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Urinary Incontinence
Solutions for an embarrassing problem
After toilet training in childhood, the thought of losing bladder control later in life is unthinkable for most people. Yet, in fact, the unthinkable is not only thinkable. It is common. This loss of bladder control is called incontinence. Thirty-five per cent of women are incontinent at some time in their adult lives and about six per cent of Canadians (over a million and a half people) suffer from this problem on a regular basis. This article will review the most common symptoms and causes of unwanted loss of urine and describe what can be done about it.
Do you have a problem?
Very few people want to discuss urinary loss unless they can not bear the problem any longer. It is time to change this way of thinking. Many treatments are available for this common ailment.
You probably do not need to be told if you have urinary incontinence. You will be very aware of the problem. You may have noticed you:
- lose your water when you cough, laugh or strain.
- sometimes find urine stains or odor on your underwear.
- have an urgent need to urinate and have problems getting to the bathroom on time.
- are bothered by losing your water during sexual activity.
- pass your water at night without knowing it.
- have to wear protection such as pads to avoid embarrassment.
- have stopped some social or sport activities because of your urine loss.
How does the bladder work?
First, it helps to understand how normal voiding (urinating) occurs. The bladder is a specialized muscle that works as a storage unit when filling with urine. When it is full, it contracts and the urine is passed during voiding.
The outlet from the bladder is a tube called the urethra. This urethra is surrounded by several muscles that work like valves to close it off and prevent urine loss. The pressure in the urethra must be higher than in the bladder to prevent any "accidents."
In normal voiding the bladder muscle contracts steadily and the urethra relaxes. This action is controlled by a network of nerves that also must be working normally for the system to work.
What can go wrong and what can be done?
Four types of incontinence occur. These are stress, urge, overflow, and functional. Some people have more than one kind. The kind of incontinence you have guides what kind of treatment may help you. The decision about treatment is usually based on the type of incontinence you have and how severe your symptoms are. Some treatments require a lot of effort on your part to be effective.
Stress incontinence occurs when the urethra does not function properly. When there is increased pressure in the abdomen while bend-ing, coughing, or laughing, the pressure in the urethra may become less than in the bladder and urine is lost. Common causes of this are pregnancy, childbirth, obesity, hormone changes (menopause), constipation and poor muscle tone. The amount of urine lost with this problem tends to be small.
The main form of treatment is aimed at removing the cause of pressure on the urethra or overcoming the muscle weakness. Pelvic floor exercises (Kegel), regulating fluid intake, physiotherapy, weight loss, medication, pessary (vaginal support devices) and surgery are available.
Kegel exercises can be done sitting, walking or talking any time of the day. All you have to do is pull in your pelvic muscles like you are trying not to void, hold the position for 10 to 15 seconds, relax and repeat. Like any exercise program, the more of these you do the stronger the muscles will become.
To check on these muscles, you can do this exercise while voiding by stopping the flow of urine for a few seconds. This should be done only once during the void and not every time you urinate.
Physiotherapy is another way people can learn to strengthen the pelvic muscles. One method - called Faradism includes low level electrical stimulation of the pelvic muscles. This helps teach the patient which muscles need strength-ening and helps improve the tone of those muscles.
Vaginal cones are also used. By trying to hold cones of increasing weight in the vagina, women learn to strengthen their pelvic muscles.
Biofeedback allows, with the help of specialized equipment, pressure recordings of the bladder, vagina or rectal passages to help train people to contract the pelvic muscles and relax the bladder.
Hormone therapy, especially estrogen vaginal cream, helps reverse the thinning of the vagina that occurs with menopause. It is also useful in treating some of the irritating voiding symptoms such as having to void often or with urgency.
Urge incontinence occurs when the bladder does not have much urine but there is a strong desire to void. The bladder may suddenly contract when it is not supposed to or it may not be filling properly. A sudden movement such as running for something, orgasm or even the thought of a long bus trip can set this contraction off. Some of the main causes are urinary infection, foreign bodies, growths in the bladder, strokes and multiple sclerosis.
Treatment for this type of incontinence includes medications, bladder training and surgery. The two main groups of helpful drugs are those that relax the bladder (ie. oxybutynin, probanthine, flavoxate or imipramine) or those that increase the urethra strength (ie. pseudoephedrine and imipramine).
Overflow incontinence occurs when the bladder cannot empty normally. This may be caused by obstruction in the urethra, such as abnormal growths. The bladder may not be able to contract because the nerve network has failed. The bladder fills to capacity, then "overflows" any extra urine.
Surgery and intermittent or continuous catheters (tubes inserted into the bladder to allow it to drain) can be used for this.
Functional incontinence is not caused by a problem in the urinary system but occurs in a range of other conditions. Sometimes a person does not have the mental ability to recognize the need to void. Others who can not move around easily may have trouble getting to a toilet.
For some people, drug related side effects cause difficulty holding the urine. For example, some diuretics (water pills) can fill the bladder so quickly that the bladder pressure is greater than the urethra pressure, resulting in urine loss. Also some blood pressure medications, antidepressants and sedatives (sleeping medications) as well as caffeine and alcohol can cause problems.
One treatment includes bladder retraining, using regular scheduled visits to the bathroom to empty the bladder. Many people also use incontinence undergarments, pads and external collection devices as protection.
Sometimes all that is needed is a change in the situation causing the problem. A different medication may help or adjusting the living space so the bathroom is closer to daily activity.
Many people have learned that cutting back on the amount they drink before going on long trips or to social events can help. Extra fluids – especially coffee, tea or colas – play a large part in increasing incontinence.
How is incontinence diagnosed?
After you have discussed your symptoms and other medical history with your doctor and have been examined, some tests will need to be done.
The first, and sometimes the only, test needed is an examination of the urine for infection. Tests can be done to look at how well the bladder contracts or fills, or how well the urethra maintains its pressure. Also, it is possible to look at the inside of the bladder (cystoscopy) for growths or chronic infection. Ultrasound can be done to assess the bladders ability to empty.
One or more of these tests should help identify what type of incontinence you have. Based on the results, the doctor will be able to give you advice about correcting your symptoms.
In summary, the unwanted loss of urine from coughing, sneezing, laughing, movement or urgency is a common everyday distressing problem. Many people think they must learn to live with it as a natural result of having had children or of aging. This is not so. The symptoms can often be helped by quite simple measures.
Don't hide in embarrassment, talk to your doctor about it!
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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