Female Urinary Incontinence

Urinary Incontinence is the involuntary loss of urine that is sufficient to be a problem. It is estimated that approximately 13 million Americans suffer from urinary incontinence. It occurs in both men and women, but is more common in women. ( See below for specifics of male incontinence ). It is believed that 25% of all women between the ages of 39 and 59 experience episodes of urinary incontinence. Urinary incontinence also affects at least 50% of the homebound elderly and is one of the leading causes of institutionalization of the elderly. Despite the prevalence and cost burden of the condition, most individuals with urinary incontinence do not seek help for their condition, opting for a lifestyle of worry and potential embarrassment. The truth is, whether you are 45 and dealing with stress incontinence, or 85 and dealing with functional incontinence, most cases of incontinence are manageable through exercise, medication, or surgery.

What are the different types of incontinence?

There are four types of chronic urinary incontinence; stress incontinence, urge incontinence, overflow incontinence, and functional incontinence.

Stress Incontinence: This is the most common type of urinary incontinence in women, but also the major type of urinary leakage in men who have had their prostates removed ( Radical Prostatectomy ). Stress incontinence usually occurs when the vaginal and pelvic floor muscles stretch after childbirth, weight gain, surgery, or lowered estrogen levels due to menopause. The stretching causes the neck of the bladder to sag and the bladder neck is not able to stay closed when abdominal pressure increase. This is why many women experience urine leakage when they cough, laugh, sneeze, or participate in strenuous physical activity.

Urge Incontinence: This type of incontinence is defined as the inability to hold urine long enough to reach a toilet. There is a strong and sudden urge to urinate followed by an involuntary loss of urine. Urge incontinence affects both men and women. People who suffer from urge incontinence say the need to urinate comes with little warning at any time of day or night. The ability to delay emptying the bladder is reduced or lost with urge incontinence. Apparently, as the bladder ages, urge incontinence may occur and may get worse. A healthy person has a series of warnings or messages that the bladder is full and can postpone voiding until a socially acceptable time is found. In men, this might be caused by an obstructive prostate, an infection or inflammation of the prostate, bladder infection or tumor, neurologic disease, etc.

Overflow Incontinence: In this type of incontinence the bladder is unable to empty completely. A relatively large amount of urine is left in the bladder after urinating and may overflow causing leakage. Diseases such as diabetes or spinal cord injuries and physical problems such as a sagging bladder may lead to overflow incontinence. Again, in men, this could also be associated with obstruction by the prostate or urethra as well as other causes mentioned above.

Functional Incontinence: In this type of incontinence there is some type of chronic impairment, either physically or mentally. People who suffer from functional incontinence usually have some type of disability that causes them to be unable to completely empty their bladder, or postpone emptying their bladder when they have the urge to urinate.

Symptoms of Urinary Incontinence

• Urine leakage when laughing, coughing, sneezing, or during physical exertion
• Urgency (difficulty postponing urination)
• Frequent urination
• Nocturia (getting up at night to urinate)
• A feeling that the bladder is not completely emptied after
• urination
• Straining during urination
• Constipation

Diagnosing Urinary Incontinence

Initially your urologist will want to talk with you about your past medical history especially any information about your symptoms. Your urologist will probably need to do some diagnostic testing to determine the cause of your problem. Once this has been determined you and your urologist can work together to find the treatment that is best for you.

Treating Urinary Incontinence

The treatment of urinary incontinence depends on the type of incontinence and the lifestyle of the patient. Many patients can be treated with a combination of exercise and lifestyle changes. Other patients may require medication and some patients will benefit most from surgery.

Exercises and lifestyle changes: Kegel exercises strengthen the pelvic floor muscles that support the bladder. In mild cases, their success rate is up to 60%. Two to three sets of Kegels should be performed every hour each day for at least two to three months to be effective. Your doctor can give you information on how to correctly perform Kegel exercises.

There are a few lifestyle changes that can help improve urinary incontinence. Practicing healthy toilet habits like taking the time to completely empty your bladder and not straining when urinating can help. Maintain an adequate fluid intake. Try to drink at least 6 to 8 large glasses of fluid per day unless otherwise advised by your doctor. And try to maintain an ideal body weight. Extra weight can increase abdominal pressure on your bladder and place an extra burden on your pelvic floor muscles.

Medication: Estrogen supplements can improve the thickness and tone of the pelvic muscles and vagina. In about 35% of cases, estrogen supplements may be enough to relieve the symptoms.

Surgery: For a more long-term solution, surgery may be the best answer. Although there are many different types of surgery being performed, clinical studies report that the most effective technique for stress incontinence in women is a vaginal sling procedure performed on an outpatient basis. This can be combined with a vaginal vault repair for vaginal prolapse if appropriate. In men who have had their prostates removed, there are several surgical options available, including AdVance and InVance urethral slings and artificial urinary sphincters.

Kegel Exercises

1. Once you start urinating, try to stop or slow the urine without tensing the muscles of your legs, buttocks, or abdomen. This is very important. Using other muscles will defeat the purpose.
2. When you are able to stop or slow the stream of urine, you know that you have located the correct muscles. Feel the sensation of the muscles puling inward and upward.

TIPS:

1. You may squeeze the area of the rectum to tighten the anus as if trying not to pass gas. This helps locate the correct muscles.
2. Remember NOT to tense the abdominal, buttock, or thigh muscles.

Now you are ready to start these exercises:

1. After you have located the correct muscles, set aside time each day for three exercise sessions (morning, midday ,evening). It is important to do these exercises in different positions (laying, sittings, standing)
2. Squeeze your muscles to the slow count of five. Then, relax the muscle completely to the slow count of five. The five second contraction and five second relaxation make one “set”.You should try to complete 20-30 “sets” with each session.

TIPS :

When your pelvic floor muscles are very weak, you should begin by contracting the muscles for only two to three seconds. Begin doing these on a regular basis. In a few weeks, you should be able to increase the amount of time you are able to hold the contraction and the number of exercise sets you are able to do. Your goal is to hold each set for five seconds, relax for five seconds and to complete 20 - 30 in each of the three exercise sessions per day.

In the beginning, check yourself by looking in the mirror and placing a hand on your abdomen and buttocks to ensure that you do not feel your belly, thigh or buttock muscles move.If there is movement, continue to experiment until you have found the muscles for the pelvic floor only.

If you are unsure that you are contracting the correct muscles, at your next visit ask your physician or his nurse to help you identify the proper muscle contraction.

Your bladder control should begin to improve in three to four weeks. If you keep a record of your urine leakage each day, you should begin to notice fewer instances.

Pelvic muscle exercises also improve orgasmic function. Whether you are doing pelvic muscle exercise to improve or maintain bladder control or control orgasmic function,or both, they must be done on a regular basis.

Use daily activities such as eating meals, watching television and walking as times to do a few pelvic muscle exercises.