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INCONTINENCE DEFINING INCONTINENCE,TYPES ,CAUSES of INCONTINENCE URINE Posted: 11 Apr 2011 09:07 PM PDT WHAT IS INCONTINENCE? DEFINING Incontinence. Incontinence is the uncontrollable loss of enough urine to cause social or sanitary difficulties. When we study the body and look at how we are able to control urination, we know that an infant does not have the proper connections between their brain and their bladder to be able to control the bladder. We also know that as the brain develops, young children can be taught to have control of when and where they empty their bladders. This learned control is then maintained, usually without much thought, throughout adulthood. To a child or an adult, any loss of bladder control feels like a return to infancy and can be an embarrassment and a source of terrible discomfort. Incontinence can be a significant problem for young, middle age and older women. Life with incontinence, even mild incontinence, can become very stressful. Incontinence threatens self-image, body image and self-esteem. Concerns about having to deal with incontinence may hinder career opportunities for women in the workforce. The embarrassing loss of self-control makes a woman feel old and helpless. Outings for shopping and recreation may be planned around the availability of a bathroom. Travel to new places becomes difficult. The need to always have a change of clothes or to worry about odor is a constant concern. Or, women suffering from incontinence may stop some of the activities they enjoy altogether; they may avoid getting together with friends or family; they may avoid sexual contact; they may feel depressed. Many people consider adult incontinence a natural part of aging. It is not! The vast majority of older women do not have incontinence. Most people are not aware that young women also can have incontinence. Since incontinence is so frequently associated with aging, those younger women are even less likely to talk about it or seek treatment. The good news is that there are now many ways to treat women of all ages who have incontinence. IS ALL INCONTINENCE THE SAME? Incontinence is a symptom- the loss of urine. The two most common types of incontinence are loss of urine with laughing, coughing or sneezing, called stress incontinence, and loss of urine proceeded by a strong urge to go, called urge incontinence or overactive bladder. Sometimes a woman has both types of incontinence at the same time. This combination of incontinence is called mixed incontinence. Different types of incontinence have different causes, and different treatments solve each type of incontinence. The first step to end the incontinence is for the doctor to determine which type of incontinence you have. This starts by having you answer questions about your symptoms. Following that, there are a number of simple tests performed to help pinpoint the nature of the problem, which we will discuss in chapter 3. But first, it will be helpful to understand what the possible types of incontinence are. The chart gives brief definitions of the types of incontinence, and more detailed explanations follow. TYPES OF INCONTINENCE (CHART) * STRESS incontinence…. urine loss with some type of physical stress to the body such as with a cough, sneeze, physical activity or laughing. * URGE incontinence…. urine loss proceeded by a sense of needing to urinate before reaching the bathroom. * MIXED incontinence…. urine loss with features of both stress and urge. * OVERFLOW incontinence…. urine loss occurring when the bladder is full, but the bladder does not contract properly to push the urine out. The urine then trickles out of the over-full bladder. * TOTAL INCONTINENCE…. the constant loss of urine. WHAT HAPPENS WHEN A LAUGH, COUGH OR SNEEZE CAUSES LEAKING? You may have noticed that sometimes a loss of urine occurs as a result of a cough, sneeze, laugh or vigorous exercise. Many women with this problem, known as stress incontinence, may begin limiting their own activities for just this reason. However, coughing, sneezing and even laughing are often unavoidable. We need to laugh and exercise (and cough and sneeze) to live life to it fullest. Understanding stress incontinence is the first step to finding a solution. Stress incontinence got its name because the pressure or strain from a laugh or cough results in a loss of urine. The bladder and urethra are normally held firmly in place by muscles and connecting tissue in the pelvis (see figure 1-1). When you cough, pressure increases inside your abdomen, and the pressure pushes on your bladder and urethra. If the supporting pelvic muscles or connecting tissues have been damaged or weakened, they may not be able to withstand the force of the cough. The pressure then forces the urethra to open, and urine leaks out. (fig 1-2) Many activities that you ordinarily wouldn’t even think about can cause increased pressure in the abdomen and the bladder. A cough, a strain to lift a heavy piece of luggage, aerobic exercise, or even a hiccup can challenge a woman with this problem. WHAT CAUSES STRESS INCONTINENCE? As we discuss in chapter 4, pregnancy and childbirth can damage