URINARY INCONTINENCE IN WOMEN

What is urinary incontinence?

Urinary incontinence occurs when you start to urinate before you are able to get to the toilet. It is a common problem that affects both sexes but is mainly found in women.

What can cause urinary incontinence?

Numerous possible causes of urinary incontinence are apparent. In some cases the issue results from an underlying illness or infection that affects the bladder and causes temporary incontinence. Taking certain types of medication can also trigger incontinence and if you are unable to pass a bowel movement, this may also result in uncontrollable urination.

In some cases urinary incontinence can become a continuous problem. If this is the case the problem may be caused by:

• A blockage in the urinary passage
• The bladder being unable to empty fully
• Weakened muscles in the bladder which control urine flow
• Nerve damage in the bladder

Underlying health conditions like arthritis can also make it difficult to control urination, as well as making it difficult to get around the house and go to the toilet.

How prevalent is urinary incontinence?

Urinary incontinence is very common and affects both men and women, but it is more common among females. A study which included the UK found that 13 per cent of females and 5 per cent of males had some case of urinary incontinence. Older females have a higher risk of urinary incontinence, but not everyone will experience problems as they get older. If you do experience problems with leaking urine, arrange to see your doctor as they will be able to help.

Childbirth and urinary incontinence

It is fairly common for women to experience urinary incontinence both during pregnancy and following the birth. However, most women find that their bladder control returns to normal shortly after they have a baby. It may just be that the muscles in and around the bladder require time for recovery.

Pregnancy can cause urine to leak for the following reasons:

• Increased stress on the muscles around the pelvis and the bladder.
• The birthing process and delivery through the vagina.
• Injury to the nerves in the bladder.
• Episiotomy (the procedure of cutting the muscles to allow more room for delivery of the baby).

It is normal to experience urinary incontinence for a short period of time after giving birth, but if you are still leaking urine after 6 weeks see your doctor. If you leave the problem it may result in long-term incontinence. It is possible for some women to experience incontinence many years after giving birth, usually after the age of 40.

Other health conditions, including strokes, congenital conditions (present from birth), multiple sclerosis, brain injuries and physical conditions associated with ageing, can cause urinary incontinence.

Does the menopause cause urinary incontinence?

Some women experience incontinence during and after the menopause, but this is not the case for all women. If you do experience leakage discuss this with your doctor. Some experts believe that decreased levels of oestrogen in the body cause the vaginal tissue to become weaker, which increases the risk of urinary incontinence.

What are the different forms of urinary incontinence?

The different forms of urinary incontinence include:

• Stress: stress incontinence is caused by pressure being applied to the bladder. This can cause urine to leak as a result of actions such as laughing, coughing, sneezing, lifting heavy objects or exercising. This is main form of incontinence and in most cases can be effectively treated and even cured completely at times.
• Urge: urge incontinence is also known as an 'overactive bladder'. This form of incontinence usually occurs when there is a strong urge to go to the toilet. This can happen at unexpected times; for example, when you are sleeping, running or perceive the sound of running water.
• Functional: functional incontinence occurs when you struggle to get to the toilet in due course. This may be caused by health conditions, such as arthritis, which cause physical difficulties, conditions such as Alzheimer's disease, which makes it difficult to communicate, or physical disabilities.
• Overflow: overflow incontinence occurs if the bladder is unable to empty completely; this type of incontinence isn't as frequent among women.
• Mixed: mixed incontinence occurs when two or more forms of incontinence occur together and occurs most commonly with urge and stress incontinence.
• Transient: transient incontinence is a temporary form of incontinence, usually caused by a bladder infection, and urine leakage usually ends when the underlying cause is treated.

Talking to your doctor

Many people feel embarrassed talking to their GP about urinary incontinence. However, it is important to realise that incontinence is common and your doctor is there to help. You will not be telling them anything they have not heard before and they will be able to help you in dealing with the problem. If you do suffer from incontinence it is advisable to visit your doctor. You may wish to query your doctor about the following:

• Could incontinence be affected by what I drink or eat?
• Could the medication I am taking be contributing to incontinence?
• Which treatments are available and what would be ideal for me?
• Could other health problems be causing incontinence?
• Is there anything I can do to ease symptoms associated with incontinence, such as odour and rashes?

It may be a good idea to keep a diary of the times that you leak urine. This will enable your doctor to identify any triggers for urination or particular times when symptoms are worse.

