the bladder is almost empty, the muscles around the urethra contract, the bladder relaxes, and the stream of urine stops flowing.

Normal voiding - urinary incontinence

Think you might have a problem?

If you experience bladder problems but are not sure if you should seek help, try the questionnaire below.

Bladder and bowel questionnaire

  • Do you sometimes feel you have not completely emptied your bladder?

  • Do you have to rush to use the toilet?

  • Are you frequently nervous because you think you might lose control of your bladder?

  • Do you wake up twice or more during the night to go to the toilet?

  • Do you sometimes leak before you get to the toilet?

  • Do you sometimes leak when you lift something heavy, sneeze, cough or laugh?

  • Do you sometimes leak when you exercise or play sport?

  • Do you sometimes leak when you change from a seated or lying position to a standing position?

  • Do you plan your daily routine around where the nearest toilet is?

    If you answered ‘yes’ to any of these questions you may have a bladder control problem.

    Women who have urinary incontinence leak urine often. They may have to wear a pad to keep from wetting their clothes.

  • A woman with urinary incontinence may also have other symptoms:

    ■ Frequency: Urinating more than every 2 hours or more than 7 times a day

    ■ Nocturia: The need to urinate often during hours of sleep

    ■ Dysuria: Painful urination

    ■ Enuresis: Bed-wetting

incontinence (1)

Causes Of Urinary Incontinence

There are many possible causes of urinary incontinence. It may be due to infection, hormone problems, pelvic support problems, abnormalities of the tissues and organs of the urinary tract, problems of the nervous system, or side effects of certain drugs.

Urinary Tract Diseases

Urinary incontinence may be due to an infection of the urinary tract. Often such an infection occurs along with pain, frequency, and blood in the urine. Infections of the bladder (cystitis) and of the urethra (urethritis) are very common in women. Incontinence may also be due to abnormal growths within the urinary tract.

Hormone Deficiency Urinary

incontinence sometimes occurs after menopause (when menstrual periods end) because of a loss of estrogen. This loss causes the lining of the urethra to become thin and the muscles around the urethra to weaken. As a result, the urethra also becomes weak, and urine leaks.

Neuromuscular Disorders

Neuromuscular disorders are problems with the nerves that control the function of the bladder and urethra. If the nerves do not control the contractions of the bladder muscle, it may expel urine. The bladder may also become too full, and urine may leak out. Most of the time it is not known why the nerves lose control of the bladder muscle. It could be linked to other medical conditions. 

Drug Therapy

Urinary incontinence may be a side effect of drugs taken for some other condition. For example, diuretics (drugs that increase the amount of urine the body makes), sedatives, or tranquilizers may cause some women to leak urine.

Pelvic Support Defects

Pelvic support defects occur when the tissues that support the pelvic organs become weakened and allow these organs to sag out of place. These problems are usually the result of stretching of the pelvic tissues during childbirth. With aging, the tissues and pelvic supports may become weakened further. If the tissues that normally support the urethra, bladder, uterus, and rectum are weakened, these organs may drop and lead to urinary incontinence or difficulty in passing urine. Leakage often occurs with coughing, sneezing, laughing, lifting, exercising, or intercourse.

Pelvic Support Defects

Urinary Tract Abnormalities

Fistulas are abnormal openings between the urinary tract (urethra, bladder, or ureters) and the vagina. These openings can allow urine to leak out through the vagina.

Fistulas may result from pelvic surgery, childbirth, radiation treatment, or advanced cancer within the pel-vis. Urinary incontinence can also be caused by a urethral diverticulum, a small pocket that bulges out of the wall of the urethra. Urine can collect in this pocket and then spill out later.

Urinary Tract Abnormalities Fistulas

Treatment for incontinence and continence problems

If you have incontinence problems, you should seek help. There is a range of management options available. The treatments depend on the type of incontinence you have and what you hope to achieve.

■ Antibiotics to treat infection

■ Estrogen as hormone replacement

■ Drugs to control abnormal bladder contractions

■ Special exercises, such as Kegel exercises (see below), or changing your voiding habits

■ Electrical stimulation of the muscles around the bladder and urethra

■ Surgery to correct pelvic support defects or to remove abnormal tumors

■ A special device called a pessary to support the pelvic organs

Kegel Exercises

Kegel exercises, or perineal exercises, are used to strengthen the muscles that surround the openings of the urethra, vagina, and anus. Your doctor or nurse can help you learn to perform these exercises. You may be told to contract these muscles for about 3 seconds, 12-15 times in a row, at least six times a day. In time, your ability to hold your urine will improve.

 Sometimes the cause of urinary incontinence cannot be cured, or the problem recurs after treatment. In these cases, there are ways to help a woman stay comfortable. She may use disposable pads, protective garments, or devices to collect urine.

Finally…

Urinary incontinence is a very common problem. If you are bothered by the symptoms of urinary incontinence, or if they affect your daily living, tell your doctor. A complete and thorough exam is needed to find the cause of the problem. In most cases, urinary incontinence can be treated with success.

Contact Dr. Gan to make an appointment here, if you would like to speak to her about this topic.

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