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Urinary Incontinence in Women

Urinary incontinence is the loss of bladder control. While it is common in older women, it can happen to women of any age. In fact, urinary incontinence affects nearly one out of four women between the ages of 15 and 64. It is a condition that ranges from mild leakage to uncontrollable and embarrassing wetting. Remember that this is a medical problem which can be improved if not cured.

Some risk factors for incontinence in women are vaginal birth, being overweight, smoking, menopause, medication side effects, urinary tract infections, and medical or neurologic conditions.

  • Pregnancy and urinary incontinence

    During pregnancy and following childbirth, there are a number of factors that often cause women to experience bladder control problems and urine leaks. While you're pregnant, the extra weight of your baby resting on your bladder can cause you to urinate more frequently (called frequency). Sometimes, the pressure your baby puts on your bladder can also cause you to leak urine when you sneeze, cough, laugh, lift a heavy object or perform other physical activities. Less commonly, some pregnant women and new mothers experience an unusually urgent need to urinate (called urgency).

    If you're pregnant and having bladder control problems, discuss this with your health care provider. It's common for pregnant women to experience some loss of bladder control – in fact, up to half of all women will have some problems with bladder control while pregnant. In most cases, women who experience this will notice that bladder control problems get worse as their pregnancy progresses. In the vast majority of cases, these problems will improve or disappear soon after delivery. Women who’ve had difficulty with bladder control during previous pregnancies are more likely than first-time mothers to experience bladder control problems during pregnancy and post-partum. If you do experience a bladder control problem that lasts for more than six weeks after childbirth, talk to your health care provider to figure out the cause and the best way to address the problem.

    Other factors that can affect bladder health during and after pregnancy include:

    • Vaginal delivery, especially if long or difficult, which can weaken and stretch your pelvic floor muscles.
    • Shifting of the position of your bladder or urethra, making it more difficult to contain the flow of urine.
    • Episiotomy during childbirth (a cut in the surrounding tissue called the vulva that creates more room for the baby during delivery) which can weaken your pelvic floor muscles.
    • Pregnancy and childbirth can also damage the nerves that control your bladder, causing it to release urine at inconvenient times.
    • The repeated stress and stretching of multiple pregnancies can further reduce the strength of pelvic floor muscles and make it more difficult to control leaks.

    Exercises that strengthen your pelvic floor muscles can help during pregnancy and childbirth. If you're considering getting pregnant, talk to your doctor about the possibility of strengthening your pelvic floor muscles ahead of time to help prevent problems.

  • Treatments for urinary incontinence

    Urinary incontinence can be helped. You do not have to learn to live with this condition. Your own personal treatment will depend on the type of bladder control problem you have. Some treatments are simple; others are more complicated. The simplest treatments for women include pelvic muscle exercises that strengthen the muscles near the urethra. These are called Kegel exercises and take only a few minutes a day. Bladder training, weight loss and reduction of foods with caffeine and alcohol in your diet may all help some types of incontinence as well.

    Another level of treatment for muscle therapy may include electrical stimulation — or biofeedback — to make the muscles stronger and tighter. Some women have problems identifying their pelvic muscles, and this prevents them from effectively performing Kegel exercises. Biofeedback is a tremendous help in these situations. During biofeedback, a computer is used to show you just what the pelvic muscles are doing so you know you are exercising the right muscles. Biofeedback is an important aid used to teach you how to gain better control over your muscle activities.

    More complicated forms of treatment include medical treatments and surgeries. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles. There is the option of collagen injections as well: Collagen, a natural substance, is one of the body's building blocks. It can be injected into the tissue around your urethra to add bulk and keep your sphincter muscles tightly closed. One drawback to this treatment is that collagen breaks down over time, so you may need to have repeated injections. Certain devices may also be inserted into the urethra to control urine flow.

    Some bladder control problems can be solved by surgery, depending on the cause of the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder muscles work better.

    Kegel exercises

    Many women who suffer from stress incontinence, or loss of bladder control when you cough, sneeze, laugh or lift heavy objects, are told to do Kegel exercises. These exercises are designed to help you strengthen the muscles controlling the bladder opening and can be effective in improving symptoms. The first step in doing Kegel exercises is to identify the proper muscles. One way to do this is to start and stop your urine stream. Another way is to tighten your rectal muscles as if to hold back gas or a bowel movement. While these do not directly surround your bladder, the rectal muscles will always work with them. It is important to isolate the right muscles and not use your stomach, buttock or leg muscles.

