November is bladder health awareness month and that is important because bladder accidents are a lot more common than one might think. In fact, according to National Association for Incontinence more than 17 million American adults suffer from involuntary bladder leakage every day.
Whether you spontaneously release urine when you laugh or sneeze, have sudden urges to urinate, struggle to make it to the bathroom on time or have an overactive bladder that gets you up frequently in the middle of the night, urinary incontinence is typically an easily treatable medical condition, regardless of age.
Bladder accidents are not something to be embarrassed about and despite the relative ease and availability of care, studies show that on average people “live with” the problem for over six years before looking for treatment options. That is a long time to suffer unnecessarily.
While urinary incontinence can happen to anyone, women are disproportionately affected with one in four women over the age of eighteen experiences leaking episodes.
There are two reasons women tend to have more bladder leaks than men:
1. Pregnancy, childbirth and menopause can weaken the muscles around the bladder and pelvis.
2. The female urethra is shorter than the male urethra so weakness, or damage in that part of the body is more likely to cause leakage.
In this blog we will focus primarily on female incontinence and the issues women face. We will expand on bladder conditions and treatment options for men in the blog that follows.
How the Urinary System Functions
The urinary tract is your body’s drainage system for removing unwanted waste and fluid. Proper functioning of the urinary tract is necessary for maintaining levels of electrolytes, keeping bones strong, regulating blood pressure, and making red blood cells.
Urine is made by the kidneys, stored in the bladder and released through a tube called the urethra. Three sets of muscles work together to create a reservoir in the bladder that stores urine.
When a person urinates, the brain sends a signal through the nervous system to the muscles around the bladder wall to contract. As those muscles tighten, urine is squeezed into the urethra. At the same time, the sphincter muscles around the urethra are instructed by the brain to relax so that urine can be released from the body.
Leakage can happen when bladder muscles suddenly tighten, and the sphincter muscles are not strong enough to pinch the urethra shut or when nerve damage inhibits proper functioning. Nerve damage can occur from injury or conditions such as multiple sclerosis, diabetes, stroke or Parkinson’s.
Common Types of Incontinence Affecting Women
There are many different types of incontinence, but the two most common in women are:
1. Stress incontinence
2. Urge incontinence, also known as overactive bladder
A person experiencing both these types is said to have mixed incontinence.
Stress urinary incontinence typically occurs when physical movement such as sneezing, coughing or exercise puts pressure on the bladder, and the supporting pelvic floor and sphincter muscles are too weak to resist the stress, causing urine to leak out.
Urge Incontinence or Overactive Bladder
Overactive bladder affects 33 million adults in the USA. It occurs when you experience an involuntary loss of urine and a sudden urge to urinate. Urge urinary incontinence is caused by spontaneous contractions of the muscle in the wall of the bladder. When this happens, women often leak large amounts because they are unable to get to the bathroom on time.
Urge incontinence can be caused by nerve damage, spinal cord injury or bladder irritation, which can be an indication of a urinary tract infection.
Other Types of Incontinence
Other types of adult female incontinence include overflow incontinence (dribbling for some time after urine has passed); structural incontinence (such as that caused by obstetric or gynecological trauma); functional incontinence (when a person realizes they need to urinate but doesn’t make it to the bathroom on time—causes include dementia, inebriation, confusion, depression or simply a need to urinate with no bathroom available) and coital incontinence (occurs during sexual activity).
How Pregnancy, Childbirth and Menopause Effect the Bladder
It is common for women to experience some form of urinary incontinence during pregnancy because the enlarging uterus puts more pressure on the bladder. During a first pregnancy, more than one-third of women develop temporary stress incontinence, but in subsequent pregnancies more than three-quarters of women experience the problem. Pregnant women typically find it helpful to use behavioral methods and bladder training exercises (see treatments section in our Incontinence Health Guide) to manage this problem.
After childbirth, bladder control problems can occur because of damage to the nerves or muscles, weight gain, a shift of the bladder and urethra during pregnancy or weakening of muscles and ligament tissues.
Incontinence is common for women going through menopause because during menopause the body stops producing the hormone estrogen. Estrogen helps to keep the lining of the bladder and the urethra healthy.
Other Incontinence Contributors
Weight gain, smoking and alcohol consumption also contribute to bladder control issues. Medications such as oral estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal anti-inflammatory drugs and calcium channel blockers can cause or worsen urinary incontinence.
Urinary incontinence is a common problem most women experience at some point in their lives. If it is frequent and/or persistent, it affects the quality of life. While it is natural for women to feel uncomfortable discussing this subject with a urologist, it is important to realize that lack of bladder control can be a sign of something a lot more serious, and it can increase the chance of injury from falls while rushing to the bathroom as you age. The sooner you treat persistent urinary incontinence, the happier, healthier and more comfortable you will be.
In our urinary incontinence guide we discuss treatments, including behavioral remedies, lifestyle changes, Kegel exercises and surgical procedures. Our goal is to educate you on a common problem that most women aren’t comfortable talking about. We hope to provide language that may make it easier for you to speak to your doctor, dispel the myths, answer your questions and most importantly, encourage sufferers to take the next step in treatment and/or management of this common, and typically easily treatable, condition.
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