Incontinence Fundamentals

It is estimated that nearly 80% of the more than 13 million people in the U.S. suffering from urinary incontinence are women. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for these high numbers. It’s interesting to note that research on urinary incontinence is common in Caucasians, but scarce in women of diverse cultures, which means there isn’t much information on how this problem affects African–Americans, Hispanics, and other populations.

What Causes Incontinence?
Incontinence in women usually occurs due to problems with the muscles that help to hold or release urine. When we urinate, muscles in our bladder contract and force urine out of the bladder and into the urethra. At the same time, our sphincter muscles, which surround the urethra, relax so that urine can pass out of the body. Incontinence occurs when our bladder muscles suddenly contract or the muscles surrounding our urethra suddenly relax. When we hold urine, different muscles contract, while the bladder relaxes, in order to keep urine in the bladder.

There are several types of urinary incontinence:

• Stress – means there is a small amount of urine leakage during physical movement like coughing, sneezing, or exercising
• Urge – is when there is a leakage of urine at unexpected times, including during sleep, because the bladder contracts involuntarily
• Functional – means that untimely urination occurs because of a physical disability, external obstacles, or problems in thinking or communicating the need to reach a toilet (diseases like multiple sclerosis, or a stroke can create this problem)
• Overflow – is when there is unexpected leakage of small amounts of urine due to a full bladder that you are unable to empty
• Mixed – is defined as the occurrence of stress and urge incontinence at the same time
• Transient – is when there is temporary urine leakage because of an infection or type of medication

Although family practitioners and internists are fully capable of evaluating urinary incontinence, a urogynecologist or urologist who specializes in female incontinence may be a good place to seek help. The types of tests required depend upon the severity of the problem. These may include:

• A stress test in which the patient relaxes, then coughs vigorously to determine if there is a loss of urine
• A urinalysis to test for evidence of infection, urinary stone, or other causes
• Blood tests to further rule out possible causes
• An ultrasound to get a better idea of the condition of the kidneys, ureters, bladder, and urethra
• Cystoscopy, where a thin tube with a tiny camera is inserted into the urethra and used to view the inside of the urethra and bladder
• Urodynamics, which are a variety of techniques used to measure pressure in the bladder and the flow of urine.

Fortunately, urinary incontinence is treatable. One of the first treatments many women try–because it is non–invasive, doesn’t involve drugs, and often cures the problem–is the Kegel exercise. Named after Dr. Arnold Kegel who discovered its usefulness for women preparing for childbirth, Kegel exercises are performed by contracting and releasing pelvic muscles. These muscles are attached to the pelvic bone and act like a hammock, holding in our pelvic organs. To isolate these muscles, try stopping and starting the flow of urine. Once the muscles have been located simply tighten and relax them. This can be done just about any time, anywhere, and if repeated 50–100 times each day will work wonders on the pelvic muscles used to stop and start the flow of urine.

Other interventions for this problem include:

• Brief doses of electrical stimulation to strengthen muscles
• Biofeedback
• Timed voiding or bladder training
• Medications
• A ring inserted into the vagina called a pessary that presses against the vaginal wall to help reposition the urethra
• Implants to add bulk and help close the urethra
• Surgery (many minimally invasive procedure are available today)

There is no reason for embarrassment about incontinence to affect your active lifestyle. Simple and effective treatments are available. Speak to your doctor to learn more.