Urinary Incontinence
Many women leak small amounts of urine at times. This can occur with certain movements, during pregnancy, or during other stress, such as coughing. Some women lose urine when they hear the sound of running water or when their hands are in water. others find that they feel the urge to urinate and are not able to control it. When leakage of urine becomes frequent or severe enough to become a problem, it is called urinary incontinence.
About Urinary Incontinence
Urinary incontinence is more common in women than in men. It affects 10-25% of women under age 65 and 15-30% of women older than 60 who do not live in nursing homes. Incontinence is even more common in nursing home residents-more than half may be affected. Incontinence does not always mean that a woman leaks often. For an active woman or a woman who loses a large amount of urine each time, even one time a week or less may be too much. Women sometimes do not tell their doctor about their symptoms of urinary incontinence. Less than one half of women seek medical care. Instead, they rely on absorbent pads or changes in lifestyle to deal with this condition. They may feel ashamed. They may even avoid certain social or work events. Some women have the false belief that urinary incontinence is a normal part of aging and that nothing can be done to correct it. Urinary inconti-nence often can be treated. Tell your doctor if you have any leakage of urine. Proper diagnosis and treatment may correct your problem and ease your symptoms.
Normal Voiding
The urinary tract is made up of:
* Kidneys, which produce urine
* Bladder
* Tubes called ureters that carry urine to the bladder
* Urethra
Normal urination (also called voiding) occurs when a woman is able to empty her bladder when she has a natural desire to do so. In normal void-ing, the muscles around the urethra relax, the blad-der 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.
Types of Incontinence
There are three types of incontinence:
* Urge
* Stress
* Overflow
The most common type is urge incontinence. It occurs if the detrusor muscle the muscle wall of the bladder is overactive. This leads to loss or leakage of urine. Stress incontinence occurs when the pressure inside the bladder (which moves urine out) is greater than the pressure in the urethra (which keeps urine in). It causes loss of urine during coughing, laughing, sneezing, or physical activity. Its main cause is when the tissues that surround and support the urethra and bladder are weakened.
In overflow incontinence, the bladder does not empty during voiding. This results in a steady leak-age of small amounts of urine. Overflow incontinence is less common than urge incontinence. It occurs when the detrusor muscle is underactive.
Symptoms
Women who have urinary incontinence may leak urine often. They may have to wear a pad to keep from wetting their clothes. Some women with incontinence feel such a strong desire to urinate that they cannot control it. This results in a loss of urine.
A woman with urinary incontinence also may have other symptoms:
* Urgency: A strong desire to urinate, whether or not the bladder is full. This often occurs along with pelvic discomfort or pressure. The fear of leakage or pain also occurs.
* Frequency: Urinating more than every 2 hours or more than seven times a day.
* Nocturia: The need to urinate two or more times during hours of sleep.
* Dysuria: Painful urination.
* Enuresis: Bed-wetting or wetting while sleeping.
Causes
There are many possible causes of urinary incontinence. These include infection, damage to organs, and muscular disorders.
Urinary Tract Infection
Urinary incontinence may occur because of an infection of the urinary tract. Often such an infec-tion occurs along with pain, frequency, and blood in the urine. Infections of the bladder (cystitis) and of the urethra (urethritis) are common in women.
Pelvic Support Problems
Pelvic support problems occur when the tissues that support the pelvic organs are stretched and damaged. This allows the organs that they support to sag out of place. If the tissues that support the urethra, bladder, uterus, and rectum are weakened, these organs may drop. This may lead to urinary incontinence or difficulty passing urine. Two types of pelvic support problems are the cystocele and the cystourethroc. When the bladder drops from its normal place into the vagina, it is called a cystocele. The place where the bladder joins the urethra is called the bladder neck. When tissues that support the bladder neck are damaged, it may drop and push against the vaginal wall. A dropped bladder neck is called a cys-tourethrocele. The main causes of pelvic support problems are childbirth and aging. As the baby passes through the vagina during childbirth, the vaginal wall and ligaments may be damaged. They may become weak. In later years, when a woman goes through menopause, the loss of the female hormone estro-gen may make these problems worse.
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
* Advanced cancer of the pelvis
Diagnosis
A number of steps may be needed to find the cause of urinary incontinence. These steps may vary. It depends on the nature of the problem. The first step often is a detailed medical history. You will be asked questions about factors that may affect your voiding habits. The voiding diary is one of the most useful methods to diagnose incontinence. The doctor may ask you to record the time and amount of urine leakage over 24-72 hours. You also may be asked to record how much water or other fluids you drank and any activity that might have caused the leakage.
A pelvic exam also may be done. It can detect physical conditions that might be linked to incon-tinence. Other exams and tests used may include:
* Lab tests to detect urinary tract infection.
* Stress test-patient must cough a few times with a full bladder. Any loss of urine is recorded.
* Pad test-patient wears a preweighed pad for one hour while doing a series of movements. If the pad weighs more at end of the hour, there was a loss of urine.
* Dye test-patient wears a pad while a nontox-ic dye is put into the bladder. If the pad is stained with the dye, there was a loss of urine.
* Cystometry-the pressure and volume of the bladder as it is filled with fluid is measured.
These tests can help detect the cause of the problem. Some patients may have more than one cause. Knowing the cause helps your doctor select the best treatment for you.
Treatment
Many women delay seeking medical care until their symptoms are so severe that they need surgery. In the meantime, they use pads to soak up the urine. Pads or adult diapers may offer security, but they have drawbacks. For instance, they can bother the skin. These products should not be the first or only treatment tried for incontinence. They should only be used to make other treatments work better or when other treatments have failed. There are many options for treatment. It depends on the cause of your problem. Treatments include behavioral changes, medication, special devices, or surgery.
Behavioral Treatments
The goal of behavioral treatment is to help a woman know why leakage occurs and how to avoid it. It may include bladder retraining and pelvic muscle exercises. With bladder retraining, you will be taught about normal and abnormal voiding patterns. You will be told to void at set times whether or not you have the urge. You will be told about ways to help you ignore any urges to pass urine. One is distraction-thinking about other things. After a few weeks you should have fewer instances of leaking urine. This method can be a success in many cases. Pelvic muscle exercises such as Kegel exercises (see box) improve urine control in 40-75% of women who use them. Biofeedback might be used with this or other treatments to improve your response. Biofeedback is a process that tells you about your body functions. This helps you to gain control of these same functions.
Medication
Medications that help control muscle spasms can help prevent leakage. Other drugs strengthen the smooth muscle of the urethra and improve symp-toms. These medications may cause:
* Dry mouth
* Constipation
* Nausea
* Blurred vision
* Sleeplessness