How does pregnancy affect urinary control. What causes incontinence during pregnancy. Can pregnancy incontinence be prevented. How long does pregnancy-related incontinence last. What exercises help with pregnancy incontinence. When should you see a doctor about pregnancy incontinence.

Understanding Pregnancy Incontinence: A Common Yet Manageable Condition

Pregnancy incontinence is a widespread issue affecting many expectant mothers. According to the National Association for Continence, 63% of women with stress incontinence report that their symptoms began during or after pregnancy. A study involving 500 healthy participants revealed that most experienced urinary incontinence at some point from the first through the third trimester.

Dr. Anthony Atala, a spokesman for the American Urological Association, states that “virtually all pregnant women experience some type of incontinence.” This high prevalence underscores the importance of understanding and addressing this condition.

The Physiology Behind Pregnancy-Related Urinary Incontinence

To comprehend pregnancy incontinence, it’s crucial to understand the normal urination process. Urination occurs when the muscles around the urethra relax, allowing urine to flow from the bladder. Once urination is complete, these muscles contract, preventing further urine flow until the next bladder emptying.

Pregnancy can disrupt this normal function due to several factors:

• Hormonal changes during pregnancy
• Increased pressure on the bladder from the growing uterus
• Weakening of pelvic floor muscles due to the weight of the baby

These factors can lead to stress incontinence, where urine leakage occurs during activities that put pressure on the bladder, such as sneezing, coughing, laughing, or physical exercise.

Risk Factors for Pregnancy Incontinence

While pregnancy itself is a significant risk factor for incontinence, researchers have identified additional factors that may increase a woman’s likelihood of experiencing this condition:

• Family history of incontinence
• Higher body mass index (BMI)
• Excessive weight gain during pregnancy
• Being over 35 years old when pregnant

Understanding these risk factors can help women and their healthcare providers take proactive steps to prevent or manage incontinence during pregnancy.

Effective Strategies for Managing Pregnancy Incontinence

While pregnancy incontinence is common, it doesn’t have to significantly impact your quality of life. Here are some effective strategies to manage and prevent leakage:

1. Scheduled Bathroom Breaks

Planning regular bathroom visits can help prevent leakage due to an overfull bladder. Dr. Atala recommends using the bathroom at least every two hours. This may require consciously scheduling breaks into your daily routine, especially if you’re in a situation where bathroom access might be limited.

2. Kegel Exercises: Strengthening the Pelvic Floor

Kegel exercises are crucial for strengthening the pelvic floor muscles, which support the bladder, uterus, and other pelvic organs. These exercises can significantly reduce incontinence when performed correctly and consistently.

How to perform Kegel exercises:

1. Identify the correct muscles by stopping the flow of urine midstream
2. Contract these muscles for a count of 10
3. Release the contraction
4. Repeat 10 to 20 times, 2 to 3 times per day

The American Congress of Obstetricians and Gynecologists recommends this regimen for optimal results. It’s important to note that it typically takes 4 to 8 weeks of consistent practice before noticeable improvements occur.

3. Weight Management

Studies have shown a correlation between higher pre-pregnancy weight or excessive weight gain during pregnancy and an increased risk of urinary incontinence. Maintaining a healthy weight before and during pregnancy can help reduce the likelihood of experiencing incontinence.

The Effectiveness of Pelvic Floor Exercises in Preventing Incontinence

Research supports the efficacy of pelvic floor muscle training in preventing and managing pregnancy-related incontinence. A review of studies found that women who practiced these exercises during their first pregnancy were less likely to experience leakage later in pregnancy and after giving birth.

Moreover, Kegel exercises proved beneficial for women with persistent incontinence problems postpartum. This underscores the importance of incorporating these exercises into prenatal and postnatal care routines.

Postpartum Incontinence: What to Expect

Pregnancy and vaginal delivery can stretch and weaken the pelvic floor muscles, potentially leading to ongoing incontinence issues after childbirth. A recent study revealed that 62% of pregnant women experienced incontinence during pregnancy, with 50% continuing to have problems with urine leakage after childbirth.

Interestingly, women who didn’t experience incontinence during pregnancy had a lower risk of postpartum incontinence compared to those who had incontinence at any point during their pregnancy. This suggests that managing incontinence during pregnancy might have long-term benefits extending into the postpartum period.

