Urinary Incontinence in Women

Urinary incontinence might be called a “silent” condition, while it’s symptoms are obvious (involuntary loss or leakage of urine) many people hide it from family, friends, and their physicians. They are often embarrassed and assume it is just a part of aging. The good news is that urinary incontinence is NOT to be an inevitable part of aging. There is a host of treatment options for managing urinary incontinence.

First we need to take a look at the types of incontinence.

  • Stress: Urine loss upon coughing, sneezing, laughing, or exercise. Stress incontinence occurs when pelvic muscles have been damaged or weakened.
  • Urge: A sudden strong urge to urinate and uncontrollable leakage of urine, also referred to as “overactive bladder”. This type of incontinence results from nerve damage along the pathway from the bladder to the brain. The scrambled signal will cause the bladder to contract suddenly.
  • Overflow: When the bladder does not empty completely, urine frequently or constantly dribbles.
  • Mixed: A combination of stress and urge.
  • Functional: This type of incontinence occurs when a person cannot get to the toilet on time due to arthritis or other condition that limits mobility.
  • Postsurgical: Some people become incontinent after surgery such as a c-section, hysterectomy, intestinal or rectal surgery, or prostate surgery.
  • Reflex: Urine loss when the person is unaware of the need to urinate. Reflex incontinence sometimes results from a leak in the bladder, urethra, or ureter, or from an abnormal bladder opening.

Treatment Options:

Bladder retraining

This involves developing a schedule for trips to the bathroom and gradually increasing the time between visits. Typically one should work to lengthen the time by 15 minutes every two weeks.

Lifestyle changes

Avoiding caffeine, artificial sweeteners, citrus fruits and juices, very spicy foods, and carbonated drinks may help to alleviate urinary incontinence. Exercise is a plus in managing leakage too. Weight management is also important as added weight can apply added pressure to the pelvic organs. Cigarettes should be given up too, as Nicotine is a bladder irritant that can contribute to incontinence.

Pelvic floor exercises

Many women do pelvic floor, or Kegal exercises, as part of preparing for childbirth. These exercises are also helpful in strengthening the pelvic muscles. Many women have trouble distinguishing between their pelvic and abdominal muscles. That’s why it’s helpful to have someone trained in pelvic floor exercises assist you in learning how to do them correctly.

Hormonal Replacement Therapy

Perimenopausal or menopausal women often develop urinary incontinence when a decline in estrogen level results in muscles around the bladder being weakened. Decreased estrogen may also thin the lining of the urethra, reducing bladder support. Supplemental hormones are very effective in treating urinary incontinence, but the treatment must be highly individualized, says Paul Fine, M.D., Director of the Department of Urogynecology at Baylor University in Texas. “Every woman is different,” says Dr. Fine. “How much estrogen she needs depends on her body and her situation.” According to Dr. Fine, some women do best with oral or transdermal estrogen combined with a vaginal estrogen cream to alleviate urinary incontinence.

“The dosage needs to be tailored to the individual,” he says. “Sometimes a woman will be on a proper dosage of oral or transdermal estrogen and it’s not enough estrogen to strengthen the urethra.” In those cases Dr. Fine adds a weaker estrogen to the vaginal area, in the form of a cream or suppository. “The cream and suppository diffuse through the vagina to the urethra.” Some perimenopausal woman still make plenty of estrogen on their own but are nevertheless lacking some in the bladder area. In this case the woman may only need to start on a weak estrogen vaginal cream or suppository before going to oral or transdermal estrogen.



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