What Is Female Incontinence
Female incontinence is the loss of bladder control in women. It is not uncommon to lose urine during pregnancy or with urinary tract infections temporarily. There are many reasons you might develop urinary incontinence as a chronic problem. The most common causes are pelvic floor trauma with childbirth, menopause, hysterectomy, obesity, cognitive impairment, chronic cough and constipation.
There are three types of female incontinence:
- Urge incontinence: Women with urge incontinence feel the need to urinate frequently. They experience leakage of urine during times associated with this urge.
- Stress incontinence: Women with stress incontinence, also known as physical or exertion incontinence, may experience urine leakage, especially when coughing, laughing, exercising or sneezing.
- Mixed incontinence: Many women experience a combination of stress incontinence and urge incontinence.
Introductionwhat Is Urinary Incontinence And What Causes It
When you are not able to hold your urine until you can get to a bathroom, you have what’s called urinary incontinence . In contrast, bladder control means you urinate only when you want to. Incontinence can often be temporary, and it always caused by an underlying medical condition. Millions of Americans experience loss of bladder control. However, women suffer from incontinence twice as often as men do. Both women and men can have trouble with bladder control from neurological injury, birth defects, strokes, multiple sclerosis , and physical problems associated with aging. Older women have more bladder control problems than younger women do.
The loss of bladder control, however, is not something that has to happen as you grow older. It can be treated and often cured, whatever your age. Don’t let any embarrassment about incontinence prevent you from talking to your health care provider about your condition. Find out if you have a medical condition that needs treatment.
Can Incontinence Be Prevented
Different events throughout your life can lead to many of the things that cause incontinence. The muscles that support your pelvic organs can weaken over time. For women, these muscles can also be weakened by big life events like pregnancy and childbirth. However, in the same way you work out to build strength in your legs or arms, you can do exercises to strengthen your pelvic floor muscles. Doing exercises to strengthen your pelvic muscles may not prevent you from having any issues with incontinence, but it can help you regain control of your bladder. Maintaining a healthy body weight can also help with bladder control. Talk to your healthcare provider about the best ways to maintain strong pelvic floor muscles throughout your life.
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Electrical And Magnetic Stimulation
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.
Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence .39 A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.40
What Are Some Of The Different Types Of Urinary Incontinence
The following are some of the different types of urinary incontinence:
Urgency incontinence: This is the inability to hold urine long enough to reach a restroom. It can be associated with having to urinate often and feeling a strong, sudden urge to urinate. It can be a separate condition, but it may also be an indication of other diseases or conditions that would also warrant medical attention.
Stress incontinence: This is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects or performing other body movements that put pressure on the bladder.
Functional incontinence: This is urine leakage due to a difficulty reaching a restroom in time because of physical conditions, such as arthritis, injury or other disabilities.
Overflow incontinence. Leakage occurs when the quantity of urine produced exceeds the bladders capacity to hold it.
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Should I Drink Less Water Or Other Fluids If I Have Urinary Incontinence
No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health.
Women need 91 ounces of fluids a day from food and drinks.11 Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.
After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.12
Risk Factors Linked To Overactive Bladder Other Urinary Problems
- The study found a significant association of OAB in women aged 45 to 54 years and postmenopausal status.
- Stress urinary incontinence symptoms were shown to increase as a result of a high body mass index and the number of times a woman has given birth.
- Other factors studied, including smoking status, history of diabetes, hysterectomy, and the use of hormone therapy , were not found to be associated with urinary incontinence.
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What Are The Symptoms
The main symptom is the accidental release of urine.
- If you have stress incontinence, you may leak a small to medium amount of urine when you cough, sneeze, laugh, exercise, or do similar things.
- If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. With this type of bladder control problem, you may leak a larger amount of urine that can soak your clothes or run down your legs.
- If you have mixed incontinence, you may have symptoms of both problems.
Ways To Treat Bladder Leakage
With so many bladder leakage products and treatment options, how do you know what is the best one for you?
First, be sure to check in with your urologist or urogynecologist to see what may be causing your bladder leakage. Knowing the cause will help you and your doctor decide what treatment option will work best for you. While certain drinks, foods and medications may stimulate your bladder, there are other medical reasons that can cause your symptoms, including:
- Urinary tract infections
- Weakened pelvic floor, sometimes caused by pregnancy, childbirth, menopause or having had a hysterectomy
- Neurological disorders
Depending on what is causing your urinary incontinence, a unique treatment plan should be developed based on your personal situation, says Nina Bhatia, M.D., urogynecologist at Hackensack Meridian Health. There are several lifestyle changes, including bladder retraining techniques, dietary changes, avoiding bladder irritants, pelvic floor exercises and pelvic floor physical therapy that can help tremendously. If those fail to provide you relief, there are non-surgical and surgical options that we can offer.