Breaking the Silence: The Importance of Discussing Incontinence with Healthcare Providers

Despite the prevalence of pregnancy-related incontinence, many women hesitate to discuss this issue with their healthcare providers. This reluctance can stem from embarrassment, the belief that incontinence is a normal part of pregnancy, or the assumption that nothing can be done to alleviate the problem.

However, open communication with healthcare providers is crucial for several reasons:

• Early intervention can prevent the condition from worsening
• Healthcare providers can offer personalized treatment plans
• Untreated incontinence can lead to other health issues, such as urinary tract infections
• Discussing incontinence can alleviate anxiety and improve overall quality of life during pregnancy

Women experiencing incontinence during pregnancy should be encouraged to speak with their healthcare providers about their symptoms, concerns, and treatment options.

Advanced Treatment Options for Persistent Pregnancy Incontinence

While lifestyle changes and pelvic floor exercises are often effective in managing pregnancy incontinence, some women may require additional interventions. Advanced treatment options may include:

1. Pessaries

A pessary is a small device inserted into the vagina to support the bladder and urethra. It can be particularly helpful for women with stress incontinence that doesn’t respond to conservative measures.

2. Biofeedback Therapy

This technique uses sensors to help women identify and strengthen the correct muscles during pelvic floor exercises, improving their effectiveness.

3. Bladder Training

This involves gradually increasing the intervals between urinating to improve bladder control and capacity.

4. Medications

In some cases, healthcare providers may prescribe medications to help control overactive bladder symptoms. However, the use of medications during pregnancy requires careful consideration and should only be done under close medical supervision.

It’s important to note that the appropriateness and safety of these treatments during pregnancy may vary. Always consult with a healthcare provider before starting any new treatment regimen.

Long-Term Outlook: Pregnancy Incontinence and Future Health

Understanding the long-term implications of pregnancy incontinence is crucial for comprehensive maternal health care. Research suggests that women who experience incontinence during pregnancy may have an increased risk of developing chronic incontinence later in life.

However, this doesn’t mean that pregnancy-related incontinence inevitably leads to lifelong bladder control issues. Many women find that their symptoms improve or resolve completely in the months following childbirth, especially with appropriate management and treatment.

Factors that may influence the long-term outlook include:

• The severity and duration of incontinence during pregnancy
• The number of pregnancies and deliveries
• The type of delivery (vaginal vs. cesarean)
• Consistency in performing pelvic floor exercises postpartum
• Overall health and lifestyle factors

Given these potential long-term implications, it’s crucial for women to address incontinence during pregnancy and continue pelvic floor care postpartum. This proactive approach can significantly improve bladder control and overall pelvic health in the years following childbirth.

Emotional and Psychological Impact of Pregnancy Incontinence

While the physical aspects of pregnancy incontinence are well-documented, it’s equally important to address the emotional and psychological impact of this condition. Many women experience feelings of embarrassment, anxiety, and decreased self-esteem due to incontinence.

The psychological effects of pregnancy incontinence can include:

• Social isolation due to fear of accidents in public
• Anxiety about intimate relationships
• Decreased confidence in professional settings
• Stress about managing symptoms during daily activities

Addressing these emotional aspects is crucial for comprehensive care. Healthcare providers should be prepared to offer not only physical treatments but also emotional support and resources. This may include referrals to support groups, counseling services, or pelvic health specialists who can provide holistic care.

By acknowledging and addressing both the physical and emotional aspects of pregnancy incontinence, healthcare providers can offer more comprehensive and effective care, improving overall quality of life for pregnant women experiencing this common condition.

How to Manage Pregnancy Incontinence

Incontinence is common during pregnancy, but it can be managed with the right habits. Find out how to keep incontinence in check when you’re expecting.

By Marie SuszynskiMedically Reviewed by Rosalyn Carson-DeWitt, MD

Reviewed: September 14, 2015

Medically Reviewed

iStock

Urinary incontinence affects some 10-13 million Americans — and the condition is twice as common in women. Women are more likely to have bladder control issues, largely because of the changes the body experiences during pregnancy and childbirth. According to the National Association for Continence, 63 percent of stress-incontinent women say their symptoms began during or after pregnancy. In one study, most of the 500 otherwise healthy participants experienced urinary incontinence at some point from the first through the third trimester.

“I would say virtually all pregnant women experience some type of incontinence,” says Anthony Atala, MD, a spokesman for the American Urological Association and director of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N. C.

