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Overcoming Urinary Incontinence
A Woman's Guide to Treatment
By Michael H. Safir, Clay N. Boyd, Tony E. Pinson, Jack Kusler
Addicus Books, Inc.Copyright © 2008 Michael H. Safir, M.D., Clay N. Boyd, M.D., and Tony E. Pinson, M.D.
All rights reserved.
Are you frustrated because you can't always control when you urinate? When you cough or sneeze, are you worried that urine might leak out? When you feel the urge to urinate, are you afraid you won't make it to the bathroom in time? If so, you aren't alone. Urinary incontinence is a common problem for millions of women. However, like many of these women, you may be too embarrassed to talk about it or even admit that you have a problem. In fact, you may feel that incontinence is something you just have to deal with. But it isn't! The more you understand about incontinence, the more you'll realize that it isn't considered normal and it isn't something you have to tolerate.
Incontinence is simply the involuntary loss of urine. The amount of urine that leaks out and the frequency with which leakage occurs can vary greatly from woman to woman. You may dribble a few drops of urine, or you may experience uncontrollable wetting. You may experience leakage only occasionally, or you may find that it's become an everyday occurrence. No matter where you fall in this spectrum, the loss of urine is a problem that should be addressed.
The Female Urinary System
The urinary system processes your body's liquid waste by creating, storing, and eliminating urine. The system consists of the kidneys, the ureters, the bladder, the urethra, the urethral sphincter, and the pelvic floor muscles.
When the system is working normally, the kidneys filter the body's liquids to create urine. The urine flows from the kidneys through two tubes called ureters that connect the kidneys to the bladder. The bladder stores the urine until you are ready to urinate. The urethral sphincter muscle is normally closed tightly to keep urine in the bladder until you are ready to urinate. The urethra is a short tube that carries the urine out of the body.
When you urinate, muscles in the bladder contract or tighten, forcing the urine out of the bladder. At the same time, the urethral sphincter and the pelvic floor muscles relax, causing the urethra to open to allow urine to flow through it. When your urinary system is working properly, you can delay urination when a bathroom isn't nearby. When you feel the urge to urinate but can't get to the bathroom, your pelvic floor muscles tighten to keep the urethra closed.
Normal urination also involves the nervous system. When your bladder is almost full, sacral nerves send a signal to your brain to alert you that it is time to urinate. Typically, the nerves send a signal before the bladder is completely full, giving you time to get to the bathroom while the bladder continues to fill.
Types of Urinary Incontinence
You may be surprised to discover that there are five types of urinary incontinence. Leakage is a symptom that is associated with all types of urinary incontinence. However, the things that trigger the leakage and the kind of leakage you experience (a few drops, a constant dribble, or the complete emptying of your bladder) depend on which type of incontinence you have. In some cases, you may experience more than one type of incontinence. The five different types of incontinence are: stress incontinence, urge incontinence/overactive bladder, overflow incontinence, functional incontinence, and mixed incontinence.
If you have stress incontinence, you may leak urine when you cough, sneeze, laugh, exercise, get up from sitting, or lift something heavy. The most common type of incontinence women experience, stress incontinence doesn't have anything to do with emotional stress. Its name comes from the fact that these activities put increased intra-abdominal pressure — or stress — on the bladder and the urethra. When you cough or sneeze, it's as if someone were squeezing your bladder from the inside. If the urethra doesn't close tightly enough to keep urine in the bladder when these pressures occur, urine leaks out.
Urge Incontinence and Overactive Bladder
If you feel sudden, overwhelming urges to urinate, you may have urge incontinence. With urge incontinence, the feeling that you need to urinate comes on so suddenly, you may have only a matter of seconds before your bladder empties uncontrollably. Unfortunately, you simply don't always have enough time to get to the bathroom before an accident occurs.
Urge incontinence may be triggered when you get up from a chair or when you drink even a small amount of liquid. It can also be triggered by what is referred to as the "key-in-the-lock" syndrome. This occurs when you experience an overwhelming urge to urinate when you start to open the door upon arriving home. It's the anticipation of being able to relieve yourself once you arrive home that brings on the uncontrollable urge the second you put that key in the lock. In some instances, the simple act of putting your hands under running water or even just hearing running water may spark the urge to urinate.
