FEMALE URINARY INCONTINENCE
Urinary incontinence is defined as the condition when one is unable to hold the urine until getting to a toilet. It is reported that over 13 million people in the United States, including both male and female, young and adults, experience incontinence. Incontinence is reported as a temporary condition which is often a side effect of an underlying medical complication.
The cases of incontinence in women are twice that in males. A range of factors including pregnancy, childbirth, and menopause affects the female urinary tract in a number of ways that contribute towards incontinence. However, some of the other reasons for the condition may include neurologic injury, birth defects, strokes, multiple sclerosis, and physical concerns associated with aging.
The rate of incontinence in older women is higher than in younger women. However, there has been no inevitable connection between age and incontinence.
While it is an embarrassing condition, the good news is that incontinence can be treated. When the muscles of the bladder do not act normal, they fail to hold or release the urine. The contraction of the tissues of the bladder results in urination. As the urine passes from the bladder to the urethra the sphincter muscles of the urethra relax and the urine is passed out of the body. The primary reason for incontinence is the work failure of the muscles in the bladder or the sphincter muscles of the urethra.
Stress continence in a condition wherein a physical activity such as coughing, laughing, sneezing, or other movements can make you leak urine. The causes of stress continence range from pregnancy to childbirth and menopause. Stress incontinence is common in women and is a treatable condition.
Pelvic floor muscles are responsible to keep the bladder in place. In case they weaken, the bladder is pushed towards the vagina, pushing the bottom of the pelvis together. This can loosen up the muscles around the urethra that prevents urine leaks. As a result, you might experience a urine leak in case of stressful activities.
Types of Urinary Incontinence
- Stress: When one leaks the urine during physical movement (coughing, sneezing, exercising).
- Urge: When leakage is large and at unexpected times, including during sleep.
- Functional: When physical disability, external obstacles, or problems in thinking or communicating causes urination.
- Overflow: When the urine leaks from the bladder unexpectedly in small amounts.
- Mixed: When stress and urge incontinence have combined a cause.
- Transient: When a condition such as infection or medication causes temporary incontinence.
How is Incontinence Evaluated?
In the case of urine leakage or incontinence, one must consult a qualified urologist. A specialist in the female urinary tract or gynecologists and obstetricians specializing in the female reproductive tract and childbirth are recommended.
The diagnosis starts with a background check to get hold of your pattern of voiding and urine leakage. The doctor would also ask questions about straining and discomfort, use of drugs, recent surgery, and illness to get a better idea.
Your doctor may ask you to keep a diary for a day or more, up to a week, to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim.
A physical exam is performed to identify any signs of medical conditions (tumor, stool impaction, poor reflexes, or sensations) causing incontinence. The bladder capacity is measured and the amount of residual urine to evaluate the functioning bladder muscles.
- Stress Test: The patient is asked to relax and then cough while the doctor evaluates the loss of urine.
- Urinalysis: To rule out any infection, urinary stones, or other contributing causes.
- Blood Tests: To find out any substance related to causes of incontinence.
- Ultrasound: A sound wave image of the kidneys, ureters, bladder, and urethra is created for closer examination.
- Cystoscopy: An endoscopic procedure to check the inside of the urethra and bladder.
- Urodynamics: The pressure in the bladder and urine flow is measured using different techniques.
How is Incontinence Treated?
- Exercises: Kegel exercises are the best in strengthening or retraining pelvic floor muscles and sphincter muscles. You can perform these exercises without any equipment.
- Electrical Stimulation: Mild doses of electrical stimulation are exerted to the lower pelvic area to strengthen the muscles. The procedure might also involve the placement of electrodes in the vagina or rectum for better stimulation.
- Biofeedback: The process involves the use of measuring devices that help track the body’s functioning. With a note about bladder and urethral muscles contraction timing, one can gain control.
- 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: Medication is effective in treating many types of leakage. Different drugs act differently on the bladder muscles, including relaxing or strengthening them. There are certain drugs that work on tightening the muscles at the bladder neck and urethra as well as some others that release estrogen, a hormone that is reported to promote the function of the bladder.
- Pessaries: A pessary is a stiff ring-like device that is placed inside the vagina and inserts the pressure on the wall of the vagina and the nearby urethra. The urethra is repositioned with the pressure and ultimately affects the stress leakage.
- Implants: In case of loss of mass, doctors suggest injecting substances into the tissues around the urethra. This is a way to treat stress incontinence. Collagen and fats from the patient’s body are used.
- Surgery: In case none of the above-mentioned treatments work, the doctor recommends surgery. The primary reason for incontinence is the hanging of the bladder down in the vagina. The surgeries are focused on pulling the bladder up to a more normal position. In case of severe stress incontinence, the surgeon may use a wide sling to secure the bladder in place. This way, the bottom of the bladder and the top of the urethra is compressed and any chances of further leakage are avoided. An artificial sphincter, a doughnut-shaped sac may also be implanted in the urethra in very rare conditions.
- Catheterization: In the case where the incontinence is caused because of the inability of the bladder to empty completely (overflow incontinence) or a condition where bladder fails to empty because of poor muscle tone, past surgery, or spinal cord injury, the doctors might install a catheter to empty the bladder. A catheter is a medical device that appears like a tube. It is inserted through the urethra into the bladder where it helps drain the urine. The use of catheters may be limited to once in a blue moon or on a permanent basis, in case of permanent catheter installation, there is a tube attached to it which further attached to a bag that one carries around the leg. The bag collects the urine that the body passes out. The constant use of a catheter may cause a urinary tract infection and hence it is important to keep a watchful eye over any changing statics.
Different women use different measures to deal with urinary incontinence. Some use pads to absorb any leakage that might happen in case of mild to severe physical activity. It is also reported that reducing the consumption of certain liquids such as coffee, tea, and alcohol can also help manage female incontinence.
Finally, in the case of elderly women especially, they prefer wearing undergarments that have absorbing nature as well as or diapers designed for adults. Wearing diapers is not only a socially embarrassing condition for most of the women, but it may also result in soreness of the skin or any skin irritation. It is important for elderly women to consult with a doctor in case of any type of incontinence. The doctor would recommend the best possible way to treat the problem through timed voiding, pelvic muscle exercises, and electrical stimulation and may consider wearing absorbent pads or diapers as the last resort.