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DESCRIPTION
Stress incontinence is an involuntary loss of urine that accompanies any action that suddenly increases the pressure in the abdomen. It can affect both sexes (males rarely) and all ages. It is the most common type of incontinence in older women. Urinary incontinence is not a condition in itself, but rather a symptom of a problem with the lower urinary tract. The body stores urine (water and wastes removed from the kidneys) in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Stress incontinence is an involuntary loss of control of urine that occurs at the same time abdominal pressure is increased as in coughing or sneezing. It develops when the muscles of the pelvic floor have become weak.
COMMON TYPES OF URINARY INCONTINENCE:
Urinary Stress Incontinence: Stress incontinence is the most common bladder control problem. It occurs when coughing, laughing, sneezing, or other movements that put pressure on the bladder result in urine leakage. The bladder is rarely completely emptied. Dribbling is more common than complete evacuation of the bladder. Pelvic floor muscles support the bladder. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken.
Urinary Urge Incontinence: People who lose urine for no apparent reason while suddenly feeling the need or urge to urinate suffer from urge incontinence. Frequent urination is common with this type of incontinence, as is nocternal urination (bed wetting), especially in men. The most common cause of urge incontinence is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable," "spastic" or "overactive." Some doctors may call this condition "reflex incontinence" if it results from overactive nerves controlling the bladder. Urge incontinence can mean that the bladder empties during sleep, after drinking a small amount of water or when a sufferer touches water or hears it running (as when washing dishes or hearing someone else taking a shower). Causes of urinary stress incontinence include physical changes resulting from pregnancy, childbirth and menopause. It is the most common form of incontinence in women and is treatable. Causes of urinary urge incontinence include involuntary actions of bladder muscles that occur because of damage to the nerves of the bladder, nervous system (spinal cord and brain) or the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke and injury can harm bladder nerves or muscles. Urge incontinence may be due to prostate problems in men. Difficulty urinating in men may also be due to prostate inflammation.
MoonDragon's Obgyn Information: Urge Incontinence
Functional Incontinence: This is characterized by an uncontrollable urge to empty the bladder before you can reach the bathroom. It can be caused by stress; changes in environment, such as having to stay in the hospital and not being able to get to the bathroom in time; and mobility restrictions.
Reflux Incontinence: Some individuals are not aware when their bladders are full, and this loss of sensation can lead to urine leakage. This is reflex incontinence, and it is most often due to spinal cord injury or other neurological impairment.
Total Incontinence: Total incontinence is the unpredictable loss of urine at all times. It can be caused by neurological dysfunction, abdominal surgery, spinal cord injury, or anatomical defect.
Incontinence is most common in people over 50 years of age, but loss of bladder control can occur at any age, especially in pregnant women. It is wrong to assume that loss of bladder control is an inevitable part of getting older. It is also wrong to assume that nothing can be done about this problem.
FREQUENT SIGNS AND SYMPTOMS
Stress incontinence is the unintentional loss of urine with lifting, sneezing, singing, coughing, laughing, crying or straining to have a bowel movement. Difficulty controlling urination. The main symptom of urge incontinence is a sudden, uncontrollable need to urinate. Women experience incontinence twice as often as men.
CAUSES
Stress incontinence can be caused by a change in the relationship of the uterus to the bladder resulting in shortening of the urethra (tube from the bladder to the outside), and loss of normal muscle support for the bladder and floor of the pelvis. These changes occur during pregnancy and after childbirth, particularly repeated childbirth. Obesity is also a factor. They may also occur as a natural consequence of aging.
Stress incontinence can worsen during the week before the menstrual period in women. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.
RISK INCREASES WITH
Pregnancy, especially third trimester when the fetus and the growing uterus is putting extra pressure on the bladder.
Repeated vaginal childbirth.
Vaginal birth of large children.
Adults over 60. Menopausal women.
Obesity.
Chronic lung disease with a cough.
Pelvic floor damage, injury, trauma.
Allergies with repeated sneezing, coughing.
PREVENTIVE MEASURES
Eat a normal, well-balanced diet and exercise regularly to build and maintain muscle strength. Drink plenty of water. Avoid alcoholic beverages, caffeine, soda pop and simple sugars.