If you feel the urge to urinate frequently, perhaps even as often as once every hour during the day, this is called overactive bladder or urinary frequency. With overactive bladder, you feel the need to urinate even though your bladder isn't full. In fact, you may only eliminate small amounts of urine with each trip to the bathroom. With overactive bladder, you may also wake up several times a night feeling like you have to go. This is called nocturia.
If you drip urine constantly, you may have overflow incontinence. With overflow incontinence, your bladder never completely empties. This leads to an accumulation of urine in the bladder. When the amount of urine exceeds the bladder's capacity, the extra urine — the overflow — pushes the urethra open and leaks out. With overflow incontinence, you may feel like you need to empty your bladder but can't, or you may feel like you never fully empty your bladder when you urinate. You may find that when you try to empty your bladder, you have trouble starting or the stream of urine is weak. Overflow incontinence is the least common type of incontinence among women.
If you have normal control over your bladder but you have trouble getting to the bathroom in time or getting your clothes off in time, you may have what's known as functional incontinence. For instance, if you're elderly and the bathroom is upstairs, you may not be able to climb the stairs fast enough to prevent an accident. If you have arthritis, you may not be able to unfasten your pants or skirt quickly enough to avoid leakage. In addition, severe mental conditions, such as Alzheimer's disease, can limit the ability to react to the urge to urinate, resulting in functional incontinence.
When you experience more than one type of incontinence, it's called mixed incontinence. Mixed incontinence is fairly common among women and in most cases, involves a combination of stress and urge incontinence. In some instances, you may begin experiencing both types of incontinence at the same time. In other cases, you may develop one type first and then develop the other type later. It's common for one type to cause stronger symptoms than the other.
Common Questions about Incontinence
* Who is at risk for becoming incontinent?
Most women think that urinary incontinence is something that only older adults experience, but any woman can become incontinent. It can affect you whether you're young, middle-aged, or in your golden years. Incontinence doesn't discriminate. Women of all ethnicities and in every part of the world are at risk for developing this common condition. Likewise, you can be at risk regardless of your economic status, your education level, or your level of physical fitness.
* How common is incontinence in women?
Researchers have had a difficult time pinpointing exact numbers, but most experts agree that at least 10 million women in the United States have incontinence. Why has it been so hard to get concrete numbers? Mainly because women are so ashamed and embarrassed about the condition that they're reluctant to talk about it. Because of this, the statistics currently available are all over the map. For instance, the National Institutes of Health reports that 50 percent of all women have occasional bouts of leakage, and that about 20 percent of women over the age of seventy-five experience leakage on a daily basis. The National Kidney and Urologic Diseases Information Clearinghouse estimates that 38 percent of women over the age of sixty have incontinence. Another study indicates that 10 to 30 percent of women ages fifteen to sixty-four are affected by the condition. Still another study shows that one in four women over the age of eighteen experience the involuntary leakage of urine.
Even though estimates vary, experts agree that incontinence is far more common in women than in men. Studies report that women suffer from the condition at twice the rate as men. And no matter how many women are estimated to have incontinence, the numbers are probably higher because so many women are either too embarrassed to admit they have a problem with leakage or simply don't recognize that they have a problem.
* How many times a day does a woman normally urinate?
Over a twenty-four-hour period, you should urinate an average of five to eight times, approximately once every two to five hours. Each time you go, the stream of urine should last at least ten seconds. For most women, that amounts to about ten to fifteen ounces of urine. The average bladder can hold about twenty ounces of urine.
Certain things can cause you to urinate more frequently throughout the day. For instance, caffeinated beverages, alcohol, and certain medications can increase urine production, causing you to urinate more often. In addition, if you drink large amounts of water or other beverages, you'll likely need to urinate more often. In today's society, the accepted rule of thumb is to drink at least eight eight-ounce glasses of water a day and to drink before you feel thirsty. But these trendy notions are flawed. So how much should you drink each day? Expert opinions vary but you should aim for about four to eight eight-ounce glasses of fluid per day, and you should let thirst be your guide. Don't forget that fluids, such as the milk you put in your cereal and the broth in soups, can count toward your overall daily fluid intake.
* Is needing to urinate several times during the night considered normal?
Waking up once or twice at the most with the urge to urinate is a common occurrence and is considered normal. If you have to get up more than twice a night to urinate, you may have a problem. If you drink a lot of liquids in the evening, you're more likely to feel the urge to urinate at night. If this is the case, you may want to drink most of your liquids during the morning and afternoon and limit your fluid intake in the evening.
