Urinary Incontinence
…simply means leaking urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
This can be embarrassing, super annoying, and costly.
Women are twice as likely as men to experience urinary incontinence. This is due to the structure of the female urinary tract as well as the effects of pregnancy, childbirth, and menopause.
- Urine loss can be small and sporadic or heavy and frequent.
- The severity ranges from an occasional leakage of urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.
- Urinary incontinence is also more common among older women, although it is not a normal part of the aging process.
Also ask yourself these questions:
- Is the urge to urinate interfering with your work because of leaking or frequent bathroom breaks?
- Do you map out where bathrooms are when you run errands?
- Is incontinence interfering with your sex life or intimacy with your partner?
- Do you wear a pad everyday?
If urinary incontinence affects your daily activities and quality of life, call and make an appointment with one of our experienced providers at County Obstetrics & Gynecology.
A thorough evaluation by one of our providers can help determine what’s behind your incontinence.
For most, simple lifestyle changes or medical treatment can ease discomfort or manage, even stop, urinary incontinence.
How does my bladder store urine?
The job of the bladder is to store and pass urine when you are ready to. The bladder holds on to urine by relaxing the muscle in its wall. There is not a valve that you open and close when you are ready to urinate. Pelvic floor muscles are constantly holding the urethra closed: The PC muscles (pubococcygeus muscle) pulls the urethra forward and larger muscle that pull the urethra towards your back called the levator muscles. This “kinks” or tightens the urethra stopping urine from leaking out.
When a certain amount of urine is inside the bladder, nerves in the bladder signal the urge to urinate. The bladder is an involuntary muscle, and when you decide that it is an appropriate time to urinate, you will relax your pelvic floor muscles (the PC muscle). The urethra “unkinks” and opens and then your bladder will contract to push urine out.
Because the bladder is an involuntary muscle, you do not have to consciously contract your bladder as it will do this on its own.
Conditions that affect the function of the bladder muscle or support of the bladder or urethra can result in an inability to appropriately store urine resulting in urine loss or urinary incontinence.
For most, simple lifestyle changes can improve urine loss:
- As little as an 8 percent weight loss can decrease incontinence by half.
- Quit Smoking
- Changing your diet. A list of bladder irritants include: coffee, chocolate, alcohol, spicy foods, and other things. We have patients skip those foods and drinks for a week or two and see what their urgency or frequency is like.
- Manage your fluid intake. If you have leakage in the early morning or at night, you may want to limit your intake of fluids several hours before bedtime. Limiting the amount of fluids you drink also may be useful (no more than 2 liters total a day).
- Bladder Retraining – “Time voiding,” which is retraining the bladder. If the patient is in the bathroom every hour, we’ll slowly lengthen that interval so they’re in the bathroom less often
- Kegel or Pelvic floor Exercise, which involve contracting and then relaxing the pelvic floor muscles to help strengthen and improve that support provided to your uterus, bladder, vagina and rectum. These exercises are especially helpful for preventing or improving urinary incontinence. They can be effective years after delivering a baby or as muscles weaken with age. LEARN MORE
There are several different types of incontinence. In women, the main types of incontinence are:
- Stress Incontinence (SUI) – Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.
- Urge Incontinence (UI) – Also known as an overactive or spastic bladder, urge incontinence is a type of incontinence that results from an immediate, strong urge to urinate.
- Mixed Incontinence – Both stress and urge incontinence symptoms.
Stress Incontinence (SUI)
Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.
These disorders occur when supportive tissues and muscles that support the urethra are damaged or weaken.
With a rise in intra-abdominal pressure, like coughing or straining, the urethra is forced against the intact pubocervical fascia which closes the urethra preventing urine loss.
Fascial tears affect the ability of the muscle to close the urethra during straining. The urethra remains open, causing urine to leak out.
Stress urinary incontinence in women is often the result of fascial tears that occur during pregnancy, childbirth, or as a result of aging.
Pregnancy and Childbirth
- During pregnancy the weight of carrying a fetus can strain and damage the on the pelvic floor structures which can be further damaged with a vaginal delivery. Women who’ve had a vaginal delivery are more likely to develop urinary incontinence than women who’ve delivered via a cesarean section. Women who’ve had a forceps delivery to more rapidly deliver a healthy baby may also have a greater risk of stress incontinence.
Age
- Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, the older you get, involuntary bladder contractions become more frequent.
Menopause
- Women produce less estrogen after menopause, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
Lifestyle
- Body weight – People who are overweight or obese have a higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs.
- Smoking can cause a chronic cough leading to a rise in abdominal pressure putting strain on the pelvic floor muscle and supportive tissue. Nicotine can have a direct a negative effect on the bladder.
- Caffeine or alcohol – Incontinence may be a side effect of substances that cause your body to make more urine.
Stress Urinary Incontinence can be corrected surgically if needed…
Midurethral sling surgery
Midurethral sling surgery usually takes less than 30 minutes to perform. It is an outpatient procedure, meaning that you usually can go home the same day. Recovery time generally is quicker than with other procedures for SUI.
The sling is a narrow strap made of synthetic mesh that is placed under the urethra. It acts as a hammock to lift or support the urethra and the neck of the bladder.
