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 signs and symptoms of urinary incontinence?
The main symptom is the release (leakage) of urine when you don’t want to. When and how this occurs will depend on the type of urinary incontinence.
Stress incontinence – this is the most common kind of urinary incontinence, especially among women who have given birth or have gone through the menopause. In this case stress refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure the person may urinate involuntarily.
The following actions may trigger stress incontinence:
• A sudden cough
• Sneezing
• Laughing
• Heavy lifting
• Exercise
The amount of urine that leaks out unwillingly depends on how full the bladder is and how affected the muscles are.
Urge incontinence (effort incontinence) -, also known as reflex incontinence. This is the second most common type of urinary incontinence. The bladder is either unstable or overactive. There is a sudden, involuntary contraction of the muscular wall of the bladder (detrusor muscles) that causes urinary urgency – an urge to urinate that cannot be stopped. There is an involuntary loss of urine for no apparent reason while suddenly feeling the need or urge to urinate.
When the urge to urinate comes the person has a very short time before the urine is released regardless of what they try to do. The urge to urinate may be caused by:
• A sudden change in position
• The sound of running water (for some people)
• Sex (especially during orgasm)
People with urge incontinence tend to have to pass urine frequently; sometimes having to get up to go to the toilet during the night.
Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.
Overflow incontinence – this type of urinary incontinence is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. The enlarged prostate gland obstructs the bladder; the person often only manages to urinate in small trickles and has to go frequently. He may feel that his bladder is never really completely emptied, even after trying hard.
Put simply, overflow incontinence is an inability to empty the bladder, the patient frequently dribbles urine. Some patients constantly dribble urine (as opposed to frequently).
Mixed incontinence – if a patient experiences both stress and urge incontinence he/she has mixed incontinence.
Functional incontinence – the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem. If a person has a disability they may not be able to get their pants down in time; this would be an example of functional incontinence. The amount of urine lost may be large. Common causes of functional incontinence include:
• Confusion
• Dementia
• Poor eyesight
• Poor mobility
• Poor dexterity (cannot unbutton pants in time)
• Depression, anxiety or anger (unwilling to go to the toilet)
People with functional incontinence may have difficulties in thinking, moving or communicating – these difficulties may prevent them from reaching a toilet.
Functional incontinence is more prevalent among elderly people, and is common in nursing homes.
Functional incontinence may occur when there is nothing physically wrong with the person. If you are on a long trip and dying to urinate but there are not toilets nearby.
Gross total incontinence – this either means the person leaks urine continuously all day and night, or has periodic uncontrollable leaking of large amounts of urine. The bladder is unable to store urine. The patient may have a congenital problem (was born with a defect), there may be an injury to the spinal cord, and injury to the urinary system, or there may be a fistula between the bladder and, for example the vagina.
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