Do not smoke.
Achieve and maintain a healthy weight.
Do not put off emptying the bladder when the urge is evident. Try to empty the bladder every three to four hours.
Kegel exercises are effective in strengthening or re-train pelvic floor muscles and sphincter muscles, which can reduce or cure stress leakage. Kegal exercises are useful because weak pelvic muscles are often involved in bladder control problems. Daily exercises can strengthen pelvic muscles and improve bladder control. Exercising your muscles just five minutes three times a day can make a big difference. They are easy to do and can be done at any time (such as sitting in your car and waiting for a red light to change to green). Learn and practice Kegel exercises before symptoms of stress incontinence begin.
The National Kidney and Urologic Diseases Information Clearinghouse can supply very useful information for all types of pelvic exercises.
National Kidney & Urolologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Phone: 1-800-891-5390
Fax: 703-738-4929
Email: nkudic@info.niddk.nih.gov
Website: kidney.niddk.nih.gov
KEGEL EXERCISE:The purpose of kegel exercises is to recognize, control and develop the muscles of the pelvic floor. These are the ones used to strengthen these muscles so you can control or relax them completely:
- To identify which muscles are involved, alternately start and stop urinating when using the toilet.
- Practice tightening and releasing these muscles while sitting, standing, walking, driving, watching TV or listening to music.
- Tighten the muscles from front to back, including the anus, as in the previous exercise.
- Practice exercises every morning, afternoon and evening. Start with 5 times each, and gradually work up to 20 to 30 each time.
EXPECTED OUTCOME
If the stress incontinence is not severe enough to require surgery, exercise can improve the muscle function. If it is severe, it can often be cured with surgery.
POSSIBLE COMPLICATIONS
Complete loss of urinary control. This requires surgery.
Urinary tract infections.
Social isolation due to concern about embarrassment.
Kidney failure.
TREATMENT
GENERAL MEASURES
Urinalysis and other laboratory studies will help determine if a urinary tract infection is causing the symptoms.
Treatment as needed for any infections or tumors.
Weight loss, smoking cessation, cough suppression may be indicated. If you are overweight, adopt a healthy weight-loss diet and exercise program to help you to lose the excess pounds. Obesity is a common factor in incontinence.
Other therapy possibilities include biofeedback, electrical stimulation, or special weights to strengthen pelvic muscles.
Practice good genital hygiene.
Wear absorbent underpants or incontinence pads if needed.
Do not use "feminine hygiene sprays," packaged douches, bubble baths, or tampons, sanitary pads, or toilet paper containing fragrance. The chemicals these products contain are potentially irritating.
A pessary (support device) made of rubber or other material to fit inside the vagina to support the uterus and lower muscular layer of the bladder is helpful for some.
Frequently, it is necessary to have urodynamic testing (studies of the actual urine flow), either in the health care provider's office or at a special clinic, to evaluate the incontinence and confirm it is stress related and not a combination of stress and urge incontinence.
Surgery to tight relaxed or damaged muscles that support the bladder helps some.
Learn and practice Kegel exercises.
Additional information available from:Help for Incontinence People
P.O. Box 54
Union, SC 29379
(803) 579-7900
or
Simon Foundation
(800) 23-SIMON
Retropubic suspension is a surgical technique used to improve urinary continence. In the procedure the bladder neck and urethra within the pelvic region are elevated and stitched to the pubic bone.
Anterior vaginal wall repair is a procedure performed to improve urinary continence. The pubocervical fascia is folded and stitched to bring the bladder and urethra into the proper position.
SURGERY
Alternative names: Urethral suspension; Marshall-Marchetti-Krantz operation; MMK; Pubo-vaginal sling; Burch procedure; Trans-vaginal tape procedure; TVT procedure; Vesicourethral suspension.
Definition: Surgeries for female stress incontinence help control involuntary leakage of urine by supporting the structure of the urethra and bladder.
