Incontinence is a problem that can be cured or controlled with treatment. Bladder control conditions include:
- Pelvic floor support problems or prolapse
- Overactive bladder or urge incontinence
- Stress incontinence
- Mixed incontinence
Nearly 85 percent of North Americans with incontinence are women, but many don’t seek help. About 25 percent of women in their reproductive years and 50 percent of women in postmenopausal years experience the condition.
If you have an uncomfortable feeling of bulging, drooping, or pressure in your vagina, you may have a condition called prolapse or pelvic support problems. This occurs when the tissues that support the pelvic organs are damaged or stretched allowing the organ to drop down out of normal position and causing a bulge. Women with prolapsed pelvic organs may have a feeling of pelvic pressure or heaviness in the pelvic region. Sometimes it feels as if something is “falling out.” Prolapse also may cause incontinence.
Childbirth and aging are the two most common causes of this condition. During childbirth, the tissues of the pelvic organs may be damaged or weakened due to the stretching that can occur. As a result, these tissues may not provide as much support for the organs as necessary. Symptoms may worsen after menopause.
The main types of pelvic support problems include:
- Cystocele, when the bladder is not supported properly.
- Enterocele, when the small intestine is not supported properly.
- Rectocele, when the rectum is not supported properly.
- Uterine prolapse, when the uterus is not supported properly.
- Vaginal prolapse, when the vagina is not supported properly.
The risk of developing prolapse is increased with:
- Connective tissue disorders
- Upper respiratory disorders
- Repetitive strain injuries
Minor prolapse can be treated with exercises (Kegels) to strengthen the pelvic floor muscles; more serious prolapse requires vaginal inserts or reconstructive surgical treatment.
Surgery typically includes repair of tears in the fascia — a sheet of connective tissue that covers or binds structures in the body — or suspension of the prolapsed tissues to stronger structures in the pelvis. In some cases, a graft may be used to help strengthen the area. The surgery may be performed through a vaginal or abdominal incision or a combination of both.
Stress Incontinence is a condition resulting from an increase in pressure in the abdomen that increases physical stress on the pelvis causing urine leakage. It is due to insufficient strength of the pelvic floor muscles. Coughing, sneezing, laughing, exercise and even standing up are activities that can cause leakage in women with this type of incontinence.
In women, physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress incontinence. Stress incontinence can worsen during the week before the menstrual period due to lowered estrogen levels, which may lead to lower muscular pressure around the urethra, increasing chances of leakage.
Behavioral changes as a form of treatment include:
- Weight loss
- Exercise (Kegels)
- Decrease the amount of liquid that you are ingesting
- Avoid drinking caffeinated or carbonated beverages and alcohol
- Avoid spicy foods and citrus
- Quitting smoking
Other treatments include:
- Biofeedback – Biofeedback therapy uses computer graphs and audible tones to show you the muscles you are exercising
- The knack – Learning to use the pelvic muscles at the right time to stop leaks
- Vaginal inserts and pessaries – used to treat bladder and pelvic support problems
- Electrical Stimulation – uses low-grade electrical current to stimulate weak or inactive pelvic muscles to contract
- Surgery – bladder neck suspension procedures and sling procedures
- Medications – Estrogen replacement therapy
Overactive Bladder or Urge Incontinence
If you leak urine and have sudden, strong urges to urinate or if you urinate excessively, you may have urge incontinence or overactive bladder. This urge and the spasm of the bladder muscles may occur at any time, regardless of the amount of urine in the bladder.
In many women, there is no known cause. In some cases, the condition is caused by:
- Neurological injuries such as spinal cord injury or stroke
- Neurological diseases such as multiple sclerosis
- Bladder stones, cancer, infection and inflammation
- Damage to the bladder muscles caused by childbirth, hysterectomy or injury
The main symptom is loss of urine associated with a sudden, strong desire to urinate that cannot be postponed. Women may describe mounting pressure or sudden loss of urine in a rush to reach the toilet. Often, this occurs with certain triggering events, such as fumbling with the keys to open the front door, the sound or sensation of running water on the hands, or exposure to sudden cold. Other symptoms include a need to urinate frequently and waking often during the night to urinate.
Treatment for urge incontinence may include behavioral treatments such as pelvic muscle exercises, bladder training, urge suppression, medication, electrical stimulation, or Botox injections.
It is quite common for a woman to experience a combination of both “stress” incontinence and “overactive bladder” symptoms.
- Overactive Bladder – If you leak urine and have sudden, strong urges to urinate or if you urinate excessively, you may have urge incontinence or overactive bladder.
- Stress Incontinence – This is a condition resulting from an increase in pressure in the abdomen that causes physical stress on the pelvis and urine leakage. Coughing, sneezing, laughing, exercise and even standing up are activities that can cause leakage in women with this type of incontinence.
Treatment for mixed incontinence can include combinations of therapies prescribed for either stress or urge related incontinence (see above).