the pelvic ligaments that anchor the uterus and bladder to the bones of the pelvis. The muscles that support the bladder work differently than most other muscles. Other muscles in your body usually relax until you ask them to do something for you, like lift a fork or bend at the waist. However, the pelvic muscles are always contracted, so they can continually hold up the bladder, uterus and the intestines. If these muscles, and the connecting tissue that attaches the muscles to the pelvic bones, get stretched or damaged, as may happen during childbirth, they become less effective at holding things up. As a consequence, the urethra may be pushed out of position as a result of a cough, sneeze or strenuous activity because the muscle support cannot withstand the extra pressure. The nerves sending messages from the brain to the pelvic muscles may also be altered due to childbirth. In the birth canal, the baby’s head puts pressure on these nerves. Prolonged pressure, or undue pressure because of the size of the baby’s head, may damage these nerves so they cannot send signals properly to the supporting muscles. As a result, the muscles may not be able to hold the bladder up. Other factors also cause an increased pressure on the pelvic organs that probably contributes to incontinence. A family history of incontinence may be an important factor since the amount and strength of the collagen that makes up the supporting tissue is inherited. Smoking can decrease the amount of oxygen the muscles and ligaments get and thereby lead to weakened tissues. In addition, smokers often cough, and every cough pushes against the bladder and pelvic ligaments and, over time, may weaken them. If a woman is overweight, extra pressure is added to an already weakened system and may aggravate the problem of leakage. Chronic constipation that causes straining to pass a bowel movement also increases abdominal pressure and can weaken the support of the bladder and pelvic organs. In some women, hormonal changes that occur with menopause can cause thinning of the tissues and blood vessels of the urethra. Try to visualize the urethra as a tube – if you were to cut across it, the cross section would look like a donut. With declining estrogen levels, the walls of this tube shrink, which results in a larger hole. The larger the opening, the more difficult it is for the muscles to seal. If the urethra is not closed, urine can leak out. (see fig 1-3) Any one or more of these factors- stretched pelvic muscles, excess body weight, damaged nerves, or thinning of the urethra – may lead to stress incontinence. As you will see in later chapters, treatment for this type of incontinence involves strengthening the pelvic muscles or repairing the supporting tissues to the bladder and urethra. WHAT IF YOU HAVE THE URGE TO URINATE FREQUENTLY? Urgency is the sense that you have to urinate right now. When you gotta go, you gotta go. A constant urge to empty the bladder and all the necessary trips to the bathroom can be disabling to many women. They do not necessarily leak urine, but their lives are nevertheless taken over by their bladder problems. Urgency is basically the result of the bladder misbehaving, of the bladder being over-active. In fact, the term overactive bladder is now frequently used instead of urgency. Instead of quietly collecting urine, the bladder is constantly making a nuisance of itself. This is perceived as ever-present bladder pressure. The bladder feels as if it is always full, but, in fact, most trips to the toilet produce no more than a few ounces of urine. Some women may note urgency during the night that repeatedly wakes them. Urgency and frequency are frustrating problems. Many women suffer in silence because they do not realize that, thankfully, there are many solutions to their problem. These include taking prescription medication, learning to urinate on a schedule or doing muscle exercises that can help reduce spasms. Simple dietary changes may also help reduce frequency and urgency. These non-surgical treatments and others are fully discussed in chapter 5. HOW COMMON IS URGENCY? Urgency is one area where age does seem to make a difference. About 6% of women under 40 have symptoms of urgency, and about 10% of women have this symptom prior to menopause. By the time women reach their late 50s and early 60s, about 40% will have urgency. And, by the time women reach their eighties, nearly 80% have this problem. About 40% of women who develop urgency also have urge incontinence, meaning urgency to the degree that they may actually lose urine. WHAT CAUSES A STRONG URGE TO URINATE? The most common temporary cause of having a strong urge to urinate is a bladder infection. The infection causes irritation of the bladder lining that leads to spasms of the bladder muscle. However, the bladder irritation and urgency goes away once the infection is treated with antibiotics. Only rarely will a bladder infection lead to such severe urgency that incontinence results. If treated, these infections have no permanent effect on your bladder. source INCONTINENCE DEFINING INCONTINENCE,TYPES ,CAUSES of INCONTINENCE URINE

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