Urinary Incontinence: What Causes It
As women get older, many experience involuntary loss of urine (incontinence), but urinary incontinence is not a normal part of aging and can (and should) be treated. More than 40% of women 65 and older have urinary incontinence, but as few as 25% of those discuss the problem with their doctor. Some believe it to be a normal part of aging, some are embarrassed, and some are afraid their doctor won't know how to treat them. Women with incontinence experience higher rates of depression, decreased social and sexual function. and increased dependence on caregivers. In this post we will discuss some causes and symptoms of incontinence. Next week, we will talk about treatments and things you can do to reduce your risk of incontinence.
Urine is made by the kidneys and stored in the bladder. When your bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. Sphincter muscles around the urethra must relax to allow urine to be released from your body. If your sphincter muscles are no longer strong enough to keep your urethra closed, you will experience a strong, often sudden, urge to urinate - referred to as urge incontinence. An increase in pressure in the abdomen caused by exercise, coughing, sneezing, laughing, lifting heavy objects, having sexual intercourse, or performing other body movements that put pressure on the bladder and the pelvic floor also can cause you to leak urine - referred to as stress incontinence. Some women experience a combination of both types. Urinary incontinence can also occur when there is a problem with the nerves that control the bladder muscles or urethra.
Pregnancy, vaginal delivery, obesity, and menopause increase the likelihood of urinary incontinence. During menopause, women experience lower levels of estrogen, which is thought to lead to thinning of the lining of the urethra. In pregnancy, as in obese women, the extra pressure on the bladder can damage the bladder sphincter and pelvic floor. Pregnancy and childbirth can also damage the nerves that control the bladder, as well as weaken the pelvic floor as a consequence of cutting pelvic floor muscles during an episiotomy. Women who have been pregnant might also experience a permanent shifting of their urethra and bladder.
The symptoms of urinary incontinence may resemble other conditions or medical problems so make sure you see your doctor if you experience any of the following:
Unusual urgency to go to the bathroom
Urinating before you reach the bathroom
Leakage of urine that stops you from doing any activity
Urine leakage with coughing, sneezing, exercise, or laughing
Urine leakage that began or continued after surgery
Feeling of wetness
Feeling of incomplete bladder emptying
Pressure or spasms in the pelvic area
Going to the bathroom more than normal (more than 8x/day or more than 2x/night)
Urinating while sleeping (bedwetting)
When you see your doctor, have the following information available for them. Consider keeping a diary for 2-3 days prior to your appointment to track when you go to the bathroom and when you experience leakage.
How often do you go to the bathroom?
When do you leak urine? How much? How often?
When did your symptoms start? Have they gotten worse?
Which medications do you take? How long have you taken them?
If you were ever pregnant, what was your labor and delivery experience? How many vaginal deliveries did you have?
Urinary incontinence is a common problem for menopausal women. See your doctor if you experience the symptoms of incontinence so that a treatment plan can be developed. Next week we will talk about the many treatments available, as well as some things you can do on your own to reduce the severity of your symptoms and decrease your risk.
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