Incontinence – Embarrassing Moments

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We are subjected occasionally to embarrassing moments but some women are unfortunate as they suffer from urinary incontinence, which can be very embarrassing and can occur frequently. Urinary incontinence is a problem affecting almost one third of women to a varying extent. It is the involuntary loss of urine, which can happen while laughing, sneezing, jogging etc., any situation where there is increased pressure within the tummy pressing on the urinary bladder resulting in escape of some urine. This is known as stress incontinence. Other women complain that once they get the urge to go to the toilet then they have to go. The problem arises if there is no toilet available or if it is busy, then they end up leaking urine as well. This condition is known as overactive bladder.

Women suffering from this condition complain as mentioned above of leakage of urine with any exercise, which can prevent them from jogging or going to the gym. Incontinence can sometimes take place during sexual intercourse, which can be very embarrassing and distressing to the couple. Urinary incontinence is usually worse during upper respiratory infections due to coughing and sneezing, which can make the situation worse.


Causes of stress incontinence

Incontinence occurs due to weakness in the muscle called sphincter.  This is situated around the urethra, which is the outlet of urine from the bladder. The sphincter’s role is to control and stop the urine escaping from the bladder during straining. When this muscle gets weak it cannot prevent the leakage of urine, thus incontinence occurs. This muscle can get weaker with aging and lack of hormones, therefore incontinence can present at old age. However many young women suffer from incontinence this may be due to trauma of natural vaginal delivery or instrumental delivery. Obstructed labor where labor is prolonged and difficult. Delivery in squatting position has been considered as one of the causes as well as repeated pregnancies and vaginal deliveries. The condition may be due to inherit defect in the collagen present in the pelvic floor area.

Urinary incontinence may be accompanied as well with prolapse. This means the drop of vagina and or womb from their normal position. Women usually complain from a swelling down below. This may cause dragging sensation, backache and pain during intercourse. Prolapsed results from similar causes of stress incontinence.


Overactive bladder

This is known as detrusor instability or urge incontinence, as mentioned earlier it differs from stress incontinence, as when women feel the urge they have to pass urine otherwise they leak. The muscle around the bladder called the detrusor muscle should normally relax when the bladder start filling with urine in order to accommodate more urine. In cases of overactive bladder the muscle contracts rather than relaxing, the pressure inside the bladder is raised and as a result urine escapes.


Diagnosing incontinence

If you experience any of the above symptoms, then you should see your gynaecologist. To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem – including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often you can begin treatment at the first medical visit.

Your doctor may instruct you to keep a diary for a day or more – sometimes up to a week—to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. You can also use the bladder diary to record your fluid intake, episodes of urine leakage, and estimated amounts of leakage.

If your diary and medical history do not define the problem, they will at least suggest which tests you need.

Your gynaecologist will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence, which may lead as well to prolapse. Other tests may be recommended in order to reach the proper diagnosis. You will be asked to cough vigorously as the doctor watches for loss of urine from the urethra. An ultrasound will be performed to check the pelvic organs, an upper abdominal ultrasound may be requested to check kidneys and ureters. You will be asked as well to have your urine tested to exclude the presence of any infection.

Urodynamic studies

This is a test done to differentiate between stress incontinence and overactive bladder. A small catheter is passed into the bladder and another one into the vagina. The bladder is slowly filled with fluid called saline. You will be asked to cough and strain. Any leakage of urine together will pressure changes in the bladder will be recorded.

How is incontinence treated?

There are a variety of ways for treating incontinence, these include change of life style, exercises to strengthen the pelvic floor muscles, medications and finally surgery


Bladder Retraining and Kegel Exercises

By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioural treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.

How do you do Kegel exercises?

It is important to find the right muscles to contract. There are many ways of doing so. You can try by inserting your index finger into the opening of the vagina and try hard to squeeze it. Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.

Repeat, but don’t overdo it. At first, find a quiet spot to practice – your bathroom or bedroom – so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.

These exercises take time to see any improvement, so don’t give up easily. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.

If you are not sure whether they are doing Kegel exercises correctly. You may ask your doctor, who may suggest examining you while you try to do them. If it turns out that you are not squeezing the right muscles, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both.

Medicines for Overactive Bladder

If you have an overactive bladder, your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency.

Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing. Other side effects include drowsiness, confusion, or memory loss. If you have glaucoma, ask your ophthalmologist if these drugs are safe for you.

Some medicines can affect the nerves and muscles of the urinary tract in different ways. Pills called diuretics which are used to get rid of excess fluid in the body and for high blood pressure may increase your urine output and contribute to bladder control problems. Talk with your doctor; you may find that taking an alternative to a medicine you already take may solve the problem without adding another prescription.

Vaginal Devices for Stress Incontinence

One of the reasons for stress incontinence may be weak pelvic muscles, the muscles that hold the bladder in place and hold urine inside. A pessary is a stiff ring that the gynaecologist inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly. These are usually recommended in older women, or women unfit for surgery due to medical problems. Pessary can be used as well if prolapse occurs during pregnancy and for 6 months following delivery.

Injections for Stress Incontinence

A variety of bulking agents, such as collagen and carbon spheres, are available for injection near the urinary sphincter. Theses agents are injected into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence. The procedure is usually done under local anaesthetic or under sedation, the procedure usually takes around 20 minutes. Unfortunately this procedure may be repeated every 1-2 years depending on how fast your body gets rid of these agents.

Important Hints

You have to make sure that you drink about 2 litres of fluid every day to dilute your urine, as concentrated urine is very irritant to the bladder. Cut down on tea, coffee, cigarettes and alcohol. These are all irritants and do worsen urinary incontinence. It is very important to exercise regularly and try and lose weight. It has been shown that by losing weight your incontinence improves significantly. A lot of surgeons including myself would refuse undergoing incontinence surgery in obese women with BMI above 35, as there is a significantly higher failure rate. Women are thus asked to lose weight prior to surgery.


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