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What Is Incontinence?
Urinary incontinence is the loss of bladder control that impacts over 13 million people in the U.S. The uncertainty associated with a lack of bladder control has a significant effect on work, exercise, and social functioning. While urinary incontinence affects both men and women, it is twice as common in women. Up to half of older women may have some type of incontinence.
Stress Incontinence: Symptoms
Unplanned urination is the main sign of incontinence. How and when this occurs depends of the precise type of incontinence. Stress incontinence is the leaking of urine when you laugh, sneeze, cough, or strain, such as by lifting something heavy. This is the most common type of incontinence in younger women.
Stress Incontinence: Causes
Stress incontinence is caused by weakening of the muscles and supporting tissues of the bladder. Increases in pressure against the bladder or the sphincter muscles (like when coughing or sneezing) result in leakage of urine. The muscles can weaken for several reasons, including pregnancies and vaginal deliveries, weight gain, or sports injuries.
Urge Incontinence: Symptoms
Urge incontinence is characterized by strong sensations of needing to urinate and being unable to reach the bathroom in time. This urge may have triggers, like hearing the sound of running water or having something to drink. In other cases, there may no precipitating event. This type of incontinence can cause leakage of a large amount of urine. Another symptom is feeling the urge to urinate even when the bladder is not full.
Urge Incontinence: Causes
Urge incontinence is believed to be a result of spasms of the bladder muscles. Spasms may arise due to damage to the muscles themselves or to the nerves that supply them. In some situations the nerve and muscle damage may be caused by a stroke, inflammation, or infection.
Urge incontinence is also sometimes referred to as overactive bladder. The primary symptom is the urgent need to urinate. Not everyone with overactive bladder will have incontinence, as some people are able to hold the urine until they reach the bathroom. Rather than leakage, the problem for these persons is having to make sudden and frequent trips to the bathroom.
Medications That Worsen Incontinence
Some medications that you may take for other conditions can worsen the symptoms of incontinence. Some high blood pressure medications can relax the bladder muscles, playing a role in stress incontinence. Among the antidepressants, some can relieve incontinence, while others may worsen the symptoms. Diuretics, which increase urine output, can make the symptoms of any type of incontinence more pronounced.
Emotional Toll of Incontinence
Incontinence itself does not cause serious or life-threatening problems, but it tremendously affects well-being. Women with incontinence have been shown to have lower self esteem, higher rates of depression, and reduced sexuality when compared to women without incontinence. The fear of having accidents may keep many women isolated from others. It’s important to understand that incontinence can be effectively managed.
To determine the best management plan, it’s important to determine the precise type of incontinence. To do so, your doctor will ask about your medical history and symptoms and perform a physical examination. You may need to provide a urine sample to rule out infection. Tests such as standing and coughing can help identify stress incontinence. Symptom diaries, that include records of your food and drink, urination habits, and any leakage can also help establish the diagnosis.
Diagnosing Incontinence: Tests
Specialized testing can help establish the diagnosis and cause of incontinence. Imaging by ultrasound can show the movement and position of the bladder and urethra during urination. A pad test measures the amount of urine that is passed on a daily basis. A bladder stress test can help diagnose stress incontinence. Measurement of the pressure in the bladder, known as cystometry, can help check for urge incontinence. The image shown here is an MRI scan of the urinary organs. This test can sometimes reveal abnormalities not seen with other imaging tests.
Managing Mild Incontinence
Drinking less fluid can help many women with mild incontinence relieve their symptoms. Avoiding caffeine in coffee, tea, and sodas may help, since caffeine is a diuretic that increases urine output. Emptying the bladder regularly, every 2 to 4 hours even if you do not feel the need to urinate, can also help manage incontinence.
Weak pelvic muscles are a cause of stress incontinence, so strengthening these muscles can help relieve incontinence. Kegel exercises strengthen the muscles around the urethra. To do these exercises, tighten the muscles you use to stop urine flow; hold for 10 seconds and then relax. Try to do three or four sets of these exercises every day for improved bladder control.
Biofeedback is a procedure in which the patient is provided with real-time feedback about the activity of muscles in the bladder and pelvis. This awareness may enable you to better control the bladder muscles. This technique can be used together with Kegel exercises to strengthen the muscles of the pelvis.
If changes in lifestyle do not help relieve incontinence, a device known as a pessary may be helpful. The device is inserted into the vagina to help reduce the leakage related to stress incontinence. The pessary can be worn as needed or continuously.
The injection of bulking agents such as collagen around the urethra builds resistance to the flow of urine from the bladder. This can provide relief from stress incontinence, but the effects are not permanent. Injections need to be repeated every 12 to 18 months.
Both stress and urge incontinence can be lessened by bladder training. This involves charting your bladder habits and instances of incontinence. Once patterns are identified, you can plan bathroom visits at times of expected leaks before they occur. It is also possible to train the bladder to hold urine for longer periods of time between bathroom visits.
Medications for Incontinence
Anticholinergic medications are sometimes prescribed for urge incontinence to reduce contractions of the bladder muscles. These are particularly effective when combined with bladder training.
Surgery for Incontinence
Surgical procedures have also been successfully used in the management of stress incontinence. Creation of a bladder “sling,” or piece of tissue that holds the bladder up to prevent leakage, is one surgical option. Another type of surgery creates a more normal position for the bladder without the sling. For urge incontinence, surgery may be done to increase the storage capacity of the bladder. Implantation of a device that controls bladder spasms through electrical signals is a further surgical option for urge incontinence.
Incontinence products can be useful both as long-term management solutions and temporary measures until surgery or other treatments are effective. Adult diapers, panty liners, and plastic-coated underwear are widely available. Protective bedding products such as mattress protectors can also be useful.
You can take steps to reduce your risk of incontinence. Keeping a healthy weight and strengthening pelvic muscles with Kegel exercises are most effective. Quitting smoking can lead to decreased coughing. Chronic coughing can stress the bladder and trigger leakage of urine.
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