Women's Sexual Health > Female Incontinence
- Written by Dr. Myron Murdock, Vibrance Medical Director
Incontinence is the involuntary loss of urine and is a common problem in women. It is unfortunately one of the "secret problems" that women do not talk about because it is embarrassing and many think that the problem cannot be solved. Fortunately, the vast majority of women with incontinence can be successfully treated and many, cured.
Incontinence can be a life-altering sentence to women and has spawned a billion dollar a year incontinence pad business. Many women stay at home, or refuse to socialize for fear of embarrassment. There are several different categories of incontinence: stress incontinence, urge incontinence, mixed incontinence and total incontinence.
Causes of Incontinence involve several different components: the pressure in the bladder, the nerves that activate and relax the bladder and the sphincter, (valve), muscles, and the sphincters themselves. Dysfunction at one or several of the points results in the different types of incontinence.
Stress Incontinence occurs associated with raising the pressure inside the abdomen by coughing, sneezing, laughing, straining or lifting or sudden movements. It is very common in women, and sometimes occurs in men after prostate surgery. Stress incontinence is caused by a decrease or loss in the sphincter, or control valve in the urethra and bladder neck.
It may be minimal, a drop or two on a rare occasion, moderate, requiring changing underwear two or three times a day, or wearing a mini pad, or severe, requiring several large pads a day. It is frequently ignored because: it is mild, "it happens as women age", "there is nothing that can be done about it", or it is too embarrassing to talk about. The vast majority of patients (men and women) can be cured.
The female urinary system sits in a precarious position, just in front of the vagina. As a result, it has poor support, only the vaginal wall. In addition it is subjected to repeated trauma as a result of sex, births, and weakening of the tissues as women go through menopause and lose the strength imparted to the pelvic tissues by female hormones. As a result, the bladder and urethra "fall", leading to shortening and widening of the urethra.
Although the mechanism of continence or control of urine is very complex, the major component can easily be visualized as an old fashioned "finger trap", made of muscle, rather than straw. In the normal anatomy, the urethra is fixed at both ends, so when the muscles contract, the urethra narrows shutting off flow of urine. When the bladder has "fallen" the upper end of the urethra is no longer fixed, so when the muscles contract, the urethra becomes shorter and wider, allowing urine to leak, especially with coughing or other forms of straining.
A second, more minor component to urinary control is the voluntary sphincter or valve muscles of the pelvic floor. These surround the urethra, vagina and rectum, and are the muscles used to "hold back" urine on a voluntary basis.
Sometimes, the bladder has unusually high pressures due to nerve or bladder muscle dysfunction. In this situation, what is an adequate valve mechanism may be overpowered. The treatment of stress incontinence is based on evaluating and treating these factors.
Urge Incontinence is present when there are sudden urges to urinate that the patient cannot control, the "mad dash syndrome". It can be related to changes in position, such as standing up, which is known as orthostatic instability, or initiated by a cough or sneeze or other movement, but different from stress incontinence in that there is not a sudden gush of urine, but a sudden urge to go. It may come on without any provocation. A frequent cause of urge incontinence is changes in the nerves activating the urinary tract, as seen in the elderly, persons with strokes, or spinal injuries or other neurological conditions. It may be associated with a " fallen bladder" in females, or occur without association to any other problem.
Mixed Incontinence is a combination of both stress and urge incontinence, and is usually caused by a combination of factors.
Total Incontinence is the continuous total loss of urine. There are many causes including holes in the bladder or pelvic scarring due to surgery, radiation or disease, or nerve damage from injury, disease or stroke.
It's easy to see where you are. And the cure and treatment is no taboo or secret to your urologist.
My mail: I am 19 years old have a problem in Urgency-Frequency. For five months I had to go to the bathroom every hour. And I had gone to a several doctors and I still have the same problem. Recently I have been taking Ditropan and I did not see any change after that. I took Novepam (Bromazepam)I have become better in the home, BUT when I go out I feel very bad and cannot stay more than one hour.
Answer: The medications you describe treat symptoms. However, it is necessary to determine the true cause of the problem. You should see an urologist to determine the cause of this urgency and frequency. Possible causes include neurological problems relating to the bladder, infection, and irritation from various causes in the bladder, prostate or urethra. An urologist would do a urine test, urine culture, a pressure volume study of the bladder (cystometrogram), a look in the bladder and urethra (cystoscopy) and possibly x-ray studies of the bladder (voiding cystogram) and/or x-ray visualization of the kidneys.
Additional resources on incontinence are available from MayoClinic.com: