Urinary leaking, also known as urinary incontinence, affects millions of women of all ages in the United States. Many women don’t mention it to their physicians, either because they are embarrassed or because they don’t think much can be done about it, or that it’s just a normal part of getting older. Many women unfortunately think it’s just a normal result of having had children. Urinary incontinence not only causes physical suffering, it causes emotional suffering and wreaks havoc with relationships and self-esteem. Women often become isolated, and participate less in many social activities.
If you or someone you know is affected, the most important thing to realize is that you are NOT ALONE. More than 25 million people in the USA are affected, and 80% are women.
Why does this affect women more than men?
Partly because their bladder neck is shorter, and so there is less of a barrier to prevent leaking, and partly because of the trauma the body experiences during pregnancy and childbirth. Childbirth trauma, and episiotomies, can cause:
- Muscle weakness of the perineum (the area between the anus and the vagina)
- Muscle weakness and spasm from injury of the deeper (levator) muscles that support and form the pelvic floor and help maintain control of bladder and bowels
- Injuries to the pelvic nerves which are responsible for maintain strong and healthy levator muscles – these are particularly common after a long of difficult delivery.
- Connective tissue and ligament tears to the pelvic floor
Unrelated to childbirth, women can also experience spasm of the bladder because of a dysfunctional nerve signal from the brain or spinal cord (overactive bladder), which affects another 33 million adults in the USA. Approximately 9 millions have accidents because they can’t make it to the bathroom.
Women who have bladder leaking have a higher risk of developing fecal incontinence (bowel control problems). There are many causes of both urinary and fecal leaking problems, and often more than one problem exist at the same time.
When should I seek help?
You should get help if you are not able to control your bladder or bowel as you once did or when the frequency or urgency to urinate is interfering with the quality of your life. Almost always, the symptoms can be controlled or at least significantly improved with an accurate diagnosis and appropriate treatment. These are MEDICAL problems, and NOT a problem you have to accept as part of having had children or getting older.
What kinds of incontinence are there?
Stress incontinence: This is an anatomical problem in which the connective tissue is not strong enough to form the “backboard” against which the urethra must close. It results in a small to medium leak with a cough, sneeze, jump, run, sudden standing, standing from a sitting position, leak after standing up from voiding, any jarring movement, lifting. It can be caused by general muscle weakness or by muscle tears. Smoking is a risk factor, as is menopause, obesity, childbirth injury, chronic cough, chronic lifting.
Urge incontinence: This is often more troubling for patients. It is an uncontrollable urge to urinate that often cannot be stopped and frequently occurs without warning. It is often accompanied by urinary frequency, and people with this problem usually know where every bathroom is in town, just in case it is needed, which it often is. The first step is to rule out infection, and bladder tumors and stones. Once those are ruled out, we are left with a diagnosis of an “overactive bladder”. This is now believed to be a pelvic nerve problem, rather than a problem of the bladder itself. Sometimes it develops after a surgery to correct stress incontinence or after a back injury. It is a treatable condition.
Mixed incontinence: A combination of the above two problems.
Overflow Incontinence: This is often a problem of voiding and emptying. The bladder doesn’t empty properly, is always a little full, and it does not take long to get to capacity and in fact “overflow” with slight changes in movement. It is sometimes a problem related to the bladder muscle not functioning properly, and sometimes a problem of the pelvic floor being too spastic and not relaxing to let the urine out.
Fecal incontinence: The “not talked about much” condition is actually very common in women, especially after childbirth. Most often it is noticed as “staining” on underwear, rather than actual incontinence of larger formed stool. It is an embarrassing condition, and often a hygiene problem which can lead to frequent bladder infections. There are both “stress incontinence” and “urge incontinence” forms of fecal incontinence, and in fact, often the equivalent of “overflow incontinence” if pelvic floor spasm and constipation are issues.
There IS help for these conditions. You can start by calling our office for an appointment. Before your appointment, we encourage you to keep a five day and fill out the following forms:
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