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Urinary Incontinence In Women Fact Book
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Urinary incontinence is an inability to hold your urine until you get
to a toilet. More than 13 million people in the United States--male and
female, young and old--experience incontinence. It is often temporary, and
it always results from an underlying medical condition.
(In this fact sheet, the term "incontinence" will be used to mean
urinary incontinence.)
Women experience incontinence twice as often as men. Pregnancy and
childbirth, menopause, and the structure of the female urinary tract
account for this difference. But both women and men can become incontinent
from neurologic injury, birth defects, strokes, multiple sclerosis, and
physical problems associated with aging.
Older women, more often than younger women, experience incontinence.
But incontinence is not inevitable with age. Incontinence is treatable and
often curable at all ages. If you experience incontinence, you may feel
embarrassed. It may help you to remember that loss of bladder control can
be treated. You will need to overcome your embarrassment and see a doctor
to learn if you need treatment for an underlying medical condition.
Incontinence in women usually occurs because of problems with muscles
that help to hold or release urine. The body stores urine--water and
wastes removed by the kidneys--in the bladder, a balloon-like organ. The
bladder connects to the urethra, the tube through which urine leaves the
body.
During urination, muscles in the wall of the bladder contract, forcing
urine out of the bladder and into the urethra. At the same time, sphincter
muscles surrounding the urethra relax, letting urine pass out of the body
(see figure 1). Incontinence will occur if your bladder muscles suddenly
contract or muscles surrounding the urethra suddenly relax.
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Figure
1.--Front view of bladder and
sphincter
muscles. |
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What Are the Types of Incontinence?
Stress Incontinence
If coughing, laughing, sneezing, or other movements that put pressure
on the bladder cause you to leak urine, you may have stress incontinence.
Physical changes resulting from pregnancy, childbirth, and menopause often
cause stress incontinence. It is the most common form of incontinence in
women and is treatable.
Pelvic floor muscles support your bladder (see figure 2). If these
muscles weaken, your bladder can move downward, pushing slightly out of
the bottom of the pelvis toward the vagina. This prevents muscles that
ordinarily force the urethra shut from squeezing as tightly as they
should. As a result, urine can leak into the urethra during moments of
physical stress. Stress incontinence also occurs if the muscles that do
the squeezing weaken.
Stress incontinence can worsen during the week before your menstrual
period. At that time, lowered estrogen levels might lead to lower muscular
pressure around the urethra, increasing chances of leakage. The incidence
of stress incontinence increases following menopause.
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Figure
2.--Side view of female
pelvic
muscles. |
Urge Incontinence
If you lose urine for no apparent reason while suddenly feeling the
need or urge to urinate, you may have urge incontinence. The most common
cause of urge incontinence is inappropriate bladder contractions.
Medical professionals describe such a bladder as "unstable," "spastic,"
or "overactive." Your doctor might call your condition "reflex
incontinence" if it results from overactive nerves controlling the
bladder.
Urge incontinence can mean that your bladder empties during sleep,
after drinking a small amount of water, or when you touch water or hear it
running (as when washing dishes or hearing someone else taking a
shower).
Involuntary actions of bladder muscles can occur because of damage to
the nerves of the bladder, to the nervous system (spinal cord and brain),
or to the muscles themselves. Multiple sclerosis, Parkinson's disease,
Alzheimer's disease, stroke, and injury--including injury that occurs
during surgery--all can harm bladder nerves or muscles.
Functional Incontinence
People with functional incontinence may have problems thinking, moving,
or communicating that prevent them from reaching a toilet. A person with
Alzheimer's disease, for example, may not think well enough to plan a
timely trip to a restroom. A person in a wheelchair may be blocked from
getting to a toilet in time. Conditions such as these are often associated
with age and account for some of the incontinence of elderly women in
nursing homes.
Overflow Incontinence
If your bladder is always full so that it frequently leaks urine, you
have overflow incontinence. Weak bladder muscles or a blocked urethra can
cause this type of incontinence. Nerve damage from diabetes or other
diseases can lead to weak bladder muscles; tumors and urinary stones can
block the urethra. Overflow incontinence is rare in women.
Other Types of Incontinence
Stress and urge incontinence often occur together in women.
Combinations of incontinence--and this combination in
particular--are
sometimes referred to as "mixed incontinence."