But incontinence problems don’t have to rule your life during pregnancy.

Why Pregnancy Incontinence Occurs

First, understand the urination process. You’re able to urinate when the muscles around your urethra relax, which allows urine to flow from your bladder out of your body. When you’re finished urinating, the muscles around your urethra contract, holding off any urine flow until you’re ready to empty your bladder again.

Pregnancy can interfere with the normal way your urethra relaxes and contracts. Hormone changes during pregnancy and added pressure on the bladder from your uterus can cause stress incontinence, Dr. Atala says. When you have stress incontinence, you may urinate when you sneeze, cough, or laugh. Walking, running, or exercising can also cause leakage.

Researchers have also discovered that women who have a family history of incontinence, have a higher body mass index, gain more than the recommended amount of weight during pregnancy, and are over 35 when they get pregnant also have a higher risk of experiencing incontinence.

How to Avoid Pregnancy Incontinence

Urinary incontinence doesn’t have to make your life miserable when you’re pregnant. Here’s what to do to avoid leakage:

Schedule your bathroom breaks. There’s no way around it: When you’re pregnant, you’re going to have to excuse yourself to use the lady’s room more often. Being more cognizant of that will help you avoid leakage. Atala suggests planning to use the bathroom at least every two hours. That may mean scheduling bathroom breaks into your day so you don’t get caught with a bladder that’s too full when you can’t get to a restroom.

Practice Kegels. Kegel exercises help to strengthen the pelvic floor and help you avoid leakage, but you need to practice in order to do them properly, Atala says. If you’ve never done a Kegel before, start by stopping the flow of urine the next time you urinate. The contraction of those muscles is how you do a Kegel, and you can do Kegel exercises any time throughout the day, whether your bladder is full or empty.

Simply contract the same muscles you would to stop the flow of urine, hold the contraction for a count of 10, and then release. The American Congress of Obstetricians and Gynecologists suggests doing Kegel exercises 10 to 20 times in a row two or three times a day.

Kegel exercises really do help with incontinence. In a review of studies, researchers found that women who practiced pelvic floor muscle training when they were pregnant with their first baby prevented leakage later in pregnancy and after giving birth. Kegel exercises also helped women who had persistent incontinence problems after giving birth. Keep in mind that it takes about four to eight weeks of doing them regularly before you’ll see results, Atala says.

Watch the weight gain. Studies show that women who weigh more when they get pregnant or who gain an excessive amount of weight during pregnancy are more likely to experience urinary incontinence.

Incontinence: Will It Continue After Pregnancy?

Pregnancy and having a vaginal delivery can stretch the muscles that support the pelvis, making them weaker. As a result, you may leak urine or have trouble urinating even after you’ve given birth.

In a recent study of pregnant women, researchers found that 62 percent had incontinence during the pregnancy. And 50 percent continued to have problems with leaking urine after childbirth. Women who didn’t have problems with incontinence during pregnancy had a lower risk of postpartum incontinence compared to women who experienced incontinence at any point during their pregnancy.

An Unspoken Epidemic?

Unfortunately, many women with incontinence don’t tell their doctors. Some experts suggest this may be because women don’t consider just a few drops of leakage anything to worry about, or they may feel embarrassed to discuss incontinence with their doctor.

But no amount of urinary incontinence needs to be tolerated. If urinary incontinence becomes a problem during your pregnancy or doesn’t go away after pregnancy, be sure to tell your doctor so you can be treated for it. In the meantime, take comfort in knowing that there are strategies to minimize the risk of those embarrassing and uncomfortable leaks from occurring in the first place.

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Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy | Women’s Health | Your Pregnancy Matters

Instructions on how to locate pelvic muscles and exercises to strengthen them can help prevent incontinence during and after pregnancy.

Friends and family describe stress urinary incontinence (SUI) to pregnant women as if it’s just a fact of life: “After you have a baby, you won’t be able to cough, sneeze, or exercise without peeing a little.”

SUI is the most common type of urinary incontinence associated with pregnancy. More than a third of pregnant women experience involuntary urine leakage during the second and third trimesters, and a third leak during the first three months after delivery.

But you don’t have to just live with urinary incontinence. There are steps you can take to prevent and reduce leakage before, during, and after pregnancy. Interventions can include lifestyle modifications and strengthening your pelvic floor muscles through Kegel exercises.

