women leak small amounts of urine at times. This can
occur with certain movements; during pregnancy; or during
other stress, such as coughing. Some women lose urine
when they hear the sound of running water or when their
hands are in water. Others find that they feel the urge
to urinate and are not able to control it. When leakage
of urine becomes frequent or severe enough to become
a problem, it is called urinary incontinence.
page will explain:
Symptoms of urinary incontinence
What causes it
How it is diagnosed and treated
you have symptoms of urinary incontinence, tell your
doctor. In most cases, urinary incontinence can be treated
incontinence is more common in women than in men. It
affects 10 percent to 25 percent of women under age
65 and 15 percent to 30 percent of women older than
60 who do not live in nursing homes. Incontinence is
even more common in nursing home residents - more than
half may be affected.
does not always mean that a woman leaks often. For an
active woman or a woman who loses a large amount of
urine each time, even one time a week or less may be
sometimes do not tell their doctor about their symptoms
of urinary incontinence. Less than one half of women
seek medical care. Instead, they rely on absorbent pads
or changes in lifestyle to deal with this condition.
They may feel ashamed. They may even avoid certain social
or work events.
women have the false belief that urinary incontinence
is a normal part of aging and that nothing can be done
to correct it. Urinary incontinence often can be treated.
Tell your doctor if you have any leakage of urine. Proper
diagnosis and treatment may correct your problem and
ease your symptoms.
urinary tract is made up of:
Kidneys, which produce urine
Tubes called ureters that carry urine to the bladder
urination (also called voiding) occurs when a woman
is able to empty her bladder when she has a natural
desire to do so. In normal voiding, the muscles around
the urethra relax, the bladder contracts, and urine
flows from the bladder to the urethra and out of the
body. When the bladder is almost empty, the muscles
around the urethra contract, the bladder relaxes, and
the stream of urine stops flowing.
are three types of incontinence:
most common type is urge incontinence. It occurs if
the detrusor muscle - the muscle wall of the bladder
- is overactive. This leads to loss or leakage of urine.
incontinence occurs when the pressure inside the bladder
(which moves urine out) is greater than the pressure
in the urethra (which keeps urine in). It causes loss
of urine during coughing, laughing, sneezing or physical
activity. Its main cause is when the tissues that surround
and support the urethra and bladder are weakened.
overflow incontinence, the bladder does not empty during
voiding. This results in a steady leakage of small amounts
of urine. Overflow incontinence is less common than
urge incontinence. It occurs when the detrusor muscle
who have urinary incontinence may leak urine often.
They may have to wear a pad to keep from wetting their
clothes. Some women with incontinence feel such a strong
desire to urinate that they cannot control it. This
results in a loss of urine. Awoman with urinary incontinence
also may have other symptoms:
Urgency - A strong desire to urinate, whether or not
the bladder is full. This often occurs along with
pelvic discomfort or pressure. The fear of leakage
or pain also occurs.
Frequency - Urinating more than every two hours or
more than seven times a day.
Nocturia - The need to urinate two or more times during
hours of sleep.
Dysuria - Painful urination.
Enuresis - Bed-wetting or wetting while sleeping.
incontinence may be caused by pelvic support problems
(cystourethrocele and cystocele) or urinary tract abnormalities
(fistula and diverticulum). There
are many possible causes of urinary incontinence. These
include infection, damage to organs and muscular disorders.
incontinence may occur because of an infection of the
urinary tract. Often such an infection occurs along
with pain, frequency and blood in the urine. Infections
of the bladder (cystitis) and of the urethra (urethritis)
are common in women.
support problems occur when the tissues that support
the pelvic organs are stretched and damaged. This allows
the organs that they support to sag out of place. If
the tissues that support the urethra, bladder, uterus
and rectum are weakened, these organs may drop. This
may lead to urinary incontinence or difficulty passing
types of pelvic support problems are the cystocele and
the cystourethrocele. When the bladder drops from its
normal place into the vagina, it is called a cystocele.
