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I’m so leaky

Urinary incontinence is not an inevitable part of ageing or childbirth, but always a symptom of some other health problem.

WHEN laughing, coughing or sneezing sends you running to the bathroom in embarrassment, it’s no laughing matter. Incontinence is a real problem that needs to be addressed medically, but most women are too shy to talk about it, accepting it as a “normal” part of getting older. While incontinence may be a minor problem for some women, for others, it can be so bad that it makes them afraid to leave their homes, meet people or live normal lives. But incontinence can be managed so that you can live your life the way you want to, not the way your bladder does.

What causes it?

To understand incontinence it helps to understand how your waterworks actually function. The kidneys filter urine from the blood and store it in your bladder. The bladder is a hollow muscular organ that holds the urine until you decide that you feel full (which is up to about 300ml).

When you reach the toilet, you relax your pelvic floor muscles (muscles under the bladder) and your brain gives permission for the bladder muscle to contract, squeezing the urine out through the urethra (the tube from the bladder to the outside). When the bladder muscle contracts, the sphincter muscle that holds the urethra shut during storage relaxes to allow the urine to pass through. The whole system is supported by the muscles of the pelvic floor. These run from the tip of your tailbone through to the pubic bone (the front bone of your pelvis).

Incontinence affects women seven to eight times more often than men. Childbirth is one of the main reasons for this. Pushing a baby through the birth canal stretches the pelvic organs a fair bit and can weaken or damage the pelvic floor muscles. Women who have weak pelvic floor muscles may not be able to sense when their bladders are full, which leads to difficulty in controlling urination. You can gain back some strength in these muscles by doing pelvic floor exercises.

The damage of childbirth can be worsened by such things as chronic coughing or sneezing, constipation and increased body weight. In addition, menopause, with its decreasing hormone levels, can also contribute to incontinence. Sometimes, there are other factors that can cause short-term incontinence, such as urinary tract and bladder infections, constipation and side effects of certain medications. These can be readily treated. However, it may not be possible to expect such quick relief for chronic incontinence caused by birth defects or progressive illnesses such as Alzheimer’s disease.

When the urge overtakes you?

Not all incontinence is the same. The two most common forms of urinary incontinence are stress incontinence and urge incontinence. If you experience leakage when coughing, sneezing, laughing, exercising, lifting or when performing other kinds of strenuous activity, you have stress incontinence. Stress incontinence is usually the result of failure of spontaneous closure of urinary sphincter during activities which increase intra-abdominal pressure. This can be caused by abnormal descent of pelvic floor (usually due to weakness of pelvic muscle) or the result of weak bladder outlet sphincter.

Therefore, urine escapes when the abdomen is under stress. This form of incontinence most commonly affects middle-aged women. If you often have the feeling of not being able to reach the toilet in time, and lose large amounts of urine, you have urge incontinence. This is usually caused by having an “overactive bladder”, one that contracts before you give it permission to. Many women experience urge incontinence due to infections that irritate the bladder or urethra, or cause muscle spasms, which force the urine out of the bladder. If you are suffering from constipation, you may also have urge incontinence through the loss of muscle control.

Finally, a stroke, spinal cord injury, dementia or diseases that affect the nervous system, such as Parkinson’s disease and multiple sclerosis, can bring on this form of incontinence. You may experience both stress and urge incontinence at different times or under different circumstances. Don’t assume that these two are caused by the same problems; always seek treatment when either form occurs. There are a few less common forms of incontinence. Overflow incontinence, often caused by nervous system disorders and spinal cord injuries, is when you either do not get the urge to urinate or have a blockage in the urethra. The bladder never completely empties, and when it overfills, excess urine is forced out.

Functional incontinence, where a person is unable or unwilling to use a toilet without assistance, can be caused by severe arthritis or confusion brought on by other illnesses. Much rarer is total incontinence, which can be caused by a birth defect, injury or dementia.

Living with incontinence

You don’t have to let incontinence control you. Incontinence is not an inevitable part of ageing or childbirth, but always a symptom of some other health problem. Many bladder control problems can be cured and all can be managed. Don’t try to treat incontinence yourself by using unproven home remedies such as drinking less water! Although urine is 95% water, you won’t cure incontinence by drinking less fluids. That will actually make things worse, because urine that is more concentrated will irritate the bladder and cause more serious problems such as infection and dehydration.

In addition, inadequate fluid intake can cause constipation, which may also make matters worse. The first step is to see your family physician or gynaecologist for advice. If you can’t hold it in, don’t hold back from your doctor!

The Star Newspaper, Sunday August 5, 2007

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