What Is Urinary Incontinence? What Causes Urinary Incontinence?

What is urinary incontinence in women?

Millions of women experience involuntary loss of urine called urinaryincontinence (UI). Some women may lose a few drops of urine while running orcoughing. Others may feel a strong, sudden urge to urinate just before losing alarge amount of urine. Many women experience both symptoms. UI can be slightlybothersome or totally debilitating. For some women, the risk of publicembarrassment keeps them from enjoying many activities with their family andfriends. Urine loss can also occur during sexual activity and cause tremendousemotional distress.

Women experience UI twice as often as men. Pregnancy and childbirth,menopause, and the structure of the female urinary tract account for thisdifference. But both women and men can become incontinent from neurologicinjury, birth defects, stroke, multiple sclerosis, and physical problemsassociated with aging.

Older women experience UI more often than younger women. But incontinence isnot inevitable with age. UI is a medical problem. Your doctor or nurse can helpyou find a solution. No single treatment works for everyone, but many women canfind improvement without surgery.

Incontinence occurs because of problems with muscles and nerves that help tohold or release urine. The body stores urine — water and wastes removed by thekidneys — in the bladder, a balloon-like organ. The bladder connects to theurethra, the tube through which urine leaves the body.
During urination, muscles in the wall of the bladder contract, forcing urineout of the bladder and into the urethra. At the same time, sphincter musclessurrounding the urethra relax, letting urine pass out of the body. Incontinencewill occur if your bladder muscles suddenly contract or the sphincter musclesare not strong enough to hold back urine. Urine may escape with less pressurethan usual if the muscles are damaged, causing a change in the position of thebladder. Obesity, which is associated with increased abdominal pressure, canworsen incontinence. Fortunately, weight loss can reduce its severity.

What are the signs and symptoms of urinary incontinence?

The main symptom is the release (leakage) of urine when you don’t want to.When and how this occurs will depend on the type of urinary incontinence

Stress incontinence – this is the most common kind ofurinary incontinence, especially among women who have given birth or have gonethrough the menopause. In this case stress refers to physicalpressure, rather than mental stress. When the bladder and muscles involved inurinary control are placed under sudden extra pressure the person may urinateinvoluntarily.

The following actions may trigger stress incontinence:

• A sudden cough
• Sneezing
• Laughing
• Heavy lifting
• Exercise

The amount of urine that leaks out unwillingly depends on how full thebladder is and how affected the muscles are.

Urge incontinence (effort incontinence) -, also known asreflex incontinence. This is the second most common type of urinaryincontinence. The bladder is either unstable or overactive. There is a sudden,involuntary contraction of the muscular wall of the bladder (detrusor muscles)that causes urinary urgency – an urge to urinate that cannot be stopped. Thereis an involuntary loss of urine for no apparent reason while suddenly feelingthe need or urge to urinate.

When the urge to urinate comes the person has a very short time before theurine is released regardless of what they try to do. The urge to urinate may becaused by:

• A sudden change in position
• The sound of running water (for some people)
• Sex (especially during orgasm)

People with urge incontinence tend to have to pass urine frequently;sometimes having to get up to go to the toilet during the night.

Bladder muscles can activate involuntarily because of damage to the nervesof the bladder, the nervous system, or to the muscles themselves.

Overflow incontinence – this type of urinary incontinenceis more common in men with prostate gland problems, a damaged bladder, or ablocked urethra. The enlarged prostate gland obstructs the bladder; the personoften only manages to urinate in small trickles and has to go frequently. Hemay feel that his bladder is never really completely emptied, even after tryinghard.

Put simply, overflow incontinence is an inability to empty the bladder, thepatient frequently dribbles urine. Some patients constantly dribble urine (asopposed to frequently).

Mixed incontinence – if a patient experiences both stressand urge incontinence he/she has mixed incontinence.

Functional incontinence – the person knows there is a needto urinate, but cannot make it to the bathroom in time due to a mobilityproblem. If a person has a disability they may not be able to get their pantsdown in time; this would be an example of functional incontinence. The amountof urine lost may be large. Common causes of functional incontinence include:

• Confusion
• Dementia
• Poor eyesight
• Poor mobility
• Poor dexterity (cannot unbutton pants in time)
• Depression, anxiety or anger (unwilling to go to the toilet)

People with functional incontinence may have difficulties in thinking,moving or communicating – these difficulties may prevent them from reaching atoilet.

Functional incontinence is more prevalent among elderly people, and iscommon in nursing homes.

Functional incontinence may occur when there is nothing physically wrongwith the person. If you are on a long trip and dying to urinate but there arenot toilets nearby.

Gross total incontinence – this either means the personleaks urine continuously all day and night, or has periodic uncontrollableleaking of large amounts of urine. The bladder is unable to store urine. Thepatient may have a congenital problem (was born with a defect), there may be aninjury to the spinal cord, and injury to the urinary system, or there may be afistula between the bladder and, for example the vagina.