Unfortunately, not all health care providers make such recommendations. Or they might suggest performing Kegels, but they don’t show patients how to do them correctly. There’s a lot going on in the pelvic region during pregnancy, and many women don’t know how to locate or engage their pelvic floor muscles.

UT Southwestern has one of the largest Female Pelvic Medicine and Reconstructive Surgery divisions in the country. We help patients at all stages of life with strategies and therapies to prevent or treat urinary incontinence.

The first step in prevention is education.

Why does urinary incontinence occur with pregnancy?

Pregnancy and childbirth can cause incontinence in several ways:

• Your growing baby takes up a lot of room. As the uterus expands, it puts increased pressure on the bladder, urethra, and pelvic floor muscles. This can lead to leakage.
• Changing progesterone levels during pregnancy can weaken the pelvic floor. Increases in this hormone loosen up your ligaments and joints so the belly can expand and so you can deliver. But it can also loosen ligaments in the pelvis that help you hold in urine.
• Childbirth, particularly vaginal delivery, can stretch and weaken the pelvic floor muscles. This can lead to pelvic organ prolapse, in which your bladder, uterus, or rectum droops into the vaginal canal. Prolapse can be associated with urinary incontinence.
• Vaginal delivery also can result in pelvic muscle and nerve injury, which can result in bladder control problems.

If you experience urinary incontinence during pregnancy, you are at higher risk of having a persistent problem after birth. Tell your health care provider about urinary incontinence symptoms as soon as you notice them during pregnancy or at your first postnatal visit.

More than 80% of postpartum women who experience SUI symptoms during pregnancy may continue to experience stress incontinence without treatment.

Related reading: Body after birth: Treating post-pregnancy problems

Where are the pelvic floor muscles?

During initial exam, I often use a clock visual to help women know where their pelvic floor muscles can be palpated. If you lie on your back, imagine the top of the opening of your vagina is 12 o’clock and the bottom of the opening is 6 o’clock.

The pelvic floor muscles are easiest to palpate at the 5 o’clock and 7 o’clock positions– about even with where your legs meet your hips and approximately 3 to 4 centimeters above the vaginal opening.

These are the same muscles you contract when you try to stop the flow of urine midstream or if you were to tighten your vagina around a tampon. And these are the muscles you contract to do Kegel exercises. These pelvic floor muscle exercises were named after Dr. Arnold Kegel, who described them in the 1940s to help patients strengthen their pelvic floor muscles to treat urinary incontinence.

The proper way to Kegel

Verbal or written instructions alone don’t necessarily help patients know whether they’re doing Kegel exercises properly.

When we see patients for urinary incontinence, we provide education and instruction. We often recommend one to six sessions of supervised Kegel exercises with a female pelvic medicine and reconstructive surgery doctor, a pelvic floor physical therapist, or another provider who has expertise in pelvic floor disorders. While physical therapy or other medical visits usually are not covered by insurance for preventive purposes, they usually are once a problem develops.

In these appointments, your provider will describe how to locate and engage the pelvic floor muscles. The provider will gently press on the pelvic floor muscles with a gloved exam finger inside your vagina and ask you to squeeze the muscles. The muscles will be identified as described. Make sure you’re not squeezing your stomach, legs, or gluteal muscles at the same time, and don’t hold your breath.

Some patients benefit from holding a mirror between the legs to visualize the external anatomy during the exercise. When done properly, you should see the area between your vagina and anus lift toward your upper body.

Doing Kegel exercises regularly is key to strengthening the pelvic floor. We recommend women do 10 repetitions, holding each squeeze for 5 to 10 seconds, three times each day.

You can do the exercises while lying down, sitting, or standing. Many patients find it easier to remember to do Kegels if the exercises become part of a daily routine. Maybe do a set while lying in bed right after you wake up, another as you eat lunch, and another at bedtime.

Most women see less frequent urine leakage within a few weeks or months after maintaining a Kegel exercise routine.

Before your big day arrives, get a preview of the accommodations for new moms at UT Southwestern’s Clements University Hospital. From the chef-prepared meals to the roomy, high-tech labor and delivery suites, we want to make sure that you, your baby, and your family have the opportunity to bond in a safe and soothing environment.

