Urinary incontinence is one of those “unmentionables” that we just don’t talk about. Many women experience it but often feel alone in their suffering. It may be surrounded by feelings of shame or a thought that this is just something they need to put up with and live with. As a result, many women keep it a secret, and avoid bringing it up with their spouse, family or even their doctor.
Urinary Incontinence is Very Common!
I was asked by a patient a few years ago to give a talk to her women’s group about this very topic. She was shocked, when her girlfriends did open up to one another, just how many of them were experiencing symptoms of urinary incontinence. Those who had children noticed symptoms postpartum that never fully resolved or got progressively worse, and even those who never had children experienced symptoms that started and progressed as they aged and went through menopause.
Please remember, if this is you, you are not alone! A staggering 50 million adults in the USA experience bladder weakness associated with childbirth and aging. Sometimes this can involve bladder accidents, other times this can mean getting out of bed at night for the toilet or feeling a sense of urgency regularly throughout the day.
The Symptoms of Urinary Incontinence Can Take a Heavy Toll
Very often, a woman experiencing these symptoms may feel that her life is ruled by her bladder. It influences where she goes, how she dresses and what she wears. She may always be scanning her environment, on the look for where the nearest toilet is. These exhausting measures and the stress surrounding it can reduce her confidence to the point where she may become reclusive, less active and less social.
Urinary incontinence can seriously impact quality of life. It has been associated with increases in depression, anxiety, and work impairment. Sexual dysfunction is common as well--coital incontinence can affect up to 1/3 of all incontinent individuals, and fear of incontinence during sexual activity also contributes to dysfunction. Urinary incontinence can lead to perineal infections including candida from moisture and skin irritation. There’s even an increase in risk of falls and fractures related to the need to rush to the bathroom.
There Are Several Different Types of Incontinence
There are four basic types of incontinence in women I’ll explain below. Do any of these sound familiar to you?
- Urge incontinence, also called overactive bladder. In this scenario a woman feels an urgent need to pass urine and she may not be able to make it to the toilet in time. Even if an accident doesn’t occur, it can cause a frequent need to pass small amounts of urine, even when the bladder isn’t full. This can also happen at night, causing frequent waking and interrupting sleep. It is called “overactive bladder” because the muscle in the bladder, known as the detrusor muscle, is “overactive” and contracts more often than normal.
- Stress incontinence. In this scenario there is a leakage of urine during movements or activities that put pressure on the bladder. Any activity that increases abdominal pressure also puts pressure on the bladder, so exercise or high impact activities (jumping, running, heavy lifting) or coughing, sneezing, or laughing can often be triggers.
- Mixed incontinence. In this scenario symptoms of both stress and urge types of incontinence are present.
- Overflow incontinence. In this scenario leakage occurs when the quantity of urine produced exceeds the bladder's ability to hold it. Additionally in this scenario the bladder may have been overstretched at some point resulting in a bladder muscle that is too weak, like a deflated balloon, and never fully empties when you urinate. This may be the result of the urethra being pinched (as can happen during childbirth) and causing the bladder to become too full, leading to difficulty voiding later on, or frequent or constant dribbling of urine from the residual urine that doesn’t empty completely.
What Causes Urinary Incontinence?
There are a number of factors that can contribute to incontinence—some more common than others.
If you have been pregnant, this can cause incontinence. As the belly grows and gains the weight of the developing child it increases intra-abdominal pressure and makes stress incontinence more likely. Stretching of the abdominal wall and pelvic floor muscles can also cause the uterus and other organs to prolapse, increasing the risk of incontinence.
Especially during a vaginal delivery, our pelvic floor muscles and nerves can become stretched and damaged and as a result they may not contract fully or in sync with each other. Factors that increase this likelihood include having a larger baby, longer labor, longer pushing phase and interventions such as an episiotomy or forceps. The risk also increases if you were older at the time of delivery and with the number of births you have had.
Factors work against us as we age, increasing our predisposition for incontinence.
The mucosal lining of our urethra thins, reducing the ability to seal and prevent urine leakage; the volume and pressure that our bladder can withstand decreases; our muscles start to deteriorate and weaken (especially our pelvic floor muscles that support the bladder and our urethral tube).
We also see genitourinary tissue changes in menopause as estrogen levels decrease, reducing the plumpness, elasticity, and health of our tissues. These tissue changes can aggravate incontinence.
Additionally, excess body weight, certain food and drink choices, lifestyle factors such as smoking, medications, and conditions such as diabetes, multiple sclerosis, stroke, dementia and depression--as well as surgeries such as a hysterectomy--can be contributing factors so it is best to look at all factors when addressing the cause or causes for you.
Now that we’ve discussed the most common types and causes of urinary incontinence in women, you may be in a better position to identify what kind of treatment is best suited for you. I’ve outlined the treatments for incontinence in this article to help you find solutions that can work for you!