    Once the muscles are identified, Kegel exercises involve slowly and quickly tightening and relaxing them. For a slow Kegel, tighten your muscles for 3-10 seconds and then relax them for 3-10 seconds. For a quick Kegel, tighten and relax your muscles rapidly. Most bladder strengthening exercises include a set of 10 Kegels four times a day. Each week, the number of tightenings and relaxations increase, as does the length of time that tightenings are held. As you can see, Kegel exercises can be done anywhere at any time and no one else is even aware. But persistence is key. To notice an improvement in bladder health, Kegels need to be done consistently and you need to follow up with your health care provider regularly.

    If you have any questions on Kegels or any related treatments or symptoms, please talk to your health care provider. Many women do have problems identifying the right muscles to use and your health care provider can help.

  • Diet and its effects on urinary incontinence

    Certain foods and drinks tend to irritate the bladder, which may contribute to how often you urinate and affect your overall bladder health.

    Foods and drinks that can be irritants include:
    • caffeine (coffee, tea, cocoa)
    • chocolate
    • alcoholic beverages
    • citrus fruits (grapefruit, oranges, lemons, limes) and juices
    • spicy foods
    • vinegar
    • artificial sweeteners
    • carbonated beverages

    If you eat excessive amounts of these foods, try to cut back and see if you notice any difference in your experience with urine leaks and how often (and how urgently) you feel like you must go to the bathroom.

    It is also important to drink six to eight glasses of water every day, which is important for proper kidney function and helps prevent constipation. Urine that is extremely concentrated due to lack of water is also more irritating to the bladder and can worsen feelings of urgency.

    The benefits of drinking the right amounts of fluid include preventing dehydration, constipation, and urinary tract infection and kidney stone formation. The average American adult requires about six to eight 8-ounce glasses of fluid a day. If you drink non-bladder-irritating fluids other than water, you do not need to force yourself to drink an additional six glasses of water.

  • Types of urinary incontinence

    There are different types of incontinence and each one has different treatment options.

    Stress incontinence -  happens if you have urine leakage during everyday activities like sneezing, coughing, laughing or lifting heavy objects. It can come from weakened pelvic muscles that support the bladder. It’s the most common cause of leakage and happens in women who are pregnant, who’ve recently had children or who are going through menopause or hormonal changes, among other causes.

    Urge incontinence -   occurs when bladder muscles become too active and you feel a strong, sudden urge to urinate, even if your bladder has little urine. While more likely to happen in older women, this problem can occur at any age.

    Overactive Bladder (OAB) -  is a form of urinary incontinence where symptoms such as a frequent, often sudden and urgent need to urinate (urgency) may be accompanied by loss of urine. Feelings of urgency (you must go immediately) and the need to empty your bladder even though you may have just urinated, are symptoms of OAB.

    The nerves that signal the feeling of urgency are sending abnormal messages to the bladder. The overactive bladder may spasm even when it contains a small amount of urine. Some foods are known bladder irritants and eating them may cause a need to urinate frequently. Urinary tract infections and some medications also can make you go to the bathroom more often. These symptoms can affect anyone at any age; they affect over 34 million people in the US.

    Overflow incontinence - the bladder does not empty properly and urine dribbles out.

    Mixed Urinary incontinence - a combination of stress and urge incontinence. 

    Functional incontinence -  occurs in older women and it is not caused by urinary tract problems. Rather, it’s due to factors that make it hard for you to get to the bathroom in time – insufficient mobility, impaired dexterity or strange surroundings.

    Other forms of incontinence may result from new medications or surgeries, faulty signals from the nervous system, or specific medical conditions. No matter what the cause, though, it’s important to let your health care provider know you are having symptoms early. Bladder control problems can be treated and managed successfully.

    Diagnosis of Incontinence
    Identifying the type of incontinence assists your provider in determining the right treatment option.  A detailed medical history and a gynecologic exam and urine testing will determine if there is a anatomic condition or urinary tract infection causing incontinence.  Additional testing including ultrasound and bladder pressure measurement, called cystometrogram, may be necessary.  You may be asked to keep a food and voiding log to help narrow down additional triggers of incontinence.  

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