Why Does Urinary Incontinence Happen
There are two main types of urinary incontinence:
- Stress incontinence
- Urge incontinence
“Stress incontinence occurs when your pelvic floor muscles the muscles that support your bladder and urethra weaken, either due to childbirth or over time,” says Dr. Lindo.
If you’re experiencing stress incontinence, you might find yourself leaking urine when you cough, sneeze, laugh, exercise or lift something heavy.
“Urge incontinence, on the other hand, occurs when the bladder muscle squeezes to empty out urine when it is not supposed to. It may be due to the amount or type of fluids you drink, resulting in spasms,” explains Dr. Lindo. “Additionally, urgency incontinence can sometimes be a sign of a larger health complication, such as a bladder infection.”
With urge incontinence, you likely experience an overwhelming, sudden need to urinate and leak urine before you can make it to the bathroom.
“For many women the exact cause of their urge urinary incontinence is unknown,” adds Dr. Lindo. “However, there are many treatments that can help you manage symptoms.”
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Can Incontinence Be Prevented
Different events throughout your life can lead to many of the things that cause incontinence. The muscles that support your pelvic organs can weaken over time. For women, these muscles can also be weakened by big life events like pregnancy and childbirth. However, in the same way you work out to build strength in your legs or arms, you can do exercises to strengthen your pelvic floor muscles. Doing exercises to strengthen your pelvic muscles may not prevent you from having any issues with incontinence, but it can help you regain control of your bladder. Maintaining a healthy body weight can also help with bladder control. Talk to your healthcare provider about the best ways to maintain strong pelvic floor muscles throughout your life.
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What To Expect At A Doctors Appointment For Urinary Incontinence
Seeing a doctor for urinary incontinence may involve the following:
- An in-depth discussion about medical history and health conditions
- A complete physical examination
- A urinalysis test to check for infections or blood in the urine
- A blood test to check kidney function, blood glucose levels, and calcium levels
Tip 3 Use A Bathroom Finder App
Leaving the safety of your home, whether for a vacation or even just to run errands, can be an anxiety-inducing ordeal if youre not sure where the nearest restroom is. Bathroom finder apps, such as Bathroom Scout and Sit or Squat, can be essential smartphone apps for anyone living with urinary incontinence.
Knowing where the closest public bathroom is can make all the difference between a successful outing and a stressful situation caused by urine leakage.
Here are some more smartphone apps that you may find helpful.
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Symptoms Of Stress Urinary Incontinence
Women with stress urinary incontinence feel a sudden and intense need to urinate, often triggered by activities that place added pressure or stress on their bladder and pelvic floor muscles. Some of the more common activities that can lead to leakage include:
Getting in or out of a car
Leakage may include just a small drop or two of urine or even a whole stream. Any amount is unwanted, so dont dismiss your concerns simply because your leakage doesnt seem as bad as it might otherwise be. If you find yourself wet, you can find yourself a treatment option.
What Are The Treatment Options For Women With Stress Urinary Incontinence
Women have both non-surgical and surgical options to treat SUI.
Not every woman with SUI will need surgery. Some factors you should consider before deciding whether to undergo surgery include:
- the severity of your SUI symptoms and their effect on your daily activities;
- your desire for future pregnancy as vaginal delivery can cause recurrence of SUI symptoms, which could require future surgery
NONSURGICAL TREATMENT OPTIONS
Examples of nonsurgical treatment options for SUI include:
- Pelvic Floor Exercises: A type of exercise to strengthen the pelvic floor by contracting and relaxing the muscles that surround the opening of the urethra, vagina, and rectum. These exercises, commonly referred to as Kegel exercises, improve the muscles strength and function and may help to hold urine in the bladder longer.
- Pessary: A removable device that is inserted into the vagina against the vaginal wall and urethra to support the bladder neck. This helps reposition the urethra to reduce SUI.
- Transurethral Bulking Agents: Collagen injections around the urethra that make the space around the urethra thicker, thus helping to control urine leakage. The effects may not be permanent.