The place where the bladder joins the urethra is called
the bladder neck. When tissues that support the bladder
neck are damaged, it may drop and push against the vaginal
wall. A dropped bladder neck is called a cystourethrocele.
main causes of pelvic support problems are childbirth
and aging. As the baby passes through the vagina during
childbirth, the vaginal wall and ligaments may be damaged.
They may become weak. In later years, when a woman goes
through menopause, the loss of the female hormone estrogen
may make these problems worse.
are abnormal openings between the urinary tract (urethra,
bladder or ureters) and the vagina. These openings can
allow urine to leak out through the vagina. Fistulas
may result from:
Advanced cancer of the pelvis
incontinence also can be caused by a urethral diverticulum
- a small pocket that bulges out of the wall of the
urethra. Urine can collect in this pocket and then spill
Abnormal growths in the urinary tract also can cause
incontinence. Sometimes, a small bladder size may cause
problems as well.
disorders are problems with the nerves that control
the function of the bladder and urethra. Bladder spasms
- uncontrolled contractions - may occur. If the nerves
do not control the contractions of the bladder muscle,
the bladder may expel urine.
The bladder also may become too full, and urine may
leak. Most of the time it is not known why the nerves
lose control of the bladder muscle. It could be linked
to other conditions, such as diabetes.
incontinence may be a side effect of medications taken
for some other condition. For instance, diuretics, sedatives,
tranquilizers or antihistamines may cause some women
to leak urine. To ease your symptoms, your doctor may
only need to change the dosage or type of medication.
women have nothing wrong with their bladder or urethra.
They have conditions, such as arthritis, that prevent
them from moving quickly. They may lose urine before
they can get to the bathroom. Such limits are a real
problem for many older women.
doctor may ask you to keep a voiding diary to record
the time and amount of urine leakage.
number of steps may be needed to find the cause of urinary
incontinence. These steps may vary. It depends on the
nature of the problem.
first step often is a detailed medical history. You
will be asked questions about factors that may affect
your voiding habits. The voiding diary is one of the
most useful methods to diagnose incontinence. The doctor
may ask you to record the time and amount of urine leakage
over 24 to 72 hours. You also may be asked to record
how much water or other fluids you drank and any activity
that might have caused the leakage.
pelvic exam also may be done. It can detect physical
conditions that might be linked to incontinence. Other
exams and tests used may include:
Lab tests - patient provides a sample of urine, which
is analyzed to detect urinary tract infection.
Stress test - patient must cough a few times with
a full bladder. Any loss of urine is recorded.
Pad test - patient wears a preweighed pad for one
hour while doing a series of movements. If the pad
weighs more at end of the hour, there was a loss of
Dye test - patient wears a pad while a nontoxic dye
is put into the bladder. If the pad is stained with
the dye, there was a loss of urine.
Cystometry - the pressure and volume of the bladder
as it is filled with fluid is measured.
tests can help detect the cause of the problem. Some
patients may have more than one cause. Knowing the cause
helps your doctor select the best treatment for you.
women delay seeking medical care until their symptoms
are so severe that they need surgery. In the meantime,
they use pads to soak up the urine. Pads or adult diapers
may offer security, but they have drawbacks. For instance,
they can bother the skin. These products should not
be the first - or only - treatment tried for incontinence.
They should only be used to make other treatments work
better or when other treatments have failed.
There are many options for treatment. It depends on
the cause of your problem. Treatments include behavioral
changes, medication, special devices or surgery.
goal of behavioral treatment is to help a woman know
why leakage occurs and how to avoid it. It may include
bladder retraining and pelvic muscle exercises.
bladder retraining, you will be taught about normal
and abnormal voiding patterns. You will be told to void
at set times - whether or not you have the urge. You
will be told about ways to help you ignore any urges
to pass urine. One is distraction - thinking about other
things. After a few weeks you should have fewer instances
of leaking urine. This method can be a success in many
muscle exercises, such as Kegel exercises (see box),
improve urine control in 40 percent to 75 percent of
women who use them. Biofeedback might be used with this
or other treatments to improve your response. Biofeedback
is a process that tells you about your body functions.