During a mid-urethral sling procedure, the surgeon makes a small incision in the vagina and then two small skin incisions near the pubic bone or in the groin area. Using specially designed needles, the surgeon positions a thin piece of synthetic mesh under the urethra. Next, the surgeon pulls the ends of the mesh through the skin incisions and adjusts them to provide the right amount of tension under the urethra. After the procedure, your tissues grow through the weave of the mesh. This typically takes several weeks and helps to secure the sling.
Use of the mesh midurethral sling is supported by the American Medicine & Urogenital Reconstruction.
Synthetic midurethral slings are not recommended if you want to get pregnant in the future.
Overactive bladder (OAB)
Overactive bladder (OAB) is the name for a group of urinary symptoms associated with a sudden strong, uncontrol need or urge to urinate. Some people will leak urine when they feel the urge. Women with this type of urinary incontinence may leak urine on the way to the bathroom or when you get home from work and are struggling to unlock your door to get to a bathroom for fear of leaking urine.
As many as 40 percent of women in the United States live with OAB.
OAB can affect your work, social life, exercise, and sleep.
Without treatment, OAB symptoms can make it hard to get through the day without many trips to the bathroom.
OAB may affect relationships with friends and family. You may not want to go out with friends or go far from home because you’re afraid of being far from a bathroom.
It can disrupt your sleep. Too little sleep will leave you tired and depressed.
OAB can affect your sex-life directly and indirectly. Chronic urine leaking can cause skin problems of your bottom or perineum.
Symptoms
- Urgency: A sudden and strong urge to urinate that you can’t ignore. This “gotta go” feeling makes you fear you will leak if you don’t get to a bathroom right away you may or may not actually leak.
- Frequency: You may need to go to the bathroom several times a day. On average if you void greater than 8 times a day this would be consider abnormal.
- Nocturia: If you wake up to go to the bathroom more than 1-2 times at night.
- Urge incontinence: Leak of urine with symptoms of urge.
What cause the bladder to be overactive?
With a healthy bladder, as your bladder fills it signals the brain to let it know that the bladder is getting full or is full, but you can wait to go to the bathroom. With OAB, the nerve signals between your bladder and brain don’t work properly. Signals might tell your bladder to empty when it isn’t full. This causes the bladder to contract, producing the symptom of urgency and in some cases leaking of urine.
Several conditions may contribute to signs and symptoms of overactive bladder, including:
- Neurological disorders, such as stroke and multiple sclerosis
- Diabetes
- Urinary tract infections that can cause symptoms similar to those of an overactive bladder
- Hormonal changes during menopause in women
- Abnormalities in the bladder, such as tumors or bladder stones
- Factors that obstruct bladder outflow —constipation or previous operations to treat other forms of incontinence
Other factors that may be associated with your symptoms include:
- Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
- Excess consumption of caffeine or alcohol
- Declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain
- Difficulty walking, which can lead to bladder urgency if you’re unable to get to the bathroom quickly
- Incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left
What can you do to treat an Overactive Bladder?
- Lifestyle changes
- Limit food and drinks that bother the bladder. There are certain foods and drinks known to irritate the bladder. You can start by avoiding diuretics – these drinks include caffeine and alcohol which encourages your body to make more urine. You can also try taking several foods out of your diet, then add them back one at a time. This will show you which foods make your symptoms worse so you can avoid them. Some foods and drinks that may affect your bladder:
- Coffee/caffeine
- Tea
- Alcohol
- Soda and other fizzy drinks
- Some Citrus fruits
- Tomato-based foods
- Dark chocolate
- Some spicy foods
- Bladder Retraining
- This is when you practice waiting before you go to the bathroom, even when you have to go. At first, you wait a few minutes and gradually increase the time that you wait. This may help you to increase the interval between voiding.
- Timed Urination
- This means you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day. You may try to go every 1-2 hours whether you feel you have to or not. Then gradually increase the interval. The goal is to prevent the urgent feeling to regain control.
- Quick Kegel
- When you feel the urge to go, quickly squeeze and relax your pelvic floor muscle repeatedly. This may help you relax your bladder as the urge passes.
- Physical Therapy and Biofeedback.
- Limit food and drinks that bother the bladder. There are certain foods and drinks known to irritate the bladder. You can start by avoiding diuretics – these drinks include caffeine and alcohol which encourages your body to make more urine. You can also try taking several foods out of your diet, then add them back one at a time. This will show you which foods make your symptoms worse so you can avoid them. Some foods and drinks that may affect your bladder:
The providers at County Obstetrics & Gynecology have the knowledge, experience, and resources to accurately identify the cause of your urine loss Our provider and will then discuss available treatment options and assists you in selecting treatment plan that best meets your needs.
Kegel Exercise
When you’re first learning how to perform Kegel exercises, you can use the following strategies to help understand the muscles you’ll be strengthening:
- While urinating, try to stop your urine midstream. The muscles you squeeze to stop the urine flow are your pelvic floor muscles.
Once you learn which muscles to engage, we don’t recommend performing Kegels while peeing, because over time it can actually lead to issues with bladder emptying and affect your ability to control urine.
- Imagine you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a “pulling” feeling in your vaginal or rectal area, you are squeezing the right muscles.
- Try squeezing only the vaginal muscles and see if the flow of urine is interrupted.
- Insert a clean finger in the vagina and squeeze only the vaginal muscles around your finger.
Be patient — practice makes perfect. It can take time to see progress in pelvic floor strength, and everyone is different.
Don’t hold your breath; stay relaxed, trying to tighten only the pelvic floor muscles — not the muscles in your stomach, legs or buttocks.