Urinary incontinence is the uncontrollable loss of urine. It is very common, especially in women. Up to 60% of postmeno-pausal women have incontinence.
The two most common types are stress incontinence and urge incontinence. Stress incontinence is losing urine in a spurt or gush with certain activities (e.g., coughing, sneezing, lifting, exercising). It can be caused by childbirth or growing older. Urge incontinence is losing urine on the way to the bathroom. It can be caused by drugs, caffeine, alcohol, or growing older. Many bladder problems worsen during menopause.
In very mild incontinence, a small amount of urine sometimes leaks (dribbles) during a cough or sneeze, or on the way to the bathroom. In mild to moderate incontinence, urine leaks daily and/or a pad is needed for protection. In severe incontinence, urine soaks a pad several times each day. Incontinence may limit daily activities.
Diagnosis involves taking a medical history, x-rays, blood tests, urinalysis, and other tests to see how the bladder works. These tests, called urodynamic tests, measure pressure in the bladder, urine flow, and the amount of urine left in the bladder after urination.
Strengthening pelvic floor muscles is usually the first step in managing stress incontinence. Tightening these muscles is called a Kegel exercise. If Kegel exercises do not help, special physical therapy may improve bladder control. This therapy includes biofeedback and electrical stimulation.
Special devices, called pessaries, are also available to treat stress incontinence. These devices can be used to support organs such as the bladder. Sometimes pessaries are useful when urine is lost only during certain activities, such as jogging, aerobics, and horseback riding.
The first step in treating urge incontinence is usually training the bladder to empty (void) at certain times. The goal is for 3 hours to pass before the need to void during the daytime without any leaking. Sometimes medicines can help with bladder training. These drugs may cause dry mouth or eyes but are generally well tolerated. Various operations can also be used for stress incontinence. Specialists such as gynecologists or urologists do these operations.
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