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Female Urinary Incontinence

incontinence

Women are twice as likely as men to experience the frustrating, embarrassing problem of urinary incontinence. People tend to suffer in silence with incontinence because they are afraid or ashamed to tell their doctor or because they believe incontinence is a normal part of the aging process.

Most symptoms of urinary incontinence can be improved or corrected with the help of a urologist.

The kidneys constantly produce urine, which flows through two long tubes, called ureters, to the bladder. The bladder stores urine until it is full. At the lowest part of the bladder–the bladder neck–the urinary sphincter muscle surrounds and constricts it. The sphincter’s job is to ensure that no urine escapes through the urethra, the channel that carries urine out of the body, before the bladder is full.

When functioning properly, the urinary tract works as follows:

  1. The bladder fills.
  2. The nerves around the bladder send a message to the brain, and the urge to urinate is felt.
  3. When the person decides to urinate, the sphincter muscle relaxes, allowing urine to flow through the urethra.
  4. The bladder muscles contract to push urine out. (Abdominal and pelvic muscles can assist in increasing bladder pressure and expelling the urine.)

The complex process of holding and releasing urine can be disrupted for a variety of reasons, including:

  • A weakened sphincter that cannot constrict the bladder neck sufficiently.
  • A physical change or injury that affects the function of the bladder neck and urethra These disruptions often result in loss of control, or urinary incontinence.
There are several types of urinary incontinence.

  • Stress incontinence is the most common type of urinary incontinence that women experience. It results in a leakage of urine, usually in small bursts, when abdominal pressure increases due to coughing, laughter, straining, sneezing, or lifting a heavy object. Weakness of the urinary sphincter–the muscle that controls urine flow–can cause stress incontinence. The problem can also be caused by a lowered resistance to urine flow through the urethra, usually due to an estrogen deficiency. Anatomic changes caused by multiple childbirths or pelvic surgery may also lead to stress incontinence.
  • Urge incontinence is defined as the inability to delay urination for more than a few minutes once the person senses the need to urinate. This type of incontinence is most often caused by a urinary tract infection, but it can also develop due to an overactive bladder, an obstruction of urine flow, bladder stones and tumors, or some medications–especially diuretics.
  • Overflow incontinence happens when urine accumulates in the bladder to the extent that the urinary sphincter cannot hold it. Urine leaks intermittently, often without bladder sensation. Women develop this type of incontinence when bladder muscles are weakened. Nerve malfunction and certain drugs can also cause overflow incontinence.
  • Total incontinence is marked by continual leakage because the urinary sphincter will not close. This can happen when the bladder is injured in an accident or following surgery.
  • Psychogenic incontinence is a loss of urine control for psychological reasons, usually emotional disturbances or depression.
  • Mixed incontinence is a combination of different types of incontinence due to a variety of causes. Many women experience a mix of stress and urge incontinence, for example.
To recommend the most effective treatment, a urologist will establish the type of incontinence you have. The doctor will discuss whether your incontinence began suddenly or developed gradually and ask about your specific symptoms. The doctor will also perform a physical exam and conduct some tests.

  • Urinalysis will help detect a number of changes including any infections or the presence of blood.
  • A bladder scanner measures the amount of urine left in the bladder after urination.
  • A urodynamic evaluation measures bladder/sphincter/urethral pressure at rest and while filling with urine.
  • A uroflow test measures the rate of urination.
  • A cystoscopy determines the presence of bladder polyps, scarring, tumors, or stones.
  • In cases of female stress incontinence, the doctor assesses urine loss with coughing or straining.
  • For women, a pelvic exam helps determine the degree of elasticity along the urethral and vaginal canal. Decreasing levels of estrogen can cause decreased elasticity. It will also help diagnose a cystocele, rectocele, or prolapsed uterus.
Various treatments are available to successfully treat urinary incontinence. Many cases can be helped with behavior changes, such as:

  • Urinating regularly.
  • Avoiding or relieving constipation.
  • Drinking enough fluids to prevent urine from becoming concentrated and irritating the bladder.
  • Avoiding bladder irritants like caffeinated beverages, spicy foods, or alcohol.
  • Certain medications, or a combination of medications, are often helpful with some types of incontinence.

Bladder training techniques can help with some kinds of incontinence.

These techniques involve:

  • Pelvic muscle exercises.
  • Biofeedback.

Patients look at a gauge that monitors muscle activity in order to learn how to control or relax the appropriate muscles

In cases of stress incontinence, estrogen cream to the vagina or estrogen tablets may improve the urethra’s elasticity and relieve symptoms.

The doctors at Metrowest Urology may recommend surgery for severe, persistent cases.

Several new, minimally invasive outpatient procedures have proven to be promising and effective in lifting the bladder and strengthen the outflow passage.

Overflow incontinence can often be managed by applying gentle pressure on the lower abdomen to fully empty the bladder during urination. In some instances, self-catheterization of the bladder is necessary to drain the bladder and prevent complications, such as recurring infections or kidney damage. Total incontinence usually requires corrective surgery.

There are various procedures that work well for this type of incontinence, including the placement of a urethral sphincter that provides complete control. When psychogenic incontinence is diagnosed, a combination of psychotherapy, behavior modifications, and medications are often effective.

 

urology

In people with an overactive bladder (OAB), the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency).

 

Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination. People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment; and can diminish self-esteem and quality of life.

Urination (micturition) involves processes within the urinary tract and the brain. The slight need to urinate is sensed when urine volume reaches about one-half of the bladder’s capacity. The brain suppresses this need until a person initiates urination.

Once urination has been initiated, the nervous system signals the detrusor muscle to contract into a funnel shape and expel urine. Pressure in the bladder increases and the detrusor muscle remains contracted until the bladder empties. Once empty, pressure falls and the bladder relaxes and resumes its normal shape.

Overactive bladder affects men and women equally.

The U.S. Department of Health and Human Services has reported that approximately 13 million people in the United States suffer from OAB and other forms of incontinence.

A malfunctioning detrusor muscle causes overactive bladder.

Identifiable underlying causes include the following:

  • Nerve damage caused by abdominal trauma, pelvic trauma, or surgery
  • Bladder stones
  • Drug side effects
  • Neurological disease (e.g., multiple sclerosis, Parkinson’s disease, stroke, spinal cord lesions)

Other conditions can produce symptoms similar to those experienced with overactive bladder, the most common of which is urinary tract infection (UTI) in women.

Three symptoms are associated with an overactive bladder: Frequency (frequent urination) Urgency (urgent need to urinate) Urge incontinence (strong need to urinate followed by leaking or involuntary and complete voiding)