The body’s drainage system that removes urine composed of wastes and extra fluid is known as the urinary tract. Other parts of urinary tract are kidneys which are in pair located just below the rib cage, ureters, thin tubes of muscle which carry urine from each kidney to the bladder, and bladder located in the pelvis bone, a hollow muscular, balloon shaped organ which can expands when filled with urine. All these parts of the urinary tract need to work together in the correct order for normal urination to occur.
Urinary incontinence is the loss of bladder control resulting in the accidental urine leakage in women is a common and often embarrassing problem. Some women may have urine leakage while running or coughing called stress incontinence. Sometimes a person gets so strong and sudden urge to urinate that they won’t be able to make to the toilet in time. This is called urgency incontinence.
Urine incontinence can be bothersome and embarrassing that keeps women from enjoying many daily physical activities such as exercising, dancing, running, laughing etc. Inactive or over-weight women may increase the chances of developing urine incontinence which can also cause emotional distress.
Urinary incontinence (UI) can occur in women when the brain does not send signals to the bladder properly, the sphincters do not squeeze strongly or even both. UI is not a disease but a symptom which can be caused by everyday habits, any underlying medical conditions or physical problems. Conditions and symptoms that may increase a woman’s chance of developing UI may include:
• Birth defects – problems with development of the urinary tract
• Genetics – if other females in a family had or has UI, the chances are higher to develop urinary incontinence
• Childbirth – muscles and nerves which controls urination can be damaged in the process of childbirth
• Chronic coughing – long chronic coughing can increase pressure on the bladder and pelvic floor muscles
• Menopause – after menopause women produces less estrogen hormone that keeps the lining of the bladder and urethra healthy
• Neurological problems – it becomes difficult to control urination if women who have diseases or conditions that affect brain and spine such as multiple sclerosis, Parkinson’s disease, a brain tumor or stroke.
• Physical inactivity – less physical activity can weaken the muscles and increases weight leading to UI conditions
• Obesity – extra weight can put pressure on the bladder causing an urge to urinate even before the bladder is full.
• Older age – in older women, bladder muscles get weak over time causing a decrease in the bladder’s capacity to store urine. Involuntary bladder contractions becomes more frequent with age
• Pelvic organ prolapsed – can cause sagging of the bladder, uterus, or bowel out of their normal positions
• Pregnancy – the fetus may pressurize the bladder during pregnancy
There are different types of urinary incontinence in women that include:
• Stress Incontinence - urine leakage caused when person sneezes, cough, and laugh, lift something or do something that puts stress on her bladder. Some physical changes occur from pregnancy and childbirth may often cause stress incontinence. Delivery of a child can weaken muscles required for bladder control and may also damage bladder nerves and other supportive tissues that cause pelvic floor muscle prolapsed.
• Urgency Incontinence - is a strong urge to urinate that a person even can't make it to the toilet in time. This can also occur when a woman is having only a small amount of urine in her bladder. Involuntary bladder contractions (caused by abnormal nerve signals) are a common cause of urgency incontinence. When these abnormal nerves send signals to the bladder at wrong time causing its muscles to squeeze without giving enough time to get to the toilet results in overactive bladder.
• Overflow Incontinence - is when a women have the urge to urinate, but is able to release only a small amount. Since the bladder doesn't empty as it should, it may leaks urine later. Overflow incontinence is rare in women.
• Total Incontinence - is when a woman is always leaking urine. It happens when the sphincter muscle no longer works.
• Functional Incontinence - means that a person can't make it to the bathroom in time to urinate due to physical disability or external obstacles. For example women in a wheelchair may have trouble going to toilet in time, Arthritis pain and swelling of the joints may make it hard for a woman to walk to the toilet quickly.
There are several tests to diagnose the urinary incontinence such as:
• Medical History – doctor will ask patient to provide medical history, a review of symptoms, eating habits, pattern of urination and urine leakage like the amount and type of liquid she drinks, number of times she urinates in a day or how much urine is released, how often she has accidental leaks, since how long the symptoms have been occurring etc.