"Transient incontinence" is a temporary version of incontinence. It can
be triggered by medications, urinary tract infections, mental impairment,
restricted mobility, and stool impaction (severe constipation), which can
push against the urinary tract and obstruct outflow.
The Types of Urinary Incontinence
| Stress |
Leakage of small amounts of urine
during physical movement (coughing, sneezing,
exercising). |
| Urge |
Leakage of large amounts of urine at
unexpected times, including during sleep. |
| Functional |
Untimely urination because of
physical disability, external obstacles, or problems in
thinking or communicating that prevent a person from reaching
a toilet. |
| Overflow |
Unexpected leakage of small amounts
of urine because of a full bladder. |
| Mixed |
Usually the occurrence of stress and
urge incontinence together. |
| Transient |
Leakage that occurs temporarily
because of a condition that will pass (infection,
medication). | |
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How Is Incontinence Evaluated?
The first step toward relief is to see a doctor who is well acquainted
with incontinence to learn the type you have. A urologist specializes in
the urinary tract, and some urologists further specialize in the female
urinary tract. Gynecologists and obstetricians specialize in the female
reproductive tract and childbirth. A urogynecologist focuses on urological
problems in women. Family practitioners and internists see patients for
all kinds of complaints. Any of these doctors may be able to help you.
To diagnose the problem, your doctor will first ask about symptoms and
medical history. Your pattern of voiding and urine leakage may suggest the
type of incontinence. Other obvious factors that can help define the
problem include straining and discomfort, use of drugs, recent surgery,
and illness. If your medical history does not define the problem, it will
at least suggest which tests are needed.
Your doctor will physically examine you for signs of medical conditions
causing incontinence, such as tumors that block the urinary tract, stool
impaction, and poor reflexes or sensations, which may be evidence of a
nerve-related cause.
Your doctor will measure your bladder capacity and residual urine for
evidence of poorly functioning bladder muscles. To do this, you will drink
plenty of fluids and urinate into a measuring pan, after which the doctor
will measure any urine remaining in the bladder. Your doctor may also
recommend
- Stress test--You relax, then cough vigorously as the doctor watches
for loss of urine.
- Urinalysis--Urine is tested for evidence of infection, urinary
stones, or other contributing causes.
- Blood tests--Blood is taken, sent to a laboratory, and examined for
substances related to causes of incontinence.
- Ultrasound--Sound waves are used to "see" the kidneys, ureters,
bladder, and urethra.
- Cystoscopy--A thin tube with a tiny camera is inserted in the
urethra and used to see the inside of the urethra and bladder.
- Urodynamics--Various techniques measure pressure in the bladder and
the flow of urine.
Your doctor may ask you to keep a diary for a day or more, up to a
week, to record when you void. This diary should note the times you
urinate and the amounts of urine you produce. To measure your urine, you
can use a special pan that fits over the toilet rim.
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How Is Incontinence Treated?
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and
sphincter muscles can reduce or cure stress leakage. Women of all ages can
learn and practice these exercises, which are taught by a health care
professional.
Most Kegel exercises do not require equipment. However, one technique
involves the use of weighted cones. For this exercise, you stand and hold
a cone-shaped object within your vagina. You then substitute cones of
increasing weight to strengthen the muscles that help keep the urethra
closed.
Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the
lower pelvis in a way similar to exercising the muscles. Electrodes are
temporarily placed in the vagina or rectum to stimulate nearby muscles.
This will stabilize overactive muscles and stimulate contraction of
urethral muscles. Electrical stimulation can be used to reduce both stress
incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your
body's functioning. By using electronic devices or diaries to track when
your bladder and urethral muscles contract, you can gain control over
these muscles. Biofeedback can be used with pelvic muscle exercises and
electrical stimulation to relieve stress and urge incontinence.
Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder training are techniques that use
biofeedback. In timed voiding, you fill in a chart of voiding and leaking.
From the patterns that appear in your chart, you can plan to empty your
bladder before you would otherwise leak. Biofeedback and muscle
conditioning--known as bladder
training--can alter the bladder's
schedule for storing and emptying urine. These techniques are effective
for urge and overflow incontinence.
Medications
Medications can reduce many types of leakage. Some drugs inhibit
contractions of an overactive bladder. Others relax muscles, leading to
more complete bladder emptying during urination. Some drugs tighten
muscles at the bladder neck and urethra, preventing leakage. And some,
especially hormones such as estrogen, are believed to cause muscles
involved in urination to function normally.
