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Sunday, April 12, 2009

Urinary Incontinence and Menopause

6:39 PM

Description

Urinary incontinence is the involuntary loss of urine, sufficient enough to cause a social or cleanliness problem.

By age 65, 1 in 10 women experiences urinary incontinence. It is most commonly seen in women who have had one or more vaginal deliveries, which cause a change in the anatomy of the uterus, vagina, and supporting structures of the bladder, urethra, and rectum. Changes may be temporary, mild, or very significant.

If you suffer from urinary incontinence, there are many new products and surgical methods available to treat this condition.


Causes

Urinary incontinence is often caused by a combination of the following:

* Pregnancy, particularly vaginal delivery.
* Weakened or damaged pelvic muscles that support the bladder.
* Lack of estrogen, e.g., menopause.
* Medical problems that affect the bladder function, e.g., diabetes mellitus.
* Urinary tract infections.
* Constipation causing straining.
* Repeated coughing, e.g., smoker's cough.
* Certain prescription and nonprescription medications.

Symptoms


Symptoms vary depending on the type of incontinence:

Stress incontinence is the loss of urine when there is a sudden increase in pressure in the abdomen caused by laughing, coughing, sneezing, exercising, or lifting something heavy.

Urge incontinence is the most common type of incontinence. It occurs when someone suddenly feels as though they need to use the toilet, but is unable to reach it in time. Urge incontinence has many causes.

Mixed incontinence is a combination of stress and urge incontinence.

Overflow incontinence occurs when the bladder cannot empty properly. A person makes frequent trips to the toilet, letting out small amounts of urine each time. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness.

Functional incontinence is not caused by problems with the bladder. Accidents occur because it may be difficult for a person to get to the toilet due to illness, arthritis, or lack of available facilities.

Diagnosis

* Review of medical history.
* Physical exam, including pelvic examination.
* Laboratory tests, including urinalysis and urine culture to rule out a urinary tract infection; blood sugars to rule out diabetes mellitus.
* Urodynamic studies where the physician tests the function of bladder and urethra by measuring bladder pressure and urine flow.
* Cystoscopy, which involves the direct visualization of the urinary bladder and urethra from inside by inserting an endoscopic tube through the urethra. Please see cystoscopy for more information.
* Cystogram to show abnormal anatomy and functions that may be causing incontinence. For a cystography or voiding cystourethrography, the bladder is filled with iodine containing X-Ray dye, and an X-Ray is taken of the bladder and urethra when filled, during urination, and immediately after urination.

Treatment



Treatment depends on the type of incontinence and may require one or more of the following:

* Estrogen creams, if estrogen deficiency (from menopause) is suspected.
* Antibiotics to treat a urinary tract infection.
* Medication to help regulate the bladder and urethra.
* Surgery to support the bladder and correct the pelvic anatomy.
* Kegel exercises to strengthen the pelvic muscles.
* Bladder training to help a person control the urgent need to urinate.
* Vaginal pessaries to support a partially prolapsed bladder.




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