• Physical Exam – to help in diagnosing urine incontinence, doctor will perform physical exam to look for signs which is causing UI.
• Digital Rectal Exam – it is a physical exam of the rectum. Patient has to bend over a table or lie on her side while holding her knees close to her chest. Doctor will slide a gloved, lubricated finger into the patient’s rectum to check for stool or masses in the rectum that may causing UI.
• Other Diagnostic Tests - such as Urinalysis, urine culture, blood tests, urodynamic testing etc.
Treatment for urinary incontinence depends on its underlying cause, type of incontinence and severity. A combination of treatments may be required and may include one or more lifestyle changes in addition to medication. Doctor will likely to recommend least invasive treatments initially and will move on to more advance procedure or surgery only if these techniques fail. These treatment options may include:
1. Lifestyle and behavioral changes
• Fluid and diet management - may help in better control of urge to go. Person with UI should drink water or other beverages in smaller amounts throughout the day instead of drinking large amounts at once. She should also avoid or control excessive intake of alcohol, caffeine or acidic foods. Losing weight and increasing physical activity can help in ease the problem.
• Bladder training – scheduling toilet trips may help person to avoid urge to go. Person may require delaying a trip to the toilet each time she gets an urge to urinate. This may help bladder and urinary tract to grow stronger. The main aim is to lengthen the time between trips to the toilet.
• Pelvic floor muscle exercises – also known as Kegel exercises that may help in rebuilding strength and tighten muscles in the pelvis and urinary tract system. These exercises are especially effective for stress incontinence. In pelvic floor muscle exercise, person should try to stop urine flow and then contract the muscles and then relax for 5 seconds. Keep holding the contractions for 10 seconds at a time. Should try to do at least three sets of 10 repetitions each day. Doctor may suggest doing this with the help of physical therapist to get the right technique of contracting muscles.
2. Medical devices – urethral insert or pessary may be suggested to treat stress incontinence. A small tampon like disposable urethral device is inserted to prevent UI during any specific activity or wear it throughout the day. Women should remove the pessary regularly for cleaning.
3. Electrical stimulation – In this technique, electrodes are temporarily inserted into the rectum to strengthen the pelvic floor muscles. Light stimulation can prove effective for stress incontinence and urge incontinence but patient may require multiple treatments for several months.
4. Bulking agents – bulking agents such as collagen and carbon beads are injected near the urinary sphincter to treat urgency and stress incontinence. This bulking agent makes the tissue thicker and helps in closing the bladder opening.
5. Surgery – the incontinence problems can be caused by dropping of the bladder neck towards the vagina. There are two main types of surgery to treat stress incontinent that include:
• Retropubic suspension - The doctor raises the bladder neck or urethra and supports it using surgical threads called sutures. The doctor makes an incision in the abdomen—a few inches below the navel and secures the sutures to strong ligaments within the pelvis to support the urethral sphincter.
• Sling - The doctor performs sling procedures through a vaginal incision and uses strips of natural tissue, man-made sling material, or synthetic mesh tape to cradle the bladder neck or urethra. The doctor attaches the sling to the pubic bone or pulls the sling through an incision behind the pubic bone or besides the vaginal opening and secures it with stitches.
6. Medications – doctor may prescribe some medicines such as antimuscarinic, tricyclic antidepressants, mirabegron etc to relax the bladder or decrease bladder spasms to treat urgency incontinence in women.
7. Botox – Botox will be injected into the bladder that relaxes the bladder, increasing storage capacity and decreasing UI. It is effective for up to 10 months.
Certain products such as pads, adult diapers, waterproof underwear, disposable pads etc may help women to cope with urine leakage who may still leak urine even after the treatment.
Urinary incontinence may not be preventive due to certain factors like age, neurological conditions etc but controlling one’s lifestyle habits like eating balanced diet, regular exercise, weight loss, strengthening pelvic floor muscles etc may help ease the condition.