Friday, December 15

Incontinence in Women

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Is urinary incontinence very common?

It is estimated that between 10 and 17 million Americans (1 in 11!) suffer urinary incontinence, (UI), also called “overactive bladder.” Twice as many women as men are afflicted. UI can strike at any age, and as a result of birth defects, strokes, multiple sclerosis, nerve injury or of aging. UI is a serious problem for anyone – it may result in alienation from other people, unwillingness to leave the house, annoyance and/or misery, skin rashes or even being banished while still young to a nursing home. While it may not be life-threatening, it is surely one of the most annoying problems a person can face. Untreated, the condition can become permanent. Fortunately there are a number of effective treatments.

Are there different types?

Yes. They are:

  • Urge incontinence:  large amounts of urine while asleep, or while listening to or handling running water. This condition is the most common form of UI among women.
  • Overflow incontinence: Small leaks due to a full bladder. Many people who suffer from overflow have trouble fully emptying the bladder. Overflow UI is fairly rare in women.
  • Functional incontinence: losing control due to inaccessibility of toilet facilities. Older people who are frail, move slowly or are mentally confused may encounter this problem frequently. People in wheelchairs may find their route to the bathroom blocked.
  • Transient incontinence: Temporary leaking due to a medical problem such as infections, mental confusion, medications and constipation; when the medical problem is resolved, transient incontinence symptoms should disappear. If they do not, contact your doctor.
  • Mixed incontinence: Combination of types, usually urge and stress.
  • Stress incontinence: Leaking during physical activity such as exercising, coughing or sneezing.

What are the symptoms?

Check with your doctor if:

            You get up more than once a night to urinate, or over 8 times in 24 hours, especially if as

            soon as you go, you have to go again.

      The urge to go is overpowering; complete loss of control.

      You don’t have time to get to the bathroom.

Is UI difficult to diagnose?

No. Your doctor will take a medical history, ask about your symptoms, other problems you might be having, medications you currently take, any surgeries you have had, pregnancies, and bladder and bowel habits. A physical exam will follow, to look for signs of conditions that might cause incontinence, like urinary tract tumors, impacted stools and nerve damage.

The doctor may suggest some tests to aid in the diagnosis, including a measuring test to see how efficiently your bladder is working. You will be asked to drink liquids, then urinate into a pan that measures your urine output. The doctor will also measure the amount of urine that remains in the bladder. Other tests may be indicated, including:

  • Urinalysis: to reveal signs of infection or other problems.

  • Blood: a sample of your blood is tested to look for indicators.

  • Stress: First you relax, then cough while the doctor looks for urine loss.

  • Ultrasound: sound waves take a picture of your kidneys, bladder, and urethra to look for possible causes.

  • Cystoscopy: a narrow tube with a little camera on the end is inserted into the urethra to check the interior.

  • Urodynamics: a test to measure bladder pressure and the flow of urine.

Your doctor may also want you to keep a diary of your urine output. This is done with a pan that fits over the rim of the toilet. You keep track of the number of times you urinate and the amount you produce.

What causes incontinence?

To understand UI, it is necessary to understand how the bladder works.

The urinary system is located inside your abdomen, between the hips and below the belly button. From the bladder a tube descends to carry the urine out of the body. At the opening, two muscles called the sphincter muscles squeeze to halt the flow of urine. Pelvic floor muscles help hold the womb, rectum and bladder in place.

When the bladder needs emptying, bladder nerves signal the brain. The brain responds by signaling the sphincter muscles to relax, and the flow begins.

A large bladder muscle called the detrusor sometimes overdoes itself by contracting at inopportune times. The detrusor is supposed to only squeeze when the bladder needs emptying, but an overactive detrusor starts squeezing when the bladder starts filling, causing a strong urge to urinate. This may be due to multiple sclerosis, or spinal cord lesions, but often the cause cannot be found.

Does being pregnant affect continence?

Yes. The weight of the growing baby puts pressure on the bladder, and weakens the pelvic floor muscles, causing loss of control. Or it may cause the bladder and urethra to shift position. If a doctor delivering your baby must cut muscles to allow the baby to emerge (episiotomy) this can also weaken the bladder muscles. Pregnancy and childbirth in particular may cause further damage to the bladder nerves. Once you have delivered, the UI should vanish; if it doesn’t, contact your doctor.

Menopause also has an effect. If you elect not to take estrogen therapy after menopause, your bladder muscles may begin to weaken. Estrogen wears many hats; it not only controls the menses but also menopause, the way your body alters through your pregnancy, breastfeeding, and keeps the lining of the bladder thick and free from diseases.

How is UI treated?

The treatment for UI depends on the patient’s circumstances, but may include:

  • Weight loss, if the patient is obese.

  • Cessation of smoking, if the patient smokes – and coughs.

  • Stopping medications like antihistimines, tranquilizers, diuretics, and sedatives which may aggravate the problem.

  • Kegel exercises: consists of squeezing the pelvic muscles for a count of three, relax, count three, squeeze again for three, relax, repeat. Do this for five minutes three times a day until it becomes a habit.

  • Retraining the bladder by waiting as long as you can before urinating.

  • Medications and/or surgery.

If you see your doctor for UI, and are prescribed medications, don’t leave until you know why you are being prescribed the medication, what it is and what it is supposed to do; how much you will be taking and how often; any side effects, and what you should do about them, and how long you will need the medication.

If you have been suffering from UI, don’t let it continue. See your doctor now.

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