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Incontinence: What Is It?
Urinary incontinence, or loss of bladder control, is a frustrating problem for millions of Americans. Never knowing when and where you might have an accident can affect everything from work to exercise to your social life. Urinary incontinence happens to both men and women but is more common in women. Studies show that at least half of older women may have some form of incontinence.
Stress Incontinence: Symptoms
The main symptom of incontinence is when you pee unexpectedly -- when and how depends on the type of incontinence. If you leak a bit when you laugh, cough, sneeze, jog, or lift something heavy, you may have stress incontinence. This is the most common bladder control problem in younger women.
Stress Incontinence: Causes
Stress incontinence happens when the muscles and tissue around the opening of the bladder get weak. When there is more pressure against the bladder and this opening does not stay closed, leakage happens. Pressure from coughing or laughing may be all it takes to leak urine. There are a few reasons why these muscles can lose strength.They may be stretched by weight gain, a sports injury, or pregnancies and vaginal childbirths.
Urge Incontinence: Symptoms
If you often have a desperate need to pee but can't get to the bathroom in time, you may have urge incontinence. The sudden urge can come from hearing the sound of running water or sipping a drink. Or there may not be any reason for it. With this type of incontinence, you may leak large amounts of urine. You may also find yourself running to the bathroom even when your bladder is mostly empty.
Urge Incontinence: Causes
A sudden, overwhelming need to pee might be caused by spasms of the bladder muscles. These spasms can come from nerve or muscle damage. In some cases, the damage might come from an illness like a stroke, or an infection or inflammation of the bladder.
Overactive bladder is another name for urge incontinence. You get the same sudden, frequent need to pee. But not everyone with overactive bladder has incontinence. Many women are able to “hold it” until they get to the toilet. Instead of leaking urine, the big problem for them is constantly having to stop what they're doing to go to the bathroom.
Medications That Worsen Incontinence
There are several medicines that can cause incontinence or make it worse. In women, some high blood pressure medicines can relax the bladder muscles, leading to stress incontinence. Some types of antidepressants can make incontinence worse, although some may relieve the symptoms. And diuretics or "water pills" create more urine, which adds to the problem.
Emotional Toll of Incontinence
Incontinence is not dangerous, but it can wear you down. Research shows that women with incontinence have lower self-esteem, a less active sex life, and higher levels of depression compared to those with healthy bladders. You might want to stay home and hide, but it doesn't have to be that way. Incontinence can be managed or even reversed.
The first step is to find out exactly what kind of incontinence you have. Your health care provider will ask about your medical history and probably get for a urine sample to check for a urinary tract infection. He or she may ask you to stand and cough, a way to signal stress incontinence. You may also be asked to keep a diary showing how much you drink, how much you pee, and how often you leak.
Diagnosing Incontinence: Tests
There are several tests to help pinpoint the cause of incontinence. Ultrasound imagery can show how the bladder and urethra change when you pee or cough. A pad test shows how much urine you pass throughout the day. A bladder stress test helps check for stress incontinence. Cystometry measures bladder pressure and can help diagnose urge incontinence. An MRI scan (seen here) may show problems that can't be seen with other tests.
Managing Mild Incontinence
Many women with mild incontinence can stop leaks by drinking less. Try pouring your cups half-full, and stay away from coffee, tea, and sodas with caffeine. Caffeine can create more urine, making you go more often. Another strategy is to empty your bladder regularly, every two to four hours, whether you need to go or not.
Because stress incontinence comes from weak pelvic muscles, consider trying to strengthen those muscles. You can do this with Kegel exercises: Clench the muscles you would use to stop the flow of urine. Hold the squeeze for 10 seconds, then relax. Do three or four sets every day. As these muscles get stronger, so will your bladder control.
Biofeedback is a method that gives you real-time information about activity in your bladder and pelvic muscles. As you learn more about these functions, you may be better able to control them. Biofeedback is often used in along with Kegel exercises.
When lifestyle adjustments don't help, you may need to talk to your doctor. If you have stress incontinence, a pessary may help. This is a device that can be put into the vagina to help cut down on the leakage. You can wear it continuously or only as needed, such as during a hard workout.
Bladder training can be help with both stress incontinence and urge incontinence. The first step is to make a chart of what times you go to the bathroom and when you leak. After studying the patterns, you can avoid accidents by heading to the bathroom before a leak might happen. It's also possible to train your bladder to hold out for longer and longer periods between bathroom visits.
Medications for Incontinence
For urge incontinence, doctors often suggest anticholinergic medicines. These pills or patches block some of the nerves in the bladder muscle. Studies show that taking the meds with bladder training works well. Botox injections into the bladder muscle can relax the bladder, which allows it to hold more urine. Botox injections aren't permanent, but they can last up to eight or nine months in the bladder. They can be repeated, too.
Surgery for Incontinence
Surgery for stress incontinence can be an outpatient procedure. For urge incontinence, a doctor can implant a device that stimulates nerves near the bladder and controls spasms with electrical signals (shown here). For stress incontinence, doctors can place the bladder in a "sling" -- a piece of tissue or material that holds the bladder up and prevents leaks. Another procedure pulls the bladder up to a more normal position without a sling.
Urinary incontinence products like panty liners, adult diapers, and plastic-coated underwear might help, too. You can find products like these in drugstores or medical supply stores. Protective bedding, such as a plastic mattress protector, may also be useful.
There are ways to lower your risk of incontinence. Keep a healthy weight and do daily Kegel exercises. If you smoke, try to quit. Smoking can lead to chronic coughing, which can stress the bladder and cause leaks.
Reviewed by Traci C. Johnson, MD, FACOG on Saturday, November 08, 2014
Slideshow Pictures: Urinary Incontinence in Women
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