Description: Open bladder and urethral surgeries are usually performed to prevent urine leakage associated with stress incontinence. Stress incontinence is an involuntary leakage of urine that occurs when laughing, coughing, sneezing, or lifting. The condition can be caused by deformity or damage to the urethra, bladder, or pelvic muscles. Multiple births and menopause can cause a loss of muscle tone in the bladder area. The bladder may sag into or outside the vagina. You may feel this during sexual intercourse, or may even see the bladder protruding outside of the vagina. Surgery is done to try and return the bladder and urethra to its normal position. There are two common ways of performing stress incontinence surgery: through the abdominal wall or though the vagina. Surgery may either require general anesthesia, local anesthesia, or regional (spinal) anesthesia. You may return from surgery with a Foley catheter or a suprapubic catheter in place. The urine may initially appear bloody, but this should gradually go away. How long the Foley or suprapubic catheter stays in place depends on your ability to completely empty your bladder. It may be removed several days after surgery or, in rare cases, it may stay in place for a longer period of time.
Another treatment option uses a cystoscope (tube to view the bladder area) to inject a bulking agent such as collagen into the urethra. Such injections help make the opening of the urethra smaller, which prevents urine loss.
Indications: Repair of the bladder and urethra may be recommended for treatment of stress incontinence (inability to prevent urine leakage when coughing, sneezing, laughing, jumping, walking, sitting, or standing).
Risks for these types of surgeries may include:
- Bladder or urethra injury.
- Incomplete cure of stress incontinence.
- Urinary retention.
- Overactive bladder.
Risks for any anesthesia are:
- Reactions to medications.
- Problems breathing.
Risks for any surgery are:
- Bleeding.
- Infection.
Expectations after surgery: This surgery can be very helpful for people with stress incontinence.
Convalescence: The amount of time it takes to recover from surgery depends on the individual. Based on an evaluation of your health status prior to surgery, your health care provider can give you a good estimate of your recovery time.
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MEDICATION
Sympathomimetic (alpha-adrenergic) drug therapy, which helps urethral muscles, may be prescribed. Tolterodine (Detrol), an antispasmodic drug, may be prescribed for some types of incontinence. Muscle relaxers and calcium channel blockers may be tried as well.
Local injections of Botilinum toxin (BoTox) are sometimes recommended for men who have bladder control difficulties related to prostate problems.
Cantharis is a homeopathic remedy for pain during urination and for frequent urination.
Antibiotics may be prescribed if there is a complicating urinary tract infection.
Estrogen therapy may be prescribed.
Kidney Bladder Formula from Nature's Way and SP-6 Cornsilk Blend from Solaray are herbal formulas that have a diuretic effect and reduce bladder spasms. Take 2 capsules twice daily. (See products below.)
ACTIVITY
No specific activity restrictions. However, if you have problems with stress or urge incontinence, it is wise to keep your bladder as empty as possible with frequent restroom visits and/or either stay near a restroom to help prevent accidents. If you are traveling, stop frequently at rest areas to relieve your bladder. Wearing incontinence pads or other feminine product pads may help with unexpected emergencies (such as lifting, coughing or sneezing) or if you are traveling long distances where you may not have frequent restroom visits. Do not delay emptying the bladder. Make sure that you urinate every two to three waking hours, often referred to as "voiding by the clock."
If you have surgery to repair a problem, consult with your health care provider about any specific activity restrictions you may need to know about.
DIET
Decrease amount of caffeine, carbonated beverages, coffee, chocolate, refined or processed foods, and alcohol. Caffeine is a natural diuretic and alcohol (especially beer) may increase the need for frequent urination. Avoid soda pop and simple sugars. Chemicals in foods, drugs, and impure water have an adverse effect on the bladder.
Start a weight loss program if being overweight is a problem.
Avoid high volume of fluid intake in situations where access to bathroom facilities is limited (airplane or road trips, shopping).
Beneficial Dietary Supplements:
- Vitamin C with Bioflavonoids help with the formation of collagen, which is important for those suffering from incontinence.
- Vitamin A helps the body produce collagen and can also encourage the strength of cartilage.
- Manganese is needed for healthy bones, cartilage and skin.
- Amino Acids helps strengthen the bladder muscle.
- Multivitamin and Mineral Supplements supplies all necessary nutrients and relieves stress.
- MSM and SAM-e normalize the bladder lining.
- Kava Kava is an anti-spasmodic traditionally used by Hawaiians for urinary difficulties. It can help ease bladder contractions and