Lifestyle changes to reduce urinary incontinence

Along with Kegel exercises, there are a few other noninvasive methods to eliminate or reduce the risk of urinary incontinence:

• Lose weight. Excess body weight puts pressure on the bladder. Even a 10% reduction in weight can significantly help with urinary incontinence. Work with your doctor to manage your weight gain during pregnancy, and after the birth of your little one, returning to your pre-pregnancy weight will help relieve the pressure on your bladder and pelvic floor.
• Quit smoking. Smoking has been shown to increase the risk of urinary incontinence as it leads to bladder irritation and chronic coughing.
• Make dietary changes. Some foods and beverages can make incontinence worse. These include caffeine, alcohol, and spicy and acidic foods. This is especially important if you experience urinary frequency and urgency and have trouble making it to the bathroom once you have the urge to urinate. Constipation can worsen symptoms of urine leakage. Stool in the rectum can put pressure on the bladder, urethra, and pelvic floor, so include plenty of higher-fiber foods and fluids in your daily diet.

Other treatments for urinary incontinence

Your doctor may recommend alternative treatment options, such as:

• Electrical stimulation: This therapy can help rehabilitate weak pelvic floor muscles and can be done in conjunction with Kegel exercises.
• Medications: Certain drugs can be used to treat urgency urinary incontinence (UUI) that does not respond to diet and behavioral modification, such as timed voiding to avoid overfilling of the bladder. UUI is associated with a sudden, intense urge to urinate followed by involuntary loss of urine. It is often associated with urinary frequency and urgency. Medications to treat UUI allow the bladder to fill up with more urine before giving the body a signal that it needs to use the bathroom.
• Pessary: This is a plastic insert that supports the vaginal walls. It can be removed, replaced, and cleaned at home.
• Surgical procedures: There are several surgical procedures that can be performed for the treatment of stress urinary incontinence that does not respond to the conservative measures described above. One of the most common and effective surgeries involves placing a synthetic mesh sling between the vagina and the middle portion of the urethra. This supports the urethra like a hammock and helps control urine leakage during activities such as coughing, sneezing, laughing, exercise. Other effective surgeries for SUI that do not involve mesh include the Burch colposuspension and the traditional pubovaginal sling with graft material procured from the patient’s own body. Urethral bulking injection is an office procedure that may provide relieve of symptoms in patients who have contraindications for surgery.

If you are experiencing urinary incontinence during or after pregnancy, know that you’re not alone. Talk with your doctor – we can help you get back to exercising, laughing, and sneezing without worrying about a accidental urine leakage.

To visit with an incontinence expert, call 214-645-8300 or request an appointment online.

Causes of urinary incontinence during pregnancy

come back

During pregnancy, even healthy women may have problems with urinary control. The changes that occur in the body during this period become the source of a number of factors that provoke incontinence. More often, urinary control may worsen starting from the second or third trimester, less often, a woman may experience incontinence in the first months. It is important to understand that now there are many opportunities to go through this important period in a woman’s life in comfort, even if the problem of incontinence has not bypassed you.

According to statistics, more than half of women experience incontinence of varying degrees during pregnancy. When the time approaches the moment of delivery, the problem may worsen and persist, on average, for six months after the birth of the child.

How is incontinence manifested in pregnant women

Problems with urinary control can manifest as episodic dripping. Usually these episodes are associated with sudden tension – coughing, sneezing, laughing, lifting weights, a sudden change in body position.

This problem significantly limits the freedom of movement of a pregnant woman and her ability to lead a socially active lifestyle. This is especially acute in the later stages. Expectant mothers feel awkward and worry that they cannot leave the house for a long time. In some cases, women may not have time to get to the toilet when they feel the urge. Such troubles in pregnant women can also happen at night.

But expectant mothers do not need to voluntarily expose themselves to social isolation. With the help of modern absorbents, you can regain confidence and completely eliminate the discomfort associated with incontinence. Special urological pads will help to keep a delicate problem a secret. Having chosen the right size, depending on the absorbent characteristics, a woman can not worry and allow herself long walks and going out.

Common causes of urinary incontinence in pregnant women

If you have a problem with urinary control during pregnancy, it is important to tell your doctor about it so that he can help you make sure that there are no pathological causes of this problem. You will need to take a urine test. If necessary, the doctor will prescribe other additional examinations.

If, according to the survey, health problems are excluded, then incontinence has exclusively physiological causes that are reversible and disappear some time after childbirth.

