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Light Incontinence - Physician’s Perspective

What to do about urinary incontinence

Urinary incontinence is unquestionably one of the most disagreeable health disorders. Patients suffering from this condition are unable to control their urinary flow. Contrary to what is considered common knowledge, the problem of urinary incontinence is not limited to the older generations. However, it is a fact that it is more prevalent among women than men.

MUDr. Ladislav Krofta, CSc. [M.D., DSc.], specialist in urogynecology and ultrasound diagnostics from the Institute for the Care of Mother and Child, Prague

A common condition

Although the frequency of incontinence increases with age, it is not a symptom of aging. In fact, women suffer from several types of urinary incontinence, of which stress incontinence is most common. For instance, over 7 % of European women suffer from this condition. Leakage of urine may be caused by a sneeze, coughing or merely clearing one’s throat, a laugh, lifting significant weight, or any sports activity that increases stress in the abdominal area. Women associate stress incontinence incorrectly with psychological stress.

The cause of involuntary urinary spotting is a disorder of the anatomy of the lower urinary tract due to increased mobility of the bladder’s neck and the urethra or inadequate functionality of the internal urinary sphincter. This type of incontinence is often accompanied by a functionality disorder and weakness of the pelvic muscles, e.g., after vaginal childbirth, gynecological operation, or pelvic injury. The treatment of stress incontinence is based on conservative (non-surgical) methods consisting primarily of strengthening of the muscles at the pelvic floor. Should any of these techniques fail, an approach based on surgical fortification of the pelvic bottom can be considered.

Urgent incontinence is the second most common form of involuntary urinary leakage. Women may feel a sudden, uncontrollable urge to urinate instantly, looking immediately for a toilet. Urgent incontinence is observed, for example, during an infection of the urinary tract or another disease; sometimes, the cause cannot be identified at all. Some women suffer from mixed incontinence, i.e., a combination of stress and urgent incontinence.

Reflexive incontinence is a condition involving a spontaneous emptying of the bladder – as in infants . This type of incontinence may be a symptom of a neurological disease or consequence of a cerebral or spinal injury.

Where to look for the cause of urinary incontinence

In the human body, the urinary bladder is a hollow muscular organ whose size varies according to the volume of urine contained in it at any given time. The bladder can hold up to half a liter urine. Emptying the bladder is a complex process that involves collaboration of the nerves, the lower section of the spine, and the urinary bladder’s muscles. During urine expulsion (excretion), the walls of the bladder contract, thereby releasing the external sphincter’s constriction. In other words, the functionality of this circumferential muscle, situated under the urinary bladder, is crucial for a woman’s ability to consciously control her micturition.

Proper functionality of the pelvic floor is the result of balanced functioning of three actors: muscles, ligament tissue, and nerves, all of which collaborate as a single dynamic entity. The most common cause of urinary incontinence is the weakening of the pelvic floor musculature or pelvic ligaments, causing the urethra to shift from its original position and allowing urine to leak even with the slightest increase of abdominal pressure. The second possible cause can be inadequate functionality of the urinary tract. This explains why urinary incontinence predominantly affects women, as its main cause is a dysfunctional pelvic floor. Consequently, urinary incontinence can be the result of changes caused by difficult childbirth or obesity. Therefore, the prevalence of stress incontinence is not limited to older women whose estrogen hormone levels typically decline during menopause.

Younger generations of women may also be affected by weakening of pelvic muscles and tissue around the urethra due to frequent pregnancies, difficult childbirth, and delivery of babies weighing more than 4 kilograms, or a hysterectomy. Other risk factors include also chronic cough that accompanies asthma or disproportionate physical stress.

Incontinence can be treated

Initially, problems accompanying urinary incontinence can be perceived as an occasional problem involving a negligible leakage of urine. With time, however, the urethra becomes increasingly feebler or the sphincter weaker, causing urine leakage to be more frequent and the volume of leakage greater. Women may have to start wearing sanitary napkins for incontinence, reducing their intake of liquids, and planning all their activities according to toilet accessibility as the problem becomes worse. It is not uncommon for women to find themselves having to avoid taking part in social activities and cultural events, sports, and sex. If involuntary urine leakage becomes a hygienic as well as social problem for a woman, she should seek a solution, because it is quite unnecessary to let this condition interfere with her personal life and disrupt her daily schedule.

Several methods exist for treating urinary incontinence. The primary choice is to arrest and prevent further deterioration of the condition by strengthening the pelvic floor muscles with Kegel exercises. However, if the muscles have become too weak, these exercises may not be effective enough. . Women in menopause can be treated medicinally with vaginal estrogen hormone treatment in the form of pills, suppositories, or creams. Stress incontinence can also be treated successfully using minimally invasive surgical procedures that help support the urethra by means of a new technology known as TVT tape.

Unfortunately, urinary incontinence is still one of the conditions that female patients often are too embarrassed to discuss. To these patients we recommend going to to find all the relevant information about this health problem and treatment options.