American Medical Association Family Medical Guide - American Medical Association [594]
Stress Incontinence
A sheet of muscles called the pelvic floor muscles lies at the base of the abdomen. These muscles support the bottom of the bladder and help close the top of the urethra, the short channel through which urine passes. When you have stress incontinence, your pelvic floor muscles are so weak that the pressure produced by coughing, sneezing, or laughing can cause an involuntary release of urine.
Stress incontinence is very common—up to 50 percent of women over age 60 experience it to some degree. The pelvic floor muscles can be weakened by vaginal childbirth or obesity. The lack of estrogen after menopause can also weaken these muscles, sometimes producing prolapse of the uterus or vagina (see page 872). Chronic lung conditions, such as emphysema (see page 656), that cause persistent coughing, can also contribute to stress incontinence.
At any age, women can have stress incontinence during exercise, particularly high-impact sports such as running, because repeated jumping can put pressure on the bladder. More than half of all gymnasts and one of every three women who regularly exercise has had stress incontinence.
Diagnosis
To diagnose stress incontinence, the doctor will ask you questions about the activities that tend to cause the leaking of urine. You will probably be asked to provide a midstream urine specimen in which you collect a sample of urine in a sterile container after you have started to urinate. The urine sample is checked for bacteria or other signs of infection. The doctor may ask you to keep a diary of when and how often the leaking occurs.
The doctor may recommend other diagnostic procedures, including a voiding cystogram (an X-ray of your bladder taken while you are urinating), cystoscopy (in which the doctor uses a viewing instrument to see inside your urethra and bladder), and urodynamic testing (which involves filling the bladder with water and then inserting a device that measures the pressure inside the bladder).
Treatment
The treatment for stress incontinence usually includes doing Kegel exercises (see page 874) regularly to strengthen the pelvic floor muscles that support the bladder. If you are overweight, your doctor will recommend that you lose weight because extra weight around the abdomen puts pressure on the pelvic floor muscles. If you are past menopause, the doctor may recommend hormone therapy (see page 853) to help strengthen these muscles. If these measures do not relieve the condition, your doctor may recommend surgery to tighten the pelvic floor muscles.
To relieve stress incontinence that occurs during exercise, try wearing a tampon while you exercise because it will slightly close off the opening to the urethra. Your doctor may be able to prescribe a device called a pessary that, when inserted into the vagina, can help elevate the urethra and block urine leakage.
Urge Incontinence
Urge incontinence, also called irritable bladder, is a condition in which the bladder contracts uncontrollably, causing a sudden urge to urinate. You may pass a small amount of urine before you are able to reach a bathroom. Why certain people develop an irritable bladder is not known, but it sometimes occurs at the same time as a urinary tract infection (see previous page), stress incontinence (see previous page), or a pelvic support problem (see page 872) such as a prolapsed uterus. The condition can also result from damage to the nerves or muscles of the bladder in people who have a neurological disorder such as multiple sclerosis (see page 696), Parkinson’s disease (see page 691), Alzheimer’s disease (see page 688), stroke (see page 669), or a brain tumor (see page 682).
Diagnosis
If you have symptoms of urge incontinence (repeated, sudden urges to urinate), your doctor will ask you to provide a midstream urine specimen, in which you collect a sample of urine after you have started to urinate. The sample is sent to a laboratory, where it is analyzed for bacteria and other signs of infection. Your doctor may also arrange for other diagnostic procedures, including a