What Causes Stress Incontinence In Females

Types Of Incontinence Among Women

The type of urine leakage that women may experience can be described as follows:

• Overflow incontinence. This incontinence denotes a bladder that does not empty out all urine, thus prompting occasional leaking in a small volume.
• Stress incontinence. When the bladder experiences physical stress or exertion, some leakage may occur. Examples of external pressure on the bladder include exercising, sneezing and coughing. Even prolonged bouts of raucous laughter can cause accidental urination.

• Urge incontinence. This one of the most common types of incontinence, and it can be related to urinary tract infections or sexually transmitted diseases. Patients often feel as if they have an uncontrollable urge to urinate, and it can be intense to the point of the accidental evacuation of the bladder. Some diabetic patients are known to suffer from urge incontinence, but there may also be issues related to neurological disorders.

Types Of Urinary Incontinence

There are two main types of urinary incontinence in women.

• Urge incontinence. This is when you feel a sudden need to pee without warning which is difficult to put off. You have to go to the toilet then and there.
• Stress incontinence. This is when urine leaks when you sneeze, cough or exert yourself.

You can also have mixed incontinence. This means you have both stress incontinence and urge incontinence.

An overactive bladder is when you get a strong urge to pee often, including at night. It sometimes, but not always, leads to urge incontinence.

What Are The Types Of Urinary Incontinence

More than half of people with stress incontinence also have urge incontinence. Having both stress and urge incontinence is known as mixed incontinence. An overactive bladder causes urge incontinence. This type of urinary incontinence causes you to leak urine when you feel an urgent need to pee.

Overflow incontinence is a different type of urinary incontinence. It causes you to leak urine because your bladder is too full or you cant completely empty it.

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Is Stress Contributing To Your Incontinence

As you may already know, incontinence is really common. Approximately 15 million American women deal with urinary incontinence. And about 24% of women over 40 have experienced fecal incontinence at least once in the past year, too.

But, just because incontinence is common doesnt take away the embarrassment. The sheer thought of an unexpected leak is stressful. Plus, research shows that stress and incontinence are closely intertwined. But do stress, anxiety, and other mental health issues cause incontinence? Or does incontinence negatively impact our mental health? With 1 in 5 American adults, or 43.8 million people, experiencing mental health issues every year, you just might want to stick around to find out.

Why Have I Suddenly Become Incontinent

Its possible youve had mild symptoms for a while. Over time, symptoms from an overactive bladder can get worse and become more noticeable. If your incontinence came on after a recent medical procedure, injury or the start of a new medication, contact your healthcare provider. A nerve injury or another problem may be causing the incontinence.

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How Is Urinary Incontinence Diagnosed

For people with urinary incontinence, it is important to consult a health care provider. In many cases, patients will then be referred to an urogynecologist or urologist, a doctor who specializes in diseases of the urinary tract. Urinary incontinence is diagnosed with a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples.

What Are Urge Incontinence Symptoms

An urgent, uncontrollable need to pee is the top sign of urge incontinence. You may or may not leak urine. If you do have urine leaks, the amount tends to be larger than with other types of urinary incontinence.

Other signs of urge incontinence include:

• Frequent urination or nocturia .
• Leaking urine before you can make it to the bathroom or just after you peed.
• Wetting the bed at night.

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What Causes Urge Incontinence

Most people with urge incontinence have overactive bladders. Your bladder is the organ in your urinary system that holds urine.

An overactive bladder causes your muscles in your bladder to squeeze more often than they should. This makes you feel like you have to pee before your bladder is actually full.

The squeezed bladder also causes your sphincter muscle inside your urethra to relax. When this muscle opens, it lets urine leak out.

Strengthening The Pelvic Floor Muscles

It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on the exercises. They may ask you to do a pelvic floor exercise while they examine you internally, to make sure you are doing them correctly. The sort of exercises are as follows:

Learning to exercise the correct muscles

• Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your back passage . You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don’t move your buttocks or legs.
• Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise . These are the ones to strengthen.
• If you are not sure that you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise. Another way to check that you are doing the exercises correctly is to use a mirror. The area between your vagina and your anus will move away from the mirror when you squeeze.
• The first few times you try these exercises, you may find it easier to do them lying down.