The most common causes of urinary incontinence in pregnant women include:

• Severe enlargement of the uterus.
• The volume and weight of the organ increases with the growth of the fetus. An enlarged uterus gradually displaces neighboring organs and puts pressure on them, including the bladder. The amount of urine produced by the kidneys increases. As a result, the overflow of the bladder occurs faster. Due to constant pressure, its volume is limited, and the urge to urinate becomes more frequent. Urinary leakage associated with this cause occurs more often in the third trimester.
• Loss of tone and overstretching of the pelvic floor muscles. This happens not only against the background of the mechanical effect of the increasing mass of the fetus, but also under the influence of the hormone progesterone. As a result, it is more difficult for a woman to control urinary retention.
• Active movements of the child. When a baby, during a change in position in the uterus, hits the bladder with a pen or leg, this can lead to involuntary leakage of urine in the expectant mother.
• Initially reduced tone of the pelvic floor muscles. It occurs more often in women who have recently given birth, in mothers of many children, in pregnant women with poor physical fitness or a large excess in weight.
• stress incontinence. During periods of strong nervous tension, the conduction of nerve impulses and the regulation of urination may be disturbed. This type of incontinence occurs already in the first weeks of pregnancy. With rare episodes of leakage of small volumes of urine, the use of a urological pad will be enough for the woman to feel free and confident again.

In addition to the main reasons listed, we can recall the factors that affect the severity of the problem. This includes fetal weight and amount of amniotic fluid and multiple pregnancies. If a pregnant woman previously had inflammation of the urinary system, exacerbations may occur during childbearing, which also provoke urinary incontinence.

Deterioration of control over urination is a source of discomfort and worries for a woman. But it is important to remember that if incontinence is caused only by physiological causes, it does not pose a danger to the mother and the unborn child, since the changes in the body associated with pregnancy are reversible. And iD LIGHT urological pads will help to maintain a feeling of comfort for the entire recovery period. The main thing for a pregnant woman is not to focus on feelings about this – after childbirth, the problem will disappear by itself.

What exercises help with incontinence?

Proper physical activity is not just a necessity for every person, but also
and an essential tool to improve urinary control.
You can read about Kegel exercises known to many in another article. And here we are
Let’s talk about new exercises to combat incontinence. With their help, you can
improve not only the muscles of the pelvic floor, but also improve the condition of the spine, muscles
back, abdomen, legs.

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Urinary incontinence in women, causes and treatment

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Urinary incontinence in women

More than half of women worldwide experience urinary incontinence. Incontinence (another name for incontinence) occurs in young women, for example, after childbirth, and in elderly patients, and in some women this delicate problem appears even in adolescence and does not go away for a long time. In any case, this negatively affects the quality of life, causes a lot of inconvenience, and therefore requires special attention.

Treatment of urinary incontinence in women largely depends on the form of the disease. Only a professional can establish the true cause and choose an effective method of treatment. If you are experiencing incontinence problems, please contact our clinic for qualified assistance.

Types of incontinence and their features

Age-related urinary incontinence

Urinary incontinence in women after 40

Over the years, the pathology progresses. One in two 40-year-old women complains of incontinence at:

• coughing;
• sneezing;
• laughter
• jumping.

The causes of urinary incontinence in women over 40 may be postpartum consequences and gynecological complications. Also, the reason may be a reduction in the synthesis of collagen in the body. The function of collagen is to maintain the elasticity of the tissues of the pelvic floor organs, urethral sphincters. Frequent stress, malnutrition, chronic lack of sleep, a sedentary lifestyle lead to hypovitaminosis and provoke the development of weakness in the pelvic floor muscles. As a result, the internal organs are displaced and lowered.

Urinary incontinence in women over 50

After 50 years, the female body begins to work differently – the hormonal background changes, the pressure can be unstable.

Causes of incontinence in women over 50:

• Diabetes mellitus, thyroid disease, overactive bladder;
• Age-related hormonal changes;
• Difficult childbirth in history;
• Chronic inflammation of the pelvic organs;
• Hypertension and medication;
• Lifting weights, straining the pelvic floor muscles, prolapsing organs.

