Women's Health
Urinary Incontinence in Women

​​Overview:

  • Urinary incontinence (UI) refers to the loss of bladder control, causing urine to accidentally or involuntarily leak.
  • The physical changes associated with pregnancy and delivery usually cause urinary incontinence.
  • If urinary occurs frequently, and affects the patient’s life, medical attention should be sought.
  • Non-surgical therapies can prove effective, but if not, a surgery may be necessary.
  • There are some measures to mitigate the risk of urinary incontinence.

Introduction:
Urinary incontinence (UI) is a condition of loss of bladder control, leading to leakage of urine. Even though numerous men and women are susceptible to UI, it may affect their personal life, as well as their professional and social relations. Women are at higher risk of UI than men. Although it is more common among the elderly, UI is not a natural outcome of aging. 

Names:
Urinary incontinence (UI)

Urinary tract:
Urinary tract, or urinary system, is the system responsible for eliminating the body of the wastes, toxins and extra fluids. Natural urination signals that all organs of the urinary system are healthy and work properly. Those organs are:
  • Kidneys: The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Working around the clock, the two kidneys filter about 120-150 liters of blood to produce 1-2 liters of urine.
  • Ureters: Two small muscular tubes that transfer the urine from the kidneys to the bladder.
  • Bladder: The bladder is located in the pelvis, nestled between the pelvic bones. This muscular balloon-like organ expands in size as it fills with urine. We have no control over how the kidney functions, but we typically have control over when the bladder empties, which is known as urination. The bladder functions as a tank for urine. A healthy bladder can typically hold around 1.5-2 cups of urine. The frequency of urination is entirely dependent on how quickly the kidney produces the urine that fills the bladder. When the bladder is full, the brain will be notified by a signal that it’s time to use the bathroom. During urination, the bladder deflates as it’s emptied through the urethra.
Types of Urinary Incontinence:
  • Stress incontinence: occurs during coughing, sneezing, or exercising. 
  • Urgency incontinence: describes loss of urine after experiencing a strong and urgent desire to urinate.
  • Mixed incontinence: occurs when an individual experiences both urgency and mixed incontinence at the same time.
  • Functional incontinence: occurs when a physical barrier, such as a physical disability.
  • Transient incontinence: is a temporary UI condition.

Causes:
  • Stress incontinence: Stress incontinence occurs when the bladder experiences force or pressure that causes urine to leak out (e.g. laughing, sneezing, coughing or physical activities). Pregnant women frequently experience stress incontinence due to the physical changes in the body during pregnancy. Weak pelvic floor muscles can result in the bladder moving in a downward motion, pushing it out of the range of the sphincter to hold it in place properly. Thus, when the bladder is under stress urine may leak out. Stress incontinence can also occur without the bladder moving downward, if the urethra is weak. 
  • Urgency incontinence: Urgency incontinence occurs due to abnormal never signals which could also lead to involuntary bladder contractions, causing a strong and urgent desire to urinate. Damage to the bladder muscles, bladder nerves, brain and spinal cord can cause the bladder to contract involuntarily (e.g. Alzheimer's disease, sclerosis, Parkinson’s disease, strokes, etc). There are a number of common triggers for women who experience urgency incontinence. These include touching water, hearing running water, drinking a small amount of water as well as being in an area with a cold temperature, even for a short span of time.
  • Mixed incontinence: Mixed incontinence occurs when an individual experiences both urgency and mixed incontinence at the same time.
  • Functional incontinence: Functional incontinence occurs when a physical barrier, such as a physical disability or physical obstacle stops an individual from reaching the bathroom in time.
  • Transient incontinence: Transient incontinence occurs when an individual experiences UI for a short span of time. This specific condition is typically caused by a temporary condition or medication. These include: urinary tract infection (UTI), excessive caffeine consumption, chronic cough, constipation, and mental impairment.

