Pregnancy, childbirth, menopause and even the female anatomy can lead to bladder control problems, making half of all women susceptible to developing incontinence at some point in their lives. Thankfully, incontinence is not a normal sign of aging, nor is it a problem you have to tolerate.
First, be aware of some of the most common triggers for bladder control problems.
Anatomy. Because a woman’s urethra is only about 1 inch long, germs from the vagina and anus can make it to the bladder relatively easily. Girls can have germs living there almost from the time they are born. When these germs begin growing in the bladder, the result can be a urinary tract infection, which causes frequent urination (often with a burning sensation) and strong, sudden urges to urinate.
Pregnancy. “During pregnancy, the added weight and pressure of the baby can weaken pelvic floor muscles, which may affect your ability to control your bladder,” says Holly E. Richter, Ph.D., M.D., a UAB urogynecologist.
Childbirth. Vaginal delivery, episiotomy and childbirth-related nerve damage also can lead to bladder control problems. For most new moms, problems with incontinence resolve within a few weeks, as their bodies heal. If new moms still have leakage after six weeks, they should let their doctor know. And, “Although some incontinence problems with pregnancy are short-term, injury and weakening of pelvic muscles and nerves can also cause incontinence later in life,” Dr. Richter says.
Menopause. During menopause, a woman’s body makes less estrogen. Some experts believe this decrease in estrogen leads to the weakening of the muscles that help control urine flow.
Take Control
The first step toward controlling incontinence begins with a visit to your doctor, during which he or she will determine what type of incontinence you have. “An accurate diagnosis is the first step toward effective treatment and a cure for incontinence,” Dr. Richter says.
Stress and urge incontinence are the main types of incontinence women suffer, with some women experiencing a blend of the two, called mixed incontinence.
“Stress incontinence is characterized by the uncontrollable loss of urine when coughing, sneezing, exercising or lifting,” Dr. Richter explains. It’s the most common type of incontinence and the type triggered by pregnancy, childbirth and menopause.
Urge incontinence means you feel a sudden, overwhelming need to urinate. This type of incontinence may be caused by problems with the bladder muscle or the nervous system, urinary tract infections or in rare instances, bladder cancer.
In some stress incontinence cases, your medical history and a physical exam may be enough for your doctor to make a diagnosis.
Tests performed in the clinic that may be used to help diagnose your disorder include:
- Lab tests, which examine the urine and blood.
- Cystoscopy, to view the inside of the urethra and bladder via a small tube.
- Uroflowmetry, which measures the amount of urine, the time it takes to urinate, and the speed of the urinary stream.
- Postvoid residual measurement, to see how much urine remains in your bladder after voiding.
- Cystometry (CMG), which tests how well the bladder muscle stretches during filling, how well it stores fluid and how well you empty your bladder.
- Electromyography (EMG), a test to see whether nerve messages are coordinated correctly.
- Videourodynamics, where video imaging takes pictures of the bladder during filling and emptying.
- Leak point pressure measurement, which determines the lowest amount of pressure and amount of urine that causes leakage.
- Pressure flow study, to measure pressure required to urinate.
Make a Plan
Once your doctor has diagnosed your type of incontinence, he or she can develop a treatment plan. Treatment often may start with conservative management, such as behavioral modification with fluid restriction, caffeine restriction and pelvic floor muscle exercises.
Medication, bladder training, electrical stimulation and biofeedback—a training technique that enables people to gain some control over involuntary bodily functions—can help in many cases, and surgery is a highly successful option for cases in which other treatments fail. Virtually all types of incontinence can be treated, so take control of the situation and stop suffering in silence.
Better Treatments
Researchers nationwide are looking for the best ways to treat incontinence. Talk to your doctors to find out more about these clinical studies:
ATLAS (Ambulatory Therapies for Leakage Associate with Stress)- Testing whether the nonsurgical treatments of pelvic muscle training and exercises, pressary use, or a combination of both exercises and pressary is most effective at improving incontinence in women.
Enhancing Conservative Therapy for Urge of Incontinence- Evaluating whether enhancing drug therapy with components of behavioral training, including pelvic floor muscle exercises, results in better outcomes than drug therapy alone for urge incontinence.
PRIDE (Program to Reduce Incontince by Diet and Exercise)- Evaluating the impact of weight loss on urinary incontinence in a radomized, controlled diet.
RUBI (Refractory Urge Botox Injection)- Determining how effective Botox is in reducing the amount of urine leaked in those who have urinary urge incontinence that has not been helped by medication or behavioral therapy.
TOMUS (Trial of Mid-Urethral Slings)- Comparing treatment successes for two minimally invasive surgical procedures to treat stress unrinary incontinence in women. These procedures are called mid-urethral slings.