Diagnosing urinary incontinence

Your doctor should be your first port of call, but if for some reason they do not treat bladder problems, they will be able to recommend a doctor that does. When you see your doctor they will question you on your medical history and relevant symptoms, as well as questions relating to:

• The regularity in which you void your bladder
• When and how you are most likely to leak urine
• The amount of urine you leak

The medical practitioner will carry out a physical examination to find symptoms of conditions that may be contributing to urinary incontinence. They will also conduct an investigation to see how the bladder is functioning and the amount of fluid it can retain. You will be asked to drink a glass of water and then urinate into a container. The doctor will check how much, if any, urine is left in the bladder. Doctors may also order further tests:

• Stress test: the doctor will look out for signs of leakage when you cough or pressure is applied to the bladder.
• Urinalysis: a sample of urine is analysed to check for indications of infection or other sources of incontinence.
• Blood test: a sample of blood is analysed to check for possible reasons for the development of incontinence.
• Ultrasound: an ultrasound scan is used to check for abnormalities or blockages in the bladder, kidneys and urethra.
• Cystoscopy: this test involves inserting a long, thin flexible tube into the urethra to allow doctors to see inside the bladder and the urethra.
• Urodynamics: this test is used to measure pressure inside the bladder and involves passing a thin tube into the bladder and filling the bladder with fluid.

The doctor may also get you to record a diary over 1 to 7 days to discover the amount of urine that is emptied and at what times.

Prevention of urinary incontinence

Pelvic floor muscle exercises can help to stop urinary incontinence and these are known as Kegel exercises. Details on how to perform this exercise is below:

• Start by lying down.
• Squeeze the muscles around your genital region like you would if attempting to prevent yourself from passing urine or wind, but do not squeeze the stomach or leg muscles while doing this.
• Relax and then squeeze the muscles for 3 seconds. You can relax for a short time and then repeat the cycle 8 times. Gradually increase the cycle up to 5 sets and 10 repetitions.
• Once your muscles are stronger you can try exercising sitting or standing up.
• It can take up to 6 weeks to see results but it is well worth putting in the effort, and you can do the exercises whenever you want; for example, while you are sitting at your desk at work or watching television.

If you are unsure whether you are doing the exercises correctly ask your doctor for advice.

Treatment for urinary incontinence

There are a number of different treatment options for urinary incontinence and the doctor will recommend treatments based on your general health and medical history, symptoms and what they feel will be best for you. Treatment options include:

• Kegel exercises (also known as pelvic floor muscle exercises): these exercises help to strengthen the pelvic muscles, reducing the risk of urine leakage. Kegel exercises can be particularly beneficial for pregnant women. If you are unsure how to perform Kegel exercises ask your nurse or doctor for advice.
• Electrical stimulation: this method involves stimulating the muscles in and around the rectum or vagina to strengthen them. This treatment is able to be effective for both urge and stress incontinence.
• Biofeedback: this is a method that teaches people how the body works, so that they can learn how to control their bladder. Treatment involves showing the patient images of the bladder and the urinary process, helping them to understand what happens during urination so that they can learn how to control the muscles. This will enable the bladder to hold urine more effectively. Biofeedback is often used in conjunction with Kegel exercises.
• Bladder retraining (also known as timed voiding): this method aims to train the bladder to retain urine more effectively. Timed voiding involves urinating at certain times rather than responding to urges. Bladder retraining involves gradually increasing the periods of time between urination to enable better control of the bladder.
• Weight loss: being overweight can cause incontinence because extra pressure is applied to the bladder. If you are overweight losing weight will also make a very positive impact on your general health. If you want to lose weight ask your doctor for advice about exercise and healthy eating.
• Changes to your diet: some drinks and foods, including caffeine, can cause you to urinate more frequently. Restricting your intake of these drinks and foods may decrease incontinence.
• Medications: some medicines can lessen your urine leakage. Your doctor will discuss medications with you if they feel that this is an appropriate course of action.
• Pessary: this is a tiny appliance which is inserted into the vagina to decrease leakage. Your nurse or doctor will help to decide the size and type of pessary used, and once the pessary is in place it will be checked regularly.
• Implants: a special type of material may be injected into the area surrounding the urethra to thicken the space around the urethra, enabling better bladder control.
• Surgery: surgery may be required if incontinence is caused by a blockage. It can also be used to increase support for the bladder and the urethra to avert leakage. The surgeon may also insert a tiny device to help control bladder activity.
• Urethral inserts: these are thin tubes which are placed within the urethra to stop urine from leaking out. You can remove the tube when you want to urinate and replace it afterwards to prevent unwanted urination.
• External urethral barrier: a small gel or foam pad which is disposable and will be placed over the top of the urethra to prevent leaking. When you need to visit the toilet you remove the pad and then replace it with a new pad once you have finished urinating.
• Catheters: a catheter is usually the last resort when other treatment options have failed. A catheter is a fine tube which is inserted into the bladder. It drains fluid from the bladder so you do not have to go to the toilet.