- Behavioral Modification: This includes avoiding activities that trigger episodes of leaking.
SURGICAL TREATMENT OPTIONS
Surgical mesh in the form of a sling is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a sling procedure.
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What To Tell A Doctor When Experiencing Urinary Incontinence
When someone has urinary incontinence, it is best to take note of the following to tell the doctor about the symptoms they are experiencing. This includes but is not limited to:
- How often and what times they urinate throughout the day
- How much they urinate
- A description and frequency of their accidents;
- The types of drinks and foods they consume
Path To Improved Health
Ask your doctor about starting a bladder training program. He or she may ask you to keep a diary. You can use the diary to record how much and how often you urinate. This information will help your doctor create a plan thats right for you.
Three bladder training methods are listed below. Your doctor may recommend 1 or more of these methods to help control your incontinence.
Keep in mind it may take 3 to 12 weeks of bladder training to see results. During your training program, your doctor may have you keep track of the number of urine leaks you have each day. This will help you and your doctor see if bladder training is helping. Dont be discouraged if you dont see immediate results or if you still experience some incontinence.
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What Are Signs Of Urinary Incontinence In Older Adults
Common tell-tale signs of urinary incontinence in the elderly include:;
- Leaking urine when laughing, coughing, lifting objects, or partaking in physical activities
- Inability to hold urine or bowel movements and soiling ones undergarments
- Experiencing a complete lack of both bladder and bowel control;
What Is Bowel Incontinence
Bowel incontinence is when youâre not able to control your bowel movements. Its a common problem, especially among older adults, and ranges from irregular stool leaks while passing gas to a total loss of control of your bowels.
Accidental bowel leakage isnât usually a serious medical problem. But it can dramatically interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.
Many effective treatments can help people with bowel incontinence. These include:
Talking to your doctor is the first step toward freedom from bowel incontinence.
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Treating An Overactive Bladder
How Is Incontinence Diagnosed
Often, the diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:
- How often do you urinate?
- Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
- How long have you been experiencing incontinence?
These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, its important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.
There are also several specific tests that your provider might do to diagnose incontinence, including:
While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. Youll then bring this journal with you to your appointment and talk about it with your provider.
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Tip 4 Pack An Accident Bag To Prepare Ahead Of Unexpected Urine Leakage
Being prepared in advance can help many people overcome the stress and anxiety of wondering when the next accident may occur. If youre traveling, visiting friends, or going out, having a small bag with some essential items packed can be a great tool to lower stress and help in case of bladder leakage.
So what should your accident bag contain? It can consist of anything you feel you need to clean up and feel fresh before or after urine leakage due to urinary incontinence.
However, here are some helpful ideas for packing your accident bag:
- Personal wipes
- Several pairs of Attends or your favorite brand of incontinence adult briefs
- An extra pair of pants
- A few extra pairs of underwear
- Your favorite fragrance to spray if youre concerned about the smell of urinary incontinence
How Can You Support The Elderly Who Have Urinary Problems
First and foremost, it is important to check with their healthcare provider to determine if there is an underlying medical condition resulting in incontinence. Seeing a primary care doctor, geriatrician, nurse practitioner, or urinary specialist may help improve their quality of life. If they are experiencing symptoms of incontinence, it is recommended for them to get a physical examination and to see if there are any treatment options available. Once a diagnosis has been made, learning more about incontinence and ways to cope are great ways to help support them.
If they do not want to see a healthcare professional, be sure to make sure they can access the bathroom easily to avoid slips and falls. Some seniors may not want to see a doctor and instead try to remedy their incontinence by using adult diapers or disposable bed pads for elderly. Using absorbent pads and washable underwear can help absorb leaks and prevent slip-and-fall accidents.
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How Is It Treated
Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. After your doctor knows what has caused the incontinence, your treatment may include medicines, simple exercises, or both. A few men need surgery, but most do not.
There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.
- Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And dont drink more than one alcoholic drink a day.
- Eat foods high in fibre to help avoid constipation.
- Dont smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
- Stay at a healthy weight.