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Q How To Cope With Incontinence
Urinary incontinence can more or less become an obstacle in day-to-day activities. Women suffering from this problem can use absorbent pads for bladder leakages. Also, instead of drinking too much water at once, you can drink a little from time to time.
Some lifestyle changes can also help in dealing with the issue. Through muscles training, you can learn to tighten your pelvic muscles every time you cough or laugh to avoid stress incontinence.
Kegel exercises, specifically designed for urinary incontinence, can help. Kegels can help you identify your pelvic muscles, manage them to avoid leakages and strengthen them.
Also, taking dietary fibre can help in preventing urinary incontinence. You can eat lentils, berries, beans and avocados, which are good sources of fibre. They will help in improving bowel health.
Bladder training is one of the effective ways to control your urge. Start by making frequent trips to the bathroom to urinate within equal time gaps. This way the urge to urinate will minimize. Continue doing so and when you notice that the urge is reducing, go to the bathroom in increased time gaps. Go to the bathroom even if you do not feel any urge to urinate. For example, if you are going in every 45 minutes, keep doing that until it increases to 3-4 hours.
When Should I See A Doctor About Incontinence
Its important to know that incontinence can be treated. Many people believe that its something that just goes along with aging and is an unavoidable issue. If you find that incontinence is disturbing your daily activities and causing you to miss out on things you typically enjoy, talk to your healthcare provider. There are a wide range of options to treat incontinence.
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Clinical Management Of Urinary Incontinence In Women
This is a corrected version of the article that appeared in print.
LAUREN HERSH, MD, and BROOKE SALZMAN, MD, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Am Fam Physician. 2013 May 1 87:634-640.
Patient information: A handout on this topic is available at .
Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide. 1 Estimations of prevalence range from 3 to 55 percent, depending on the definition and the population.2 Within nursing homes, 60 to 70 percent of patients experience the disorder.3 These estimates are thought to be conservative, because at least one-half of patients do not report incontinence to a physician.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
|Clinical recommendation||Evidence rating||References|
Pharmacologic interventions should be used as an adjunct to behavioral therapies for refractory urge incontinence.
Surgical therapy should be considered in women with stress incontinence that has not responded to less invasive treatment modalities.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
Classification of Urinary Incontinence in Women
Treatments For Urgency Incontinence
Urgency incontinence is when you get the urge to go, and if you dont make it to a bathroom, your bladder will empty. It can have serious effects on your life and your work.
Experts dont know what causes urgency incontinence, but there are different ways to approach it. First we start with behavioral changes, which vary based on your situation. Steps could include:
Weight loss again, losing even a small amount of weight can help.
Avoiding excess fluids. If youre having trouble sleeping, we talk about limiting fluids before bedtime so sleep is less interrupted.
Time voiding, which is retraining the bladder. If the patient is in the bathroom every hour, well slowly lengthen that interval so theyre in the bathroom less often.
Pelvic floor exercises, with help from a physical therapist.
Changing your diet. I review a list of bladder irritants: coffee, chocolate, alcohol, spicy foods, and other things. We have patients skip those foods and drinks for a week or two and see what their urgency or frequency is like.
If behavioral changes dont help, there are other options to explore. We can try certain medications that relax your bladder muscles and prevent leakage. Botox, injected into the muscles of the bladder, can help some patients temporarily. And there are several medications we can try, including anticholinergics, which block the impulse to urinate. This can help you get more sleep at night.
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Why Is Urinary Incontinence A Health Issue
Urinary incontinence is a very common problem in aging women . When women leak urine during exercise, sneezing, or coughing, doctors call this type of incontinence stress-related . When women have strong urges to urinate and have trouble holding urine until getting to the bathroom, they may have what is known as urgency incontinence . Although most women have one or the other type of incontinence, older women often have both types. Incontinence hurts women’s self-confidence, interferes with their ability to enjoy their favorite activities, and decreases the quality of their lives .
Medications For Urinary Incontinence
If medications are used, this is usually in combination with other techniques or exercises.