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What You Can Do

Its easy for someone on the outside to say just dont worry, right? However, this is definitely one of those things thats easier said than done. If you have significant anxiety or depression, please give your doctor a call. For the more common daily stressors in all of our lives, there are things you can do to help you worry less and hopefully decrease leaks too.

One option is to use absorbent products, so that the only person that knows you leaked is you. NAFC recently conducted a study that found that those who felt positively about wearing absorbent products said it was because it made them feel more protected and in control. And who doesnt want to feel more in control? Plus, Lily Bird can help take the stress out of going to the store by delivering pads and disposable underwear straight to your door.

Dont forget about trying pilates to doing Kegels or making dietary changes to see if that helps with incontinence or stress, too. Whether your stress is a symptom or a cause, getting it under control can help no matter what situation youre in.

~Written by Lily Bird, a proud Trusted Partner of NAFC

Some General Lifestyle Measures Which May Help

• Your GP may refer you to the local continence adviser. Continence advisors can give advice on treatments, especially pelvic floor exercises. If incontinence remains a problem, they can also give lots of advice on how to cope. Examples include the supply of various appliances and aids such as incontinence pads, etc.
• Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
• Obesity. Stress incontinence is more common in women who are obese. Weight loss is advised in those who are overweight or obese. It has been shown that losing a modest amount of weight can improve urinary incontinence in overweight and obese women. Even just 5-10% weight loss can help symptoms.
• Smoking can cause cough which can aggravate symptoms of incontinence. It would help not to smoke.

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Urinary Incontinence In Women Facts

*Urinary incontinence in women facts medical author: Melissa Conrad Stöppler, MD

• The definition of urinary incontinence in women is the unintentional loss of urine.
• Urinary incontinence occurs more often in women than in men. Pregnancy, childbirth, and menopause may contribute to urinary incontinence in women.
• Weak bladder muscles, overactive bladder muscles, and nerve damage may also cause urinary incontinence in women.
• Urinary incontinence in women is common and treatable.
• There are different types of urinary incontinence in women, including stress incontinence, urge incontinence, overactive bladder, functional incontinence, overflow incontinence, mixed incontinence, and transient incontinence.
• Diagnosis of urinary incontinence in women may involve a physical exam, an ultrasound, urodynamic testing, and tests including cystoscopy, urinalysis, and a bladder stress test. The doctor will also take a medical history and may recommend keeping a bladder diary.
• Treatment of urinary incontinence in women may include behavioral or nonpharmacologic treatments, like bladder training and Kegel exercises, medication, biofeedback, neuromodulation, surgery, catheterization, or a combination of these therapies.
• Research is ongoing to discover new and better treatments for urinary incontinence in women.

Causes Of Stress Incontinence

Stress incontinence is the most common occurring form of incontinence in women under the age of 60 and accounts for more than half the cases. As weve mentioned, anything that creates pressure on the pelvic floor muscles and your bladder may cause urine leakage.

While pregnancy and childbirth head the list for causes of stress incontinence, there are other health factors that may put you at risk, too. They include:

• Loss of pelvic muscle tone. This can often occur with aging or childbirth, although people of all ages can develop SUI.

• Hysterectomy

• Nerve and muscle damage from childbirth or surgical trauma

• Obesity

• Repeated heavy lifting or high impact sports

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What Are The Symptoms Of Urinary Incontinence

The following are common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:

• Needing to rush to the restroom and/or losing urine if you do not get to the restroom in time

• Urine leakage with movements or exercise

• Leakage of urine that prevents activities

• Urine leakage with coughing, sneezing or laughing

• Leakage of urine that began or continued after surgery

• Leakage of urine that causes embarrassment

• Constant feeling of wetness without sensation of urine leakage

• Feeling of incomplete bladder emptying

The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

7 Things You Should Always Discuss with Your Gynecologist

When it comes to sexual and reproductive health, it can be hard to know whats normal and what may be a sign of a potential health problem. Even if you feel embarrassed about certain issues, your gynecologist has seen and heard it all and is there to help you, not to pass judgment.

