Incontinence in women
A discussion of incontinence in women, which includes types, diagnosis, and treatment options.
Incontinence is a condition that has been estimated to affect three to six million people in the UK. Women are approximately two times as likely to suffer from incontinence as men are. Women of all ages may be affected, with the incidence increasing as a female ages. The following article will outline the types of incontinence, diagnosis of this common complaint, and treatment of incontinence in women.
Types of Incontinence
Urinary incontinence can be defined as the involuntary passage of urine, which can range from an occasional leakage to continuous leaking of urine, and is usually classified as mild, moderate, or severe. Physicians differentiate among four types of incontinence because treatment may differ depending on the type.
Stress incontinence is the involuntary leakage of urine that occurs as a result of a stress placed on the bladder. Coughing, sneezing, lifting a heavy object, exercising, and even laughter can cause incontinence. The underlying problem is a weakness of the sphincter, or valve, which keeps the bladder outlet closed. The cause of this type of incontinence may be a weakness of the pelvic floor muscles that can cause the urethra to move from its normal position.
Urge incontinence, or overactive bladder, is characterized by an urgent need to urinate frequently. It may be accompanied by painful spasms of the bladder. It occurs when the muscular bladder wall contracts too often, causing the bladder to empty before the bladder is at full capacity.
Mixed incontinence is a combination of both stress and urge incontinence. Women with this type of incontinence have the frequent urge to urinate accompanied by leakage of urine, quite often while sneezing, coughing, or exercising.
Overflow incontinence is the result of an overly full bladder The bladder simply fills up to the point where it cannot fill up any more; at this point, dribbling of urine occurs. The cause of overflow incontinence may be obstruction blocking the urethra or damage to the bladder that affects the nerve supply, such as occurs in spinal cord injuries or Multiple Sclerosis.
It has been reported that women who suffer from female incontinence wait an average of 6.5 years after the onset of symptoms before consulting a physician. This is likely due to the social stigma that many perceive to be associated with incontinence. Avoiding diagnosis due to embarrassment is unwise, as research has shown, in some cases, that incontinence can be cured.
Women experiencing female incontinence should start with a visit to their family doctor. During an initial consult, a urinalysis will be collected to check for infection. The physician will ask many questions regarding the nature of the problem. It is helpful if women can keep a diary of their patterns of incontinence for at least a week leading up to their appointment. Information to record should include the number of times the patient was incontinent, what time of day incontinence occurred, and any activities associated with incontinence, such as exercising, sneezing, or coughing. Patients should also keep track of their fluid intake for a 24-hour period.
Questions to expect at an initial visit might include:
Incontinence in women is quite often referred to a urologist, a specialist in urinary tract disorders, or to a gynecologist, who specializes in women’s reproductive health. The specialist will generally start by asking the same questions as the family doctor and will include a physical exam. During the physical exam, the specialist may examine the vagina and rectum as well as the tissue between the two, called the perineum. He or she may ask you to cough and check for any leakage of urine. You may also be asked if you have normal sensation when the perineum is touched. An abdominal exam is also performed. Although uncomfortable, the exam is not painful.
Tests for diagnosis of female incontinence may also be performed. If a cause for the incontinence cannot be found through history or exam, the patient may have one or several of the following tests done in hospital:
Treatments for female incontinence range from self-help practices to surgery. Surgery usually is not done unless all other treatments fail or there is a physical abnormality that can only be corrected by surgery.
Self-help practices consist of simple measures that the patient can do at home. Cutting down or eliminating caffeine may reduce bladder irritation. Patients who are overweight may find their symptoms improve with weight loss. Cutting down on fluid intake (if excessive fluid intake is a factor) may be helpful; however, cutting down on fluids too much may lead to bladder infection, so patients should discuss fluid intake with their physicians.
Female incontinence can sometimes be helped by physical therapy. Kegel exercises are the mainstay of treatment. Kegel exercises are used to isolate and strengthen the pelvic floor muscles which support the bladder and urethra. Strengthening these muscles can lead to better control and less leakage of urine. These exercises are easy to learn and perform and can be done discreetly at any time or place. Kegel exercises are performed by contracting the muscles that stop and start the urine flow. These should be performed three times a day and patients should work up to doing at least ten at a time. It may take several weeks before the patient notices an improvement in bladder control.
Vaginal cones are sometimes used to treat female incontinence. These cones are small weights that fit inside the vagina. Patients perform pelvic floor exercises while holding the cone in place, which encourages use of these muscles. Patients may gradually increase the weight of the cones.
Bladder training involves emptying the bladder at specific times. Patients gradually increase the time between voids. This method may also take several weeks to show any positive effect.
Biofeedback is sometimes used in female incontinence. Biofeedback involves the use of sensors to tell the patient when they are using the right set of muscles in the pelvic floor.
Electrical stimulation is performed by trained health care professionals. In this method, a small electric charge is applied which causes the pelvic floor muscles to contract. This method is not well tolerated by some patients.
Medications to treat female incontinence make the bladder less likely to contract involuntarily. Oxybutynin (Cystrin), Tolterodine (Detrusitol), and Duloxetine (Yentreve) are some of the common drugs used to treat the condition. Yentreve is the first drug approved for treatment of women with moderate to severe stress incontinence and is only available in the UK.
Surgery to treat female incontinence problems is, as previously mentioned, usually performed only after other treatment measures have been attempted. The most common procedure is a “bladder sling”, which creates a pelvic sling around the neck of the bladder and urethra and provides support to keep the urethra closed, even when the patient coughs or sneezes. Another procedure involves an injection of a bulking agent into the tissue surrounding the urethra, which supports the urethra and prevents leakage of urine. Surgical treatment carries its own risks and benefits and should be discussed thoroughly prior to surgery.
Female incontinence is a common condition. Women are often unwilling to seek treatment due to embarrassment over their condition. Personal embarrassment may cause women to curtail their normal activities, leading to isolation and depression. However, there is hope. Incontinence in women may be curable and women should first see their family physician, who may send the patient to a specialist who deals with issues of continence. There are several treatments options, including self-help measures, physiotherapy, medications, and surgery as a last resort.
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