Is it a big problem?

Fortunately, for most, incontinence is no more than a temporary problem. A few weeks after giving birth, the scars are healed, and all the muscles in the area have regained their normal tone. But childbirth is just the first of several onslaughts that make women particularly vulnerable to urinary incontinence - it's more than twice as common in women than men).

Causes of urinary incontinence

The body normally relies on a sophisticated system, which combines nervous control (from both the brain and bladder) with structural design, to make passing urine a subtle subconscious action.

There are several ways in which this control can be upset. For example, multiple sclerosis, Alzheimer's disease, stroke, Parkinson's disease, brain tumours and pelvic surgery, can all harm bladder nerves or muscles. But childbirth remains one of the main risk factors.

One of the most controversial childbirth factors is whether the risk of urinary incontinence is increased by an episiotomy (a cut made in the tissues of the birth canal to allow easier passage of the baby). The latest evidence seems to suggest that episiotomies do not significantly increase the risk of urinary incontinence.

External factors can affect bladder control. For example, many medicines interfere with the function of the urinary tract.

Several types of urinary incontinence

Because the control of urine flow involves several elements, there are a variety of ways it can go wrong. Six different types of urinary incontinence are recognised - stress, urge, mixed, neurogenic, overflow and post-prostatectomy incontinence. The treatment you need will depend on which type of incontinence you have.

Menopause

The menopause, with its loss of female hormones, leaves many women vulnerable. Oestrogens are essential for helping the tissues keep their strength and elasticity. When levels fall, so delicate body tissues become dry and thin, and muscles more lax. As pelvic floor muscles support your bladder and help to keep the exit tube (urethra) tightly shut, a leaky bladder can be the result.

Although urinary incontinence becomes more common with age, it's not inevitable.

Avoiding surgery

  • Pelvic floor exercises are a simple way to improve bladder control, especially in stress incontinence (one much-used technique is called Kegel exercises). But you must practise them regularly and intensively for good effect. Ask physiotherapists about pelvic floor exercises or try vaginal cones (from any large chemist). These are special weights that you practise holding in your vagina to teach the pelvic floor muscles to contract.
  • Bladder training: there are many different techniques, such as emptying your bladder at fixed intervals (part of what's known as "bladder drill"), which may show improvements in as little as a week.
  • Oestrogens: hormone replacement therapy can be taken as tablets, patches or creams, and has been shown to significantly improve symptoms, especially in stress and urge incontinence.
  • Other drugs, which help to stimulate the nerves that control urine flow - or which tone up the bladder muscles, may be as effective as pelvic floor exercises.
  • Electrical stimulation of the pelvic floor may be effective therapy, both for stress incontinence and urge incontinence. In one study about one-third of the patients were cured or substantially improved.

Surgery

Surgery for urinary incontinence should be held back as a last choice; only to be used after other treatments have been tried. Many surgical options, such as pulling a drooping bladder up into a more normal position, have good success rates. Occasionally, an artificial sphincter (a doughnut-shaped sac that circles the urethra) is put into place.

 
 
 
 
By Dr_Trisha-Macnair 01/29/2016 14:36:00

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