The following medications are prescribed to treat urinary incontinence:
- Anticholinergics calm overactive bladders and may help patients with urge incontinence.
- Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
- Imipramine is a tricyclic antidepressant.
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What About Hormone Therapy And Urinary Incontinence Symptoms
There werent enough women receiving hormone therapy for the authors to draw conclusions about its impact, notes Faubion. It would have been nice to be able to determine the effect of hormone therapy although as the authors mention, systemic hormone therapy has not been shown to help with urinary incontinence if anything it has been implicated in worsening it, she says.
Topical estrogen, such as a vaginal estrogen cream, has been shown to be helpful in urge incontinence, and so it would be helpful to have research to provide further clarification of this, says Faubion.
Pelvic Floor Muscle Training
Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
A GP may refer you to a specialist to start a programme of pelvic floor muscle training.
The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.
If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.
Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.
Find out more about pelvic floor exercises.
Absorbent Pads Catheters And Medical Devices
If medical treatments cant completely eliminate your incontinence, you can try products that help ease the discomfort and inconvenience of leaking urine:
- Pads and protective garments
- Pessaries and vaginal inserts a small device inserted into the vagina to help provide support to prevent leakage
What Causes Bladder Leaks
There are two main types of urinary incontinence:
If you have this type, activities that raise the pressure inside your abdomen cause urine to leak through the ring of muscle in your bladder that normally holds it in. Coughing, sneezing, jumping and lifting heavy objects could lead to a leak.
Going through childbirth, smoking or being overweight can raise the risk of stress incontinence for women, Wright says. Stress incontinence in men is rare, and when it arises, its often due to prostate cancer treatment, such as radiation or surgery.
With this type, your brain, spinal cord and bladder dont work together properly to allow you to hold and release urine at the right time. Your bladder may suddenly empty itself without warning. Or you may feel like you need to urinate frequently, a problem called overactive bladder.
Some diseases that affect the nervous system, such as multiple sclerosis or stroke, can cause this kind of incontinence, says Wright. In men, an enlarged prostate may be the culprit. But in many cases, doctors dont know what causes urge incontinence.
It is possible to have both types of incontinence at the same time.
TRY IT: Keep Records
Your doctor will want to know as much as possible about your bladder leakswhen they occur, how much urine comes out, and what youre doing when leaks happen. Consider keeping a diary of when you urinate and when you have leaks, recommends Wright.
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Exercises Help Women With Urinary Incontinence
Aug. 29, 2000 — Urinary incontinence is a common problem for many older women. Frequent, uncontrolled leaking of urine from the bladder causes many women to avoid activities that were once enjoyable, including exercise and sex.
A variety of treatment options are available for women with this problem, including urinating on a timed schedule to “retrain” the bladder, surgery, and pelvic floor muscle exercises. The latter, known as Kegel exercises, involve strengthening weakened pelvic muscles by contracting and releasing them.
“The real issue with is it takes a fair amount of effort on the patient’s part,” says urologist Jenny Franke, MD, of Vanderbilt University School of Medicine in Nashville. “When I examine a patient, part of that examination involves seeing whether they can isolate the pelvic floor and contract those muscles, and, if they’re able to do that, I have some written instructions, and I give them some little techniques to help them remember to do the exercises.”
Franke says simple, self-adhesive notes left on the dashboard of your car or on your TV can be a big help. “I try to get them to use what I would otherwise consider wasted time: sitting at a stoplight or watching a commercial. They can do their exercises during that time and then it becomes a routine.”
A new study from Norway shows that the exercises help women get back to doing social or physical activities that they enjoy.
Exercises To Help Female Incontinence
One of the easiest treatments for female incontinence is regular exercise, which can be done even at home, at any time. It is recommended to do exercises for strength, endurance, and speed of the pelvic floor muscles 5 times a week, for a few minutes each time. You can check the right type of muscle contraction, if you put two fingers in the vagina and contract the vaginal muscles around the fingers like when holding urine. The muscles of the pelvic floor should feel squeezed around the fingers.
To train the muscle strength, contract your anus, vagina, and urethra as if you were holding urine. Keep the maximum contraction for 5 to 10 seconds, and then relax the pelvic floor for 10 seconds. Repeat the exercise at least 5 times.
For endurance training, try to gently contract the pelvic floor from the anus to the urethra for 20 seconds, then relax the muscles. Repeat the exercise at least 5 times.
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