This helps you to gain control of these same functions.
exercises tone your pelvic muscles. They strengthen
the muscles that surround the openings of the urethra,
vagina and rectum. Just like doing sit-ups to flatten
your abdomen, these exercises work only if the right
muscles are used, the "squeeze" is held long
enough, and enough repetitions are done. This is how
they are done:
Squeeze the muscles that you use to stop the flow
Hold for up to 10 seconds, then release.
Do this 10 to 20 times in a row at least three times
doing these exercises on a regular basis for at least
six weeks, you should be able to better hold your urine.
that help control muscle spasms can help prevent leakage.
Other drugs strengthen the smooth muscle of the urethra
and improve symptoms. These medications may cause:
you have gone through menopause, your doctor may prescribe
estrogen replacement therapy. This improves the elasticity
of the muscles and the tissues that surround them. Treatment
can be with a cream that is placed in the vagina, pills
or a patch applied to the skin. Although it may take
a while for the medications to take effect, they must
be continued. Symptoms improve in many patients with
you have a urinary tract infection, you will be given
antibiotics. Leakage may stop once the infection is
devices can be used to strengthen the pelvic muscles.
Weighted cones are devices like a tampon that a woman
places in her vagina twice a day. When
she contracts her pelvic muscles to keep the cone in
place, the muscles are strengthened.
device used is called a pessary. It supports the pelvic
organs. It also helps prevent leakage by pressing against
pelvic muscles also can be made to contract by using
electrical stimulation. This may help women who were
not helped by other treatments.
has different risks than drug or behavioral therapy.
If you are thinking about surgery, you should know the
chances of success as well as the complications that
Factors that put extra pressure on the pelvic muscles
add to the problem of urinary incontinence. Make the
following changes in your lifestyle, before and after
your surgery, if they apply to you. It can increase
your chances for solving the problem:
Get treatment for lung diseases
Avoid heavy lifting
are many types of operations used to correct urinary
incontinence. Your doctor's evaluation will help decide
if your incontinence occurs from lack of support at
the bladder neck or from weakness of the bladder neck
most common cause of incontinence in women is lack of
support at the bladder neck. This type of incontinence
can be treated with three basic procedures:
Needle suspension (a more minor procedure)
abdominal incision has the highest long-term success
rates. It is also more serious surgery. You and your
doctor will need to think about many factors before
choosing the surgery that is right for you. They include:
Need for hysterectomy or treatment of pelvic prolapse
Whether you've had radiation or prior surgery for
Your general health
of the complications that may occur after surgery include:
Difficulty emptying your bladder
Injury to the bladder during surgery
Recurrence of incontinence
spasms are short-term in most cases. They last while
the bladder is going through the healing process and
can be controlled with medication. Not being able to
empty your bladder after surgery may occur, but it also
is short-term. You may need to wear a catheter for a
few weeks. Or, you may be taught to empty your own bladder
with a small catheter that can be thrown away.
incontinence is a common problem. If you have symptoms
of urinary incontinence, or if they affect your daily
living, tell your doctor. A complete and thorough exam
is needed to find the cause of the problem. In most
cases, urinary incontinence can be treated with success.
A muscular organ in which urine is stored.
Drugs given to increase the production of urine.
An abnormal pouch or sac in an internal organ or structure.
A female hormone produced in the ovaries, which stimulates
the growth of the lining of the uterus.
An abnormal opening or passage between two internal
A pair of tubes, each leading from one of the kidneys
to the bladder.
A short, narrow tube that carries urine from the bladder
out of the body.
excerpt from ACOG's Patient Education Pamphlet is provided
for your information. It is not medical advice and should
not be relied upon as a substitute for visiting your
doctor. If you need medical care, or have any questions,
please contact your obstetrician-gynecologist. Copyright
(c) 2000 The American College of Obstetricians and Gynecologists.
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