* Is it normal to have to push or strain to empty the bladder?
There should be no need to push or strain to empty the bladder. The stream should flow comfortably. In fact, urination shouldn't be something you have to think about. If your body is functioning normally, you typically won't even be aware of the number of times you go to the bathroom to urinate, and the mechanics involved in urination probably won't be something you think about. However, if you're conscious of how often you're going or you've noticed anything about the mechanics (pushing, straining, starting and stopping, dribbling, difficulty getting the flow started), you may have a problem.
* Does incontinence come on suddenly, or does it occur gradually?
Stress and urge incontinence tend to develop gradually and worsen over time. At first, you may leak only a few drops of urine on rare occasions. As time passes, however, you may discover that you're leaking greater amounts on a more frequent basis. Or you may initially experience urinary frequency, which makes you feel like you have to urinate more than normal, but no leakage. This can progress to urge incontinence, where your urge to urinate sometimes results in leakage. Although this gradual pattern is typical, incontinence can also occur suddenly. For example, temporary incontinence is more likely to occur suddenly.
* Is incontinence a temporary problem or is it a permanent condition?
In some cases, incontinence is a temporary problem. In other instances, it is a long-term condition. Temporary incontinence, which is also called transient incontinence, is typically treatable. Persistent incontinence, which is also called established incontinence, usually doesn't go away on its own. Whether the incontinence you're experiencing is temporary or persistent depends on the underlying causes.
* Is incontinence a normal part of aging?
Many women think that urinary incontinence is a normal part of aging, but it isn't. In fact, most women over the age of sixty do not have incontinence. In most cases, incontinence can be prevented or treated, meaning you don't have to live with the fear of leakage. Even so, many women feel resigned that incontinence is a fact of life and simply tolerate it when it occurs. Instead of giving in to incontinence, speak to your family doctor, primary care physician, or gynecologist to gain an understanding of what is and isn't normal. If needed, one of these physicians can refer you to an incontinence specialist.
* Does incontinence lead to other physical problems?
Leakage and sudden urges to urinate may pose additional physical problems. For instance, lingering wetness can cause a urinary tract infection or skin rashes. In addition, if you're older, you may be more at risk for a fall if you're trying to rush to the bathroom when you feel a sudden urge to urinate.
* How does incontinence affect overall quality of life?
Considering that incontinence can affect your psychological well-being, your social life, your sex life, and even your career choices, it's no surprise that it can have a tremendous impact on your overall quality of life. In fact, according to studies about how certain diseases and conditions affect your quality of life, incontinence ranks as one of the most devastating.
* Is one's work life affected by incontinence?
Incontinence can affect every aspect of your life, even your career. Having to urinate frequently or rush to the bathroom when you feel a sudden urge or when you have an accident can be disruptive to your job. In addition, incontinence may play a role in your career choices. For instance, you may pass up promotions or new job opportunities that would require you to travel. Or you may choose a job based on the fact that you'll have easy access to a bathroom. These concerns can prevent you from being successful at and getting ahead in your career.
* How does incontinence affect one's social life?
The inability to control your bladder can have a negative impact on your social life. If you're like many women with incontinence, you may avoid social situations because you're afraid you'll leak. You may find yourself mapping out your day's activities according to where you can find public bathrooms. You may have to tote around pads or a change of clothes in case of an accident. You may no longer want to go to events where you might have to wait in line to use the restroom. You may stop exercising or you might even try to refrain from laughing in an effort to avoid leakage. You may start avoiding any trips that take you away from the house for more than a short period of time. If you're on the dating scene, the fear of leakage can greatly inhibit your willingness to go out on dates or meet new people. This kind of social withdrawal can dramatically affect your relationships with friends and family.
* What is the effect of incontinence on one's sex life?
Unexpected leaking during intercourse can be a traumatic experience. Likewise, feeling the urge to urinate during intercourse can put a damper on sexual intimacy. If you leak during sexual relations, or even if you're just afraid that you might leak, you may choose to avoid intimacy with your partner.
Excerpted from Overcoming Urinary Incontinence by Michael H. Safir, Clay N. Boyd, Tony E. Pinson, Jack Kusler. Copyright © 2008 Michael H. Safir, M.D., Clay N. Boyd, M.D., and Tony E. Pinson, M.D.. Excerpted by permission of Addicus Books, Inc..
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