What is urinary incontinence in women?
Millions of women experience involuntary loss of urine called
urinary incontinence (UI). Some women may lose a few drops of
urine while running or coughing. Others may feel a strong, sudden
urge to urinate just before losing a large amount of urine. Many
women experience both symptoms. UI can be slightly bothersome or
totally debilitating. For some women, the risk of public
embarrassment keeps them from enjoying many activities with their
family and friends. Urine loss can also occur during sexual
activity and cause tremendous emotional distress.
Women experience UI 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, stroke,
multiple sclerosis, and physical problems associated with aging.
Older women experience UI more often than younger women. But
incontinence is not inevitable with age. UI is a medical problem.
Your doctor or nurse can help you find a solution. No single
treatment works for everyone, but many women can find improvement
without surgery.
Incontinence occurs because of problems with muscles and nerves
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. Incontinence will occur if your
bladder muscles suddenly contract or the sphincter muscles are not
strong enough to hold back urine. Urine may escape with less
pressure than usual if the muscles are damaged, causing a change
in the position of the bladder. Obesity, which is associated with
increased abdominal pressure, can worsen incontinence.
Fortunately, weight loss can reduce its severity.
What are the types of 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. This
type of incontinence is common in women and, in many cases, can be
treated.
Childbirth and other events can injure the scaffolding that helps
support the bladder in women. Pelvic floor muscles, the vagina,
and ligaments support your bladder (see figure 2). If these
structures 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 squeezing muscles 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.
How is incontinence treated?
Behavioral remedies: bladder retraining and Kegel exercises
By looking at your bladder diary, the doctor may see a pattern and
suggest making it a point to use the bathroom at regular timed
intervals, a habit called timed voiding. As you gain control, you
can extend the time between scheduled trips to the bathroom.
Behavioral treatment also includes Kegel exercises to strengthen
the muscles that help hold in urine.
Growing Stronger, Growing
Better
Global Health
Healthcare Provider
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