Urinary incontinence is a tough health problem to face. It is embarrassing and frustrating for many women, and one of the least comfortable conditions to bring up to their doctor. Urinary incontinence is more common than you think and we want to help you through it as much as we possibly can. It all starts with a visit to your gynecologist!
By: Elizabeth Oler MD/OB/GYN
Evergreen Women's Health
Urinary incontinence is more common than you think, and yet it’s one of the conditions that women are least comfortable bringing up to their doctor. Fortunately, we are here to help! As your gynecologist, we can help to diagnose your condition and then eventually, sometimes treat you for your incontinence. However, not all incontinence is created equal. The most common types of urinary incontinence in women are urgency, stress, and overflow incontinence. Differentiating the type that you have is critical in determining the best way to treat you.
Your bladder, urethra, and all of the muscles and nerves of the urinary system work together in complex ways, and because of this there are many parts of the process that can go wrong.
Urgency incontinence is a condition caused by overactive bladder. In this type of incontinence, the muscles and nerves of your bladder are firing more frequently and strongly than they need to, which causes the bladder to contract. The muscles of your urethra, or the tube through which your urine flows out of your body, push back with a certain amount of pressure. If your bladder contracts enough to overcome this pressure, a little bit of urine can leak out. If you feel like you can’t make it to the bathroom in time because you feel such a strong urge, and you can’t stop yourself from peeing a little, you might have this type of incontinence.
Stress incontinence, on the other hand, happens when you cough, sneeze, laugh, or do other activities that cause your abdominal muscles to strain and bear down on your pelvic floor. Although it seems similar, it is caused by a very different problem – not enough strength pushing back from the urethra. This can occur because of the angle of the bladder and urethra, or because the muscles of the pelvic floor weaken over time. The urine leaks out because the pressure from your abdominal muscles with these activities, combined with the change in the angle of your bladder neck, overcome the back pressure from your urethra.
Finally, overflow incontinence occurs when your bladder doesn’t empty all the way and continues to fill with too much urine. Eventually the volume of urine in your bladder is too much, and like with stress incontinence, the urine comes out because the urethra can’t hold back that pressure, even though it is passive and can happen without being provoked.
Since the causes of incontinence are so different, they are also treated differently. Urgency incontinence can be treated with a medication that calms down the muscle and nerve firing of your bladder and can be very effective. However, it can lead to retention of urine, so it is critical to ensure that this won’t harm you.
Since stress incontinence is more due to anatomic changes, it can be mitigated by strengthening the muscles of the pelvic floor (yes, do your Kegels!), or by referring you to a physical therapist to help strengthen those muscles with targeted exercises and strength training. We can also place a device called an incontinence pessary, that puts pressure on the urethra to help change the angle. There are even some over the counter solutions available, similar to tampons. If you have pure stress incontinence, it can also be fixed by a minor surgical procedure, or a “bladder sling”, to suspend the urethra and add another mechanical barrier to keep the pressure system more balanced. This can lead to retention of urine, and it is important to be sure you don’t have other incontinence issues before going forward with this type of surgery, which can be done here in Roseburg by my partner, Dr. Mary Powell.
Many women ultimately need to be referred to urology or urogynecology to get further testing done, particularly if you seem to have a mixed incontinence picture. However, it is always a good idea to get started with your gynecologist, so we can help determine what’s going on, and then coordinate referrals and offer initial treatments that are safe and appropriate for you.
This is a tough health problem to face, and it is embarrassing and frustrating for many women, and we want to help you through it as much as we possibly can. It all starts with a visit to your gynecologist!