Seeking Professional Advice Is The First Step

In many cases incontinence can be prevented, better managed and even cured. Talk to your doctor, a continence health professional or contact the National Continence Helpline on .

The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.

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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.

What Are Stress Incontinence Symptoms

Leaking urine when theres pressure on your bladder is the top sign of stress incontinence. Mild stress incontinence may cause you to leak drops of urine during activities like heavy exercise, laughing, coughing or sneezing.

With moderate to severe stress incontinence, you may leak more than a tablespoon of urine even during less strenuous activities like standing up or bending over. You may even leak urine while having sex.

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Electrical And Magnetic Stimulation

Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.

Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence .39 A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.40

Prevention Of Urinary Incontinence

Being overweight, being constipated, lifting heavy weights and drinking a lot of caffeine all make incontinence more likely. So, if youre worried about incontinence, try to maintain a healthy weight, eat and drink healthily and modify the strenuous exercise you do.

You may be able to prevent incontinence during pregnancy and in the first few months afterwards by doing pelvic floor exercises while youre pregnant. Ask your midwife for more information.

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Medications For Stress Incontinence

Though millions of individuals suffer from SUI, there are no FDA-approved pharmaceutical medications to treat the condition. A couple of off-label medications that have shown to mitigate some symptoms of SUI are imipramine and pseudophedrine. Duloxetine is the only medication used to treat SUI, but it is not FDA-approved for this indication in the United States.

• Topical Estrogen. Your doctor may prescribe local, low dosage estrogen administered vaginally to gently lubricate the tissues of the vagina. Many clinicians observe improvement in symptoms of SUI in many women. This should not be confused with Hormone Replacement Therapy , which has been not proven to relieve incontinence in postmenopausal women.

How Is Urge Incontinence Diagnosed

Youll get a physical exam, which may include a pelvic exam or a rectal prostate exam. To help your healthcare provider make an accurate diagnosis, you might keep a bladder diary for two to three days, where you write down your fluid intake, bathroom use and urine leakage, including what you were doing when the leaks occurred.

Tests for urge incontinence include:

• Urinalysis to rule out infections, blood in your urine and other problems.
• Abdominal ultrasound to view your bladder, kidneys and other organs.
• Cystoscopy to examine your urinary tract.
• Urodynamic testing, including a postvoid residual urine test, to show how well your urinary system holds and releases urine.

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Mixed Incontinence In Women

There are several forms of incontinence. In urge incontinence also called overactive bladder the woman experiences loss of urine that is associated with a sudden, strong desire to urinate that can’t be postponed. In stress incontinence, increased pressure in the abdomen momentarily puts physical stress on the pelvis, resulting in urine loss. Activities such as coughing, sneezing, laughing, exercise, and even standing up can cause leakage in women with stress incontinence.

It’s common for women to experience symptoms of both urge and stress incontinence. This condition is called mixed incontinence.

Surgery For Stress Incontinence

If the less invasive treatments dont help you, your GP will refer you to a specialist to discuss surgery. The main types of surgery for stress incontinence include the following.

• Colposuspension. Your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone.
• Sling surgery. In this procedure, your surgeon will place a piece of your own tissue under your urethra. This acts as a sling to support it.
• Injections of bulking agents into the wall of the urethra. This narrows your urethra, helping it to stay closed and so hold urine in your bladder. The effects of this procedure may wear off over time. So, you may need to have further injections.
• Artificial sphincters. If youve already had surgery for stress incontinence and this hasnt worked, you may be offered an artificial urinary sphincter.

Each procedure comes with risks and benefits. Its important to discuss these with your doctor before you agree to go ahead with the procedure.

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What Is The Treatment For Urinary Incontinence

Specific treatment for urinary incontinence will be determined by your doctor based on:

• Your age, overall health and medical history

• Type of incontinence and extent of the disease

• Your tolerance for specific medications, procedures or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment may include:

• Behavioral therapies:

• Bladder training: Teaches people to resist the urge to void and gradually expand the intervals between voiding.

• Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.

Consult your doctor with questions regarding the management and treatment of urinary incontinence.

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