Urinary Incontinence
URINARY INCONTINENCE OVERVIEW:
Urinary incontinence, also known as accidental bladder leakage, is an embarrassing problem that affects millions of women. Although it is more common in older women, it can affect younger women as well. It is not a normal part of aging or something that you just have to live with.
This article discusses the different types of leakage and the tests that may be done during your evaluation. The treatment of incontinence and frequency is discussed separately.
TYPES OF URINARY INCONTINENCE :
The two most common types of urine leakage in women are stress incontinence and urgency incontinence. Incontinence may be caused or worsened by medical problems, medications, and/or problems with the brain due to a stroke or dementia.
Stress incontinence — Stress incontinence occurs when the muscles and tissues around the urethra (where urine exits) do not stay closed properly when there is increased pressure (“stress”) in the abdomen, leading to urine leakage. As an example, coughing, sneezing, laughing, or running can cause stress incontinence. Stress incontinence is a common reason for incontinence in women, especially those who are obese or have given birth by vaginal delivery.
Urgency incontinence — In people with urgency incontinence (also called overactive bladder), there is a sudden, uncontrollable urge to urinate. You may leak urine on the way to the toilet. Common triggers of urgency incontinence include unlocking the door when returning home, going out in the cold, turning on the faucet, or washing your hands.
Many people with urgency incontinence also have to go to the bathroom more frequently than most people during the day and/or night. “Normal” frequency is considered to be eight times per day and once at night, but this depends on how much you drink and may increase if you drink more than 64 ounces of fluid in a day.
Mixed incontinence — Women with symptoms of both stress and urgency incontinence are said to have mixed incontinence.
Overflow incontinence — Overflow incontinence occurs when the bladder does not empty completely, causing leakage when the bladder becomes overly full. It may result in symptoms of either stress or urgency incontinence or both.
INCONTINENCE DIAGNOSIS :
Although leaking urine can be difficult to talk about, it is often treatable with weight management for women who are obese, pelvic floor muscle exercises, and/or medications. Talking about it with your health care provider is the first step in getting help for this problem that is affecting your life.
Important questions to discuss include :
● When do you leak? (When you get a sudden urge, with coughing/sneezing, or does it occur without warning?)
● When did your leakage begin? Has it worsened or improved over time?
● Have you tried any treatments to reduce leakage?
● Are there any medications that you are taking that might be worsening the problem (diuretic medicine for high blood pressure or high doses of pain medications)?
● Have you seen blood in your urine or had fevers with bladder pain or other pelvic symptoms such as bulge or pressure? These symptoms should not be ignored and you should be evaluated by a clinician.
Bladder diary — A bladder diary is a record of how much urine you make and how frequently you go generally during a 24-hour period. You should write down how much fluid you drink and how much urine you make and record any leakage and the activities that caused leakage. This diary may provide useful information about the cause(s) and potential treatment of your leakage.
Tests — Simple tests may be done during an office visit to determine the type of leakage you are experiencing. This may include a cough test, when you are asked to cough while your doctor or nurse watches for urine leakage.
A urine test (urinalysis and sometimes a urine culture to test for bacteria) is usually done to look for signs of infection or blood in the urine. Blood tests may be ordered to measure the kidney function.
A test to see how well you empty your bladder when urinating may be done. This can involve inserting a small catheter in the bladder or a simple ultrasound.
Urodynamic testing — For a urodynamic test, small catheters are placed inside the bladder and vagina (or rectum) to measure how much urine your bladder can hold, what makes you leak urine, and whether there are problems emptying the bladder. This test can be done in the office and may be recommended if you are planning surgery for urine leakage or if the cause of your leakage is not clear.
URINARY INCONTINENCE OVERVIEW :
Up to 50 percent of women experience urinary leakage during their lifetime, and 10 to 20 percent suffer from bothersome leakage. It is important to understand that leakage is not a normal part of aging and that treatments are available to reduce or eliminate the problem. Your health care clinician can help you with treatment if you are bothered by leaking urine, having to rush to the toilet frequently, or getting up from sleeping to go to the toilet.
This article discusses treatments for the two main types of leakage in women, stress incontinence and urgency incontinence. These treatments also apply to women who have a combination of urgency and stress incontinence, called mixed incontinence.
BEFORE STARTING TREATMENT :
Certain health conditions can worsen urine leakage. You should talk to your health care provider about treating these conditions and any medications that might be worsening your urinary leakage. Your primary care clinician can help you initiate treatment, but you should seek treatment from a continence specialist if you experience blood in the urine, multiple infections (three or more in one year), fevers, pain, or vaginal prolapse (a bulge) beyond the opening of the vagina.