Some of these medications can produce harmful side effects if used for
long periods. In particular, estrogen therapy has been associated with an
increased risk for cancers of the breast and endometrium (lining of the
uterus). Talk to your doctor about the risks and benefits of long-term use
of medications.
Pessaries
A pessary is a stiff ring that is inserted by a doctor or nurse into
the vagina, where it presses against the wall of the vagina and the nearby
urethra. The pressure helps reposition the urethra, leading to less stress
leakage. If you use a pessary, you should watch for possible vaginal and
urinary tract infections and see your doctor regularly.
Implants
Implants are substances injected into tissues around the urethra. The
implant adds bulk and helps to close the urethra to reduce stress
incontinence. Collagen (a fibrous natural tissue from cows) and fat from
the patient's body have been used. Implants can be injected by a doctor in
about half an hour using local anesthesia.
Implants have a partial success rate. Injections must be repeated after
a time because the body slowly eliminates the substances. Before you
receive collagen, a doctor must perform a skin test to determine whether
you would have an allergic reaction to the material.
Surgery
Doctors usually suggest surgery to alleviate incontinence only after
other treatments have been tried. Many surgical options have high rates of
success.
Most stress incontinence results from the bladder dropping down toward
the vagina. Therefore, common surgery for stress incontinence involves
pulling the bladder up to a more normal position. Working through an
incision in the vagina or abdomen, the surgeon raises the bladder and
secures it with a string attached to muscle, ligament, or bone.
For severe cases of stress incontinence, the surgeon may secure the
bladder with a wide sling. This not only holds up the bladder but also
compresses the bottom of the bladder and the top of the urethra, further
preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a
doughnut-shaped sac that circles the urethra. A fluid fills and expands
the sac, which squeezes the urethra closed. By pressing a valve implanted
under the skin, you can cause the artificial sphincter to deflate. This
removes pressure from the urethra, allowing urine from the bladder to
pass.
Catheterization
If you are incontinent because your bladder never empties completely
(overflow incontinence) or your bladder cannot empty because of poor
muscle tone, past surgery, or spinal cord injury, you might use a catheter
to empty your bladder. A catheter is a tube that you can learn to insert
through the urethra into the bladder to drain urine. Catheters may be used
once in a while or on a constant basis, in which case the tube connects to
a bag that you can attach to your leg. If you use a long-term (or
indwelling) catheter, you should watch for possible urinary tract
infections.
Other Procedures
Many women manage urinary incontinence with pads that catch slight
leakage during activities such as exercising. Also, you often can reduce
incontinence by restricting certain liquids, such as coffee, tea, and
alcohol.
Finally, many women who could be treated resort instead to wearing
absorbent undergarments, or diapers--especially elderly women in nursing
homes. This is unfortunate, because diapering can lead to diminished
self-esteem, as well as skin irritation and sores. If you are an elderly
woman, you and your family should discuss with your doctor the possible
effectiveness of treatments such as timed voiding, pelvic muscle
exercises, and electrical stimulation before resorting to absorbent pads
or undergarments.
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Points to Remember
- Urinary incontinence is common in women.
- All types of urinary incontinence can be treated.
- Incontinence can be treated at all ages.
- You need not be embarrassed by incontinence.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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Additional Resources
American Foundation for Urologic Disease
The Bladder Health
Council
1128 North Charles Street
Baltimore, MD 21201
Phone:
1-800-242-2383 or (410) 468-1800
Email: admin@afud.org
Internet: http://www.afud.org/
American Urogynecologic Society
2025 M Street, NW., Suite
800
Washington, DC 20036
Phone: (202) 367-1167
Email: AUGS@dc.sba.com
Internet: http://www.augs.org/
American Urological Association
1120 North Charles
Street
Baltimore, MD 21201-5559
Email: aua@auanet.org
Internet: https://shop.auanet.org/timssnet/products/guidelines/patient_guides/FSUIptguide.pdf
National Association for Continence
P.O. Box
8310
Spartanburg, SC 29305-8310
Phone: 1-800-BLADDER or (864)
579-7900
Email: memberservices@nafc.org
Internet:
http://www.nafc.org/
The Simon Foundation for Continence
P.O. Box 835
Wilmette,
IL 60091
Phone: 1-800-23-SIMON or (847) 864-3913
Email: simoninfo@simonfoundation.org
Internet:
http://www.simonfoundation.org/ |
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