- Try simple pelvic-floor exercises like Kegels.
- Go to the bathroom at several set times each day, and wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
- When you urinate, practice double voiding. This means going as much as you can, relaxing for a moment, and then going again.
- Keep track of your symptoms and any leaking of urine with a bladder diary. This can help you and your doctor find the best treatment for you.
If you have symptoms of urinary incontinence, dont be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.
Maintain A Healthy Weight
Its important to maintain a healthy weight to deal with the problem of incontinence. If you are overweight, it can weaken the pelvic muscles of the body and create added pressure on the fatty tissues. This allows urine to leak out when you laugh, sneeze and cough. Losing weight will provide effective relief from the problem.
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Daily Pelvic Floor Exercises
These can be really effective at reducing leakage, but it’s important to do the exercises properly.
You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet. To strengthen your pelvic floor muscles, sit comfortably and squeeze the muscles 10 to 15 times in a row. Avoid holding your breath, or tightening your stomach, buttock, or thigh muscles at the same time.
When you get used to doing pelvic floor exercises, you can try holding each squeeze for a few seconds. Every week, you can add more squeezes, but be careful not to overdo it, and always have a rest in between sets of squeezes.
You may have to do these exercises for 3 months before you see any benefits.
Pelvic floor exercises are most effective when tailored to the person. Continence and women’s health or pelvic floor physiotherapists can assess your pelvic floor function and design an exercise program to meet your needs. Ask your GP for a referral.
The Continence Foundation of Australia has produced this video on how to do pelvic floor exercises:
The Continence Foundation of Australia has produced these videos to help explain the function and role of the pelvic floor muscles:
What Steps Can I Take At Home To Treat Urinary Incontinence
Your doctor or nurse may suggest some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:
You can also buy pads or protective underwear while you take other steps to treat urinary incontinence. These are sold in many stores that also sell feminine hygiene products like tampons and pads.
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Clinical Management Of Urinary Incontinence In Women
This is a corrected version of the article that appeared in print.
LAUREN HERSH, MD, and BROOKE SALZMAN, MD, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Am Fam Physician.;2013;May;1;87:634-640.
;Patient information: A handout on this topic is available at .
Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide. 1 Estimations of prevalence range from 3 to 55 percent, depending on the definition and the population.2 Within nursing homes, 60 to 70 percent of patients experience the disorder.3 These estimates are thought to be conservative, because at least one-half of patients do not report incontinence to a physician.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
|Clinical recommendation||Evidence rating||References|
Pharmacologic interventions should be used as an adjunct to behavioral therapies for refractory urge incontinence.
Surgical therapy should be considered in women with stress incontinence that has not responded to less invasive treatment modalities.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
Classification of Urinary Incontinence in Women
What Can You Do To Relieve Urinary Incontinence
Urinary incontinence almost never goes away on its own. But there are steps you can take to help relieve your symptoms.
“Alleviating urinary incontinence starts with understanding which type of incontinence you’re experiencing and what’s causing it,” says Dr. Lindo. “A specialist such as a urogynecologist can help provide those answers for you, as well as help you understand which behavior modifications and other treatments will be most effective for alleviating your incontinence.”
Weight loss almost always helps relieve urinary incontinence because it reduces the amount of pressure being placed on your pelvic floor. In fact, losing just 5 percent of your weight can improve your urinary symptoms by up to 70 percent.
Similarly, pelvic floor exercises, such as Kegels, can help reduce symptoms of either type of incontinence. In the case of stress incontinence, pelvic floor exercises are a way to restrengthen your weakened muscles. For urge incontinence, these exercises can help calm and retrain your bladder.
“For women experiencing stress incontinence after childbirth, sometimes weight loss and postnatal pelvic floor exercises are all it takes for symptoms to resolve over time,” adds Dr. Lindo.
Depending on the type of incontinence you’re experiencing, your doctor may suggest trying additional modifications.
Behavioral modifications for stress incontinence:
- Weight loss
- The use of a vaginal insert, such as a tampon, while exercising
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