Urinary Incontinence - Cherokee Women's Health

Urinary Incontinence

What is urinary incontinence?

  • Leakage of urine
    • Some women leak small amounts of urine
    • At other times, leakage of urine is frequent or severe

Are there different types of urinary incontinence?

  • There are several types of urinary incontinence:
    • Stress urinary incontinence
      • Loss of urine when a woman coughs, laughs, or sneezes
      • Leaks also can happen when a woman walks, runs, or exercises
      • It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra
    • Urge incontinence
      • Leakage of urine caused by overactive bladder muscles that contract too often or problems with the nerves that send signals to the bladder
    • Mixed incontinence
      • A combination of both stress and urge incontinence symptoms
    • Overflow incontinence
      • Steady loss of small amounts of urine when the bladder does not empty all the way during voiding
      • It can be caused by an underactive bladder muscle or blockage of the urethra

What are the symptoms of urinary incontinence?

  • In addition to leaking urine, a woman with incontinence also may have other symptoms:
    • Urgency
      • A strong urge to urinate whether or not the bladder is full, often with pelvic pressure
    • Frequency
      • Voiding more often than she considers usual
    • Nocturia
      • The need to void during hours of sleep
    • Dysuria
      • Painful voiding
    • Enuresis
      • Bed-wetting or leaking while sleeping

What causes urinary incontinence?

  • Urinary incontinence can have short-term causes and long-term causes
    • Short-term causes are easier to treat and include the following:
      • Urinary tract infection
        • Loss of bladder control may be caused by an infection of the urinary tract
      • Infections of the bladder (cystitis) are common in women
        • These infections are treated with antibiotics
      • Medications
        • Loss of bladder control may be a side effect of medications, such as diuretics
      • Abnormal growths
        • Polyps, bladder stones, or less commonly, bladder cancer, can cause urinary incontinence
        • Abnormal growths often cause urge incontinence and may be associated with blood in the urine
  • If you see blood in your urine, or if you are unsure about the source of any bleeding, it is important to alert your health care provider right away
  • Long-term causes include the following:
    • Pelvic support problems
      • The pelvic organs are held in place by supportive tissues and muscles
      • These supporting tissues may become torn or stretched, or they may weaken because of aging
      • If the tissues that support the urethra, bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making it hard to pass urine
    • Urinary tract abnormalities
      • A fistula is an abnormal opening from the urinary tract into another part of the body, such as the vagina
      • It can allow urine to leak out through the vagina
    • Neuromuscular problems
      • These disorders can interfere with the transmission of signals from the brain and spinal cord to the bladder and urethra

How is urinary incontinence diagnosed?

  • A number of steps may be needed to find the cause of urinary incontinence
  • In some cases, there may be more than one cause
    • You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage
    • Also note how much liquid you drank and what you were doing when a leak occurred
    • A pelvic exam will be done to detect physical conditions that might be linked to the problem
    • Lab tests may also be done to detect a urinary tract infection
    • Other tests that assess how your bladder functions include the following:
      • Urodynamic tests
        • The bladder is filled through a catheter
        • These tests check the function of the urethra and bladder
      • Postvoid residual volume test
        • The amount of urine that is left in the bladder after urinating is measured with an ultrasound device or by placing a catheter in the bladder
      • Stress test
        • You are asked to cough a few times with a full bladder
        • Any loss of urine is recorded
      • Cystoscopy
        • A thin, lighted tube with a lens at the end is used to look inside the bladder and urethra
      • Dye test
        • A pad is worn after a nontoxic dye is put in the bladder
        • If the pad gets stained with the dye, there was a loss of urine

How is urinary incontinence treated?

  • There are many options for treatment
  • Often treatments are more effective when used in combination
  • Treatment options include:
    • Lifestyle changes
    • Bladder training
    • Physical therapy
    • Devices, medications
    • Bulking agents
    • Surgery

What are some of the lifestyle changes that are used…

  • Making the following changes in your lifestyle, if they apply to you, may help the problem:
    • Lose weight
      • In overweight women, losing weight has been shown to decrease the frequency of urine leakage
    • Avoid constipation
      • Repeated straining may damage the pelvic floor
    • Drink less fluids and limit intake of caffeine, which is a diuretic
    • Seek treatment for chronic coughing
    • Stop smoking

What is bladder training?

  • It’s a procedure used to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3-4 hours during the day and every 4-8 hours at night)
    • After a few weeks of this training, leakage may occur less often

What types of physical therapy are used to treat urinary…

  • There are many types of physical therapy that can be done to treat urinary incontinence
  • Kegel exercises can help strengthen the pelvic muscles
    • Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in treating stress incontinence and urge incontinence
    • If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in women’s pelvic health
  • Biofeedback is a training technique that may be useful if you have problems locating the correct muscles

How are Kegel exercises done?

  • Kegel exercises tone your pelvic muscles
  • Here is how they are done:
    • Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating)
    • Hold for up to 10 seconds, then release
    • Do this 10-20 times in a row at least 3 times a day
    • Do not squeeze the muscles of the leg, buttock, or abdomen
    • Do these exercises on a regular basis
  • It may take 4-6 weeks to notice an improvement in urinary incontinence symptoms

What devices are used to treat urinary incontinence?

  • A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence
    • Pessaries support the pelvic structures, and some compress the urethra
    • They come in all shapes and sizes
    • They are useful for women who do not want or cannot have surgery to correct their incontinence

What medications are used for treatment?

  • Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge incontinence
    • These medications also can help reduce the frequency of urination
  • Your health care provider will help you decide which drug is most likely to work best for you

What are bulking agents?

  • These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option or has not worked
    • A substance is injected into the tissues around the urethra to add bulk
    • The urethra becomes narrowed, decreasing leakage
  • This procedure can be done in a doctor’s office or clinic

What types of surgery treat urinary incontinence?

  • Several surgical procedures have been developed to treat stress urinary incontinence
    • You and your health care provider should discuss many factors, including your age, lifestyle, and general health, before choosing to have surgery
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