This is Part II of the urinary incontinence series and is based on my interviews with local urologist, Dr. Marelyn Medina from McAllen. This week’s topic is: Incontinence, Female Symptoms and Causes. Last week’s topic was Part I: Incontinence with Males. Below is the information provided by Dr. Medina.
Female incontinence can best be discussed by organizing it into three subcategories: stress incontinence, urgency incontinence and over-flow incontinence. It is also important to emphasize that a woman may exhibit two types of incontinence at the same time, each requiring different treatment approaches.
Stress incontinence occurs when urine is lost following abdominal exertion. The woman sneezes, coughs or exercises when suddenly urine comes out, either in the form of a few drops or a complete emptying of the bladder. Women requiring more than a thin panty liner to control this symptom usually require treatment. The main cause is a weakening of pelvic and vaginal muscles. This can be a consequence of pregnancy, weight gain or general muscle weakening which can come with age. The result is a misalignment of the bladder and the urethra. When these two organs are not in proper position in relationship to each other, the natural closing mechanisms at the base of the bladder malfunction.
Correction of the situation in mild forms consists of performing “Kegel” pelvic exercises along with weight loss and attention to nutrition. Kegel exercises are performed by tightening the pelvic floor muscles and holding for 3 to 5 seconds. Release and relax the muscles before squeezing again. They can be done while urinating or in any sitting or standing position.
Failure to achieve improvement by this method may require “a bladder lift operation.” Dr. Medina prefers to perform these operations without the use of artificial materials such as mesh slings. She states it is best to avoid the placement of these devices into the vagina because if a post operative complication occurs it is very difficult to remove them. She has also seen these slings cause bladder stones.
Urgency incontinence is characterized by a sudden loss of urine while a woman is going about her normal activities, or just before reaching the bathroom to void. This can be caused when the bladder is overly active as a consequence of infection. It may also be present when there is lower back arthritis that injures the nerves supplying the bladder.
Substances that are taken orally may also cause bladder irritation and initiate involuntary contractions. These may be difficult to identify but may consist of different food items, therapeutic drugs or unsuspecting toxins that have made they way into the body. The treatment for this type of incontinence consists of prescribing antibiotics if infection is present or bladder relaxing medications that can slow down bladder emptying.
Both of these different types of treatments can result in unpleasant adverse side effects. Oral antibiotics can sometimes cause growth of resistant bacteria as well as offset the delicate balance in the bowels between the many indwelling essential microorganisms called probiotics. We now know that not all bacteria are “bad.” Some are actually necessary in order to process vitamins, enhance digestion and elimination of waste products in the bowels.
In some people, the bladder relaxing medications can also lead to chronic constipation excessive dry mouth or affect the eyes.
Over-flow incontinence occurs when the bladder becomes too weak and empties incompletely. Because the bladder never fully empties, the sensation to urinate is constantly present and at times results in an intermittent leaking of urine. A number of medical conditions can lead to over-flow incontinence. Among these, the most common are diabetes, strokes, multiple sclerosis and chronic constipation.
Before initiating treatment, it is important to establish how much urine is left in the bladder immediately after urinating. This can best be done by performing a bladder catheterization with a tiny urethral catheter. Knowing the amount of residual urine will help distinguish between the different types of urinary incontinence. Treatments consist of the use of medications, bladder training, or selective surgical procedures.
Urinary incontinence is not normal and can be improved or cured in the majority of cases by seeking professional care. Next week’s column is Part III — Child Incontinence. For a consultation, Dr. Marelyn Medina can be reached at The Family Urology Center in McAllen at 956-686-7243.
Mary Garza Cummings is a free-lance writer. The Town Crier does not warrant the information as valid. It is the responsibility of the reader to ensure validity of the information. For comments, email firstname.lastname@example.org.