Risk factors
  • Genetics
  • Aging
  • Congenital defects in the urinary tract
  • Pregnancy
  • Delivery
  • Chronic cough
  • Menopause
  • Neurological problems
  • Obesity
  • Diabetes
  • Pelvic organ prolapse

Symptoms:
Many women experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.

When to see a doctor?
If incontinence is frequent or is affecting your quality of life, it's important to seek medical advice because urinary incontinence may:
  • Cause you to restrict your activities and limit your social interactions;
  • Increase the risk of falls in older adults as they rush to the toilet.

Complications:
The UI-associated complications include:
  • skin problems such as rash and skin infections;
  • Urinary tract inflammations. 

Diagnosis:
  • Medical history
  • Clinical examination
  • Laboratory tests (blood tests and urinalysis) 
  • Other tests, including: pelvic examination, and other examinations meant to rule out urinary tract infections, and bladder stones and tumors.

Treatment:
Non-surgical therapies can prove effective, but if not, a surgery may be necessary.
  • Non-surgical therapies:
    • Lifestyle changes, which include: Maintaining a healthy weight, and limiting the caffeine consumption;
    • Doing Kegel exercises to strengthen the pelvic floor muscles;
    • Doing bladder exercises.
    • Electrical stimulation: Electrodes may be used to stimulate the nerve connected to the pelvic muscles. 
    • Magnetic-field therapy:  It is effective in painlessly contracting and strengthening the pelvic floor muscles.
  • Medications:
    • Duloxetine: is prescribed to control stress incontinence.
    • Anticholinergics: are prescribed to control urgency incontinence.
  • Surgery:
  • The surgical procedures vary depending on the type of urinary incontinence (whether it is stress or urgency incontinence).
    • Stress incontinence:
      • Bladder neck suspension.
      • This procedure is designed to provide support (collagen, etc.) to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra, to prevent the leakage of urine. 
      • Sling procedures: A plastic strip is inserted through the vagina, to create a pelvic sling around the urethra.
    • Urgency incontinence:
      • Botulinum toxin (type A) is injected into the bladder muscle.

Prevention:
Urinary incontinence isn't always preventable. However, there are certain measures to help decrease your risk, including: 
  • Maintaining a healthy weight;
  • Doing Kegel exercises designed to strengthen the pelvic floor muscles;
  • Exercising to maintain the fitness and strength of the bladder muscles, and avoid bladder irritants (e.g. caffeine, etc);
  • Increasing the intake of fiber to avoid constipation;
  •  Stopping smoking.


Health guidelines for patients with urinary incontinence:
  • Follow the doctor’s guidelines regarding the recommended quantity of fluid;
  • Limit the intake of caffeine (in beverages such as tea and coffee);
  • Make sure that cloths are not wet, and immediately change them if urine leaks;
  • Limit the consumption of fluid after supper, to reduce the risk of urine leakage at night;
  • Maintain a healthy weight to avoid pressure on the bladder.

FAQ:
  • Is there an alternative medicine for urinary incontinence?
    • No alternative medicine has been proven to be effective in controlling urinary incontinence. Studies have proposed that acupuncture may be effective in maintaining short-term bladder control. Further study in this respect is still required, though. 

Myths & Truths:
  • Urinary incontinence is natural, and is not a medical condition.
    • Truth: It depends on how much urine is leaked, and for how long. It may be normal and transient, or a medical condition that requires medical intervention.
  • Avoiding drinking water prevents urinary incontinence.
    • Truth: Not true. However, a person with urinary incontinence may be advised to reduce the quantity of consumed water when going out, to reduce the risk of urine leakage.
  • The onset of Ui-associated symptoms during pregnancy indicates a chronic UI condition.
    • Truth: Not really. Strengthening the pelvic floor muscles can be effective in this case, either in the post-pregnancy period, or months or years afterwards.

Health Promotion and Clinical Education General Department
For inquiries, contact us by this email.

 



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