Urinary incontinence in women over 60

Urinary incontinence in women over 60 years of age is quite common. Menopause comes, the reproductive system ceases to function, as a result, female sex hormones are not produced. Age-related changes become more noticeable, the pelvic muscles lose their tone, the walls of the urinary tract coarsen and become less elastic, the lack of female sex hormones leads to a reduced tone of the bladder. All of these can lead to incontinence.

Stress incontinence

The most common form of incontinence. The main reason for uncontrollable urination in this case is dysfunction of the urethral sphincter. Due to muscle weakness, increased intra-abdominal pressure causes uncontrolled leakage of urine.

Symptoms:

• leakage of urine even with slight exertion, sneezing, coughing, while laughing;
• there are no irresistible urges to urinate.

Causes of stress incontinence:

• Pregnancy: due to hormonal changes and increased uterine pressure on the pelvic organs, many women suffer from small urine leaks (especially often this problem manifests itself in the last stages).
• Childbirth: spontaneous childbirth with a particularly large fetus often causes damage to the muscles and ligaments of the pelvic floor, this leads to sphincter dysfunction and frequent uncontrolled urine leakage.
• Operations on the pelvic organs: the adhesive process that begins after any intervention violates the anatomical ratio of the organs and provokes an increase in pressure in the small pelvis, which can cause uncontrolled urination.
• Age-related changes: a decrease in the level of estrogen produced leads to a loss of elasticity of the ligaments and a decrease in muscle tone, which negatively affects the work of the sphincter.

The likelihood of problems with uncontrolled urination is also influenced by factors such as heredity, neurological diseases, obesity, urinary tract infections.

Stress incontinence causes a lot of trouble and significantly worsens the life of patients. In order to solve the problem once and for all, it is important not to delay going to the doctor, and at the doctor’s appointment, do not be shy and tell in detail about the symptoms so that the specialist can choose the most effective treatment for urinary incontinence.

Stress incontinence treatment features

In stress incontinence, surgical treatment is preferable. Drug therapy is effective only in some cases, while the following drugs are used: adrenomimetics (Gutron), anticholinesterase drugs (Ubretide), antidepressants (Cymbalta).

Urgent incontinence

The reason for the imperative urge to urinate frequently is the high reactivity of the bladder.

Normally, the urge to urinate occurs when a certain amount of urine accumulates in the bladder. At the same time, a woman can easily restrain her urges until the next visit to the toilet room. In the case of an overactive bladder, even a minimal amount of urine causes strong, unbearable urges.

The occurrence of urge incontinence is influenced by the same factors as in the case of stress incontinence, in addition, these two forms of incontinence often combine, giving the woman additional inconvenience.

Symptoms of urge incontinence include:

• frequent, unbearable urge to urinate;
• urges are usually determined by external factors;
• The urge to urinate is almost always sudden.

Treatment of urge urinary incontinence

To eliminate frequent imperative urge to urinate, non-drug, general methods of treatment, in particular therapeutic exercises, are preferred. Surgical intervention in this case is ineffective, and drug treatment is used only if the general methods did not give the desired result.

Drugs for the treatment of urinary incontinence in women:

• drugs that relax the bladder wall, minimize the frequency of its contractions: Vesicar, Driptan, Spasmex, Detruzitol.
• drugs that improve the blood circulation of the bladder and at the same time relax it in the filling phase: Omnic, Kaldura, Dalfaz.
• hormone replacement therapy in case of estrogen deficiency in menopausal women.

If drug therapy is not effective enough, it is also possible to use botulinum toxin type A preparations (for example, Lantox) to treat an overactive bladder.

During cystoscopy, using an endoscopic needle, a solution of the Lantox drug is injected into the wall of the bladder, which temporarily blocks the contraction of muscle fibers, reducing the reactivity of the bladder.

Drug incontinence

Otherwise, iatrogenic incontinence. This type of disease can occur as a result of taking certain drugs: adrenomimetics, diuretics, colchicine, and some sedatives.

Other forms of urinary incontinence

Uncontrollable urge to urinate and leakage of urine can also cause multiple sclerosis, damage to the brain or spinal cord, and other organic damage.

Diagnostics

Finding out the causes of incontinence and developing an effective treatment plan are impossible without a comprehensive examination, which includes the following steps:

• specialist advice

At the doctor’s appointment, the patient should be as detailed as possible about the problem and complaints. Particular attention should be paid to factors that provoke incontinence, the severity of symptoms and the time of their onset, and possible additional complaints.

It is also proposed to fill out a questionnaire created specifically for people suffering from urinary incontinence.

• urination diary

Detailed, regular records of urination and incontinence will help the doctor more accurately determine the cause of the disease and prescribe effective treatment.

• PAD test

Used to assess the severity of the disease. The pad test helps to more accurately determine the amount of urine lost, which is necessary for a correct diagnosis.

• gynecological examination

A standard examination of the external genital organs and the vagina with the help of a gynecological mirror allows you to exclude the presence of other diseases. During the examination, a cough test is also used, when the doctor checks whether urine is excreted from the urethra when coughing.

• urinalysis

Urine analysis is carried out in order to identify inflammatory processes in the organs of the genitourinary system, which can also be the cause of incontinence of small portions of urine. Infections are indicated by white blood cells, red blood cells, and bacteria in the urine.

• urodynamic studies

They include a number of tests necessary to determine the type of incontinence and assess the functional state of the bladder and urethra.

• Imaging (ultrasound, MRI)

Ultrasound is used to determine the degree of displacement of the bladder and urethra when urinating or coughing, and MRI can detect various abnormalities that other imaging methods do not show.

Treatment of urinary incontinence in women

Therapy for any type of urinary incontinence begins with fairly simple and affordable, but effective methods. These include, first of all, lifestyle correction and the implementation of special exercises:

• normalization of weight in obesity (large body weight is a serious burden on the entire body, in particular, intra-abdominal pressure increases, which negatively affects the normal arrangement of internal organs, disrupting urination)
• reduction of caffeinated beverages consumed (coffee, tea and some other drinks provoke frequent urge to urinate)
• smoking cessation (chronic nicotinic bronchitis, which many smokers suffer from, exacerbates urinary incontinence problems)
• treatment of chronic respiratory diseases
• creation and maintenance of urination regimen (the method is based on emptying the bladder at strictly defined hours, regardless of the urge to urinate)
• pelvic floor muscle training (special exercises to strengthen the sphincter muscles to get rid of involuntary urination).

Surgical methods for the treatment of stress urinary incontinence in women include:

• Sling (loop) operations

Modern minimally invasive TVT and TVT-O surgeries are considered one of the most effective ways to treat stress urinary incontinence.

The duration of the procedure is on average 30 minutes. During the operation, a special synthetic loop is placed under the middle part of the urethra, which holds the urethra in the required position and prevents involuntary leakage of urine.

The main advantages of the technique are minimally invasiveness, safety and rapid recovery. In this case, the effect is felt almost immediately.

The disadvantage of TVT and TVT-O operations is the likelihood of recurrences. But, despite this shortcoming, the method is considered the most effective.

• Bulk injections

Injections of special drugs under the control of a cystoscope are injected into the submucosa of the urethra. Fillers compensate for the missing soft tissue and thus keep the urethra in the correct position.

Gymnastics in the treatment of urinary incontinence in women

Kegel exercises

Kegel exercises for urinary incontinence in women show particular effectiveness. At the heart of gymnastics is the training of the pelvic floor muscles. To find the “necessary” muscles, it is necessary to imagine the urge to urinate while sitting and try to “hold” the imaginary stream of urine. It is the muscles involved in this process that need to be trained.

Gymnastics is performed three times a day. During training, the muscles tense and relax, gradually increasing the contraction time from a few seconds to 2-3 minutes.

Complex of exercises with biofeedback

During training, a special biofeedback apparatus (BFB) is used, which registers muscle tone. In addition to monitoring the correctness of the exercises performed, the device can also be used for electrical stimulation.

Gymnast using special equipment

If desired, during training, the patient can use special simulators that allow you to most effectively strengthen the muscles of the pelvic floor.

Prevention of urinary incontinence

To prevent problems with urination, the following rules must be observed:

• Keep your body hydrated by drinking up to 2 liters of water a day. But it should be noted: excessive drinking, as well as a lack of fluid, can adversely affect a person’s well-being.
• Create and maintain an individual urination regimen: the habit of emptying the bladder at a certain time helps to normalize urination, reduce the reactivity of the bladder.
• Do therapeutic exercises, strengthen the muscles of the pelvic floor.
• Maintain normal weight, get rid of extra pounds.
• Reduce consumption of coffee, tea, other caffeinated drinks, and salty foods.
• Give up smoking and other bad habits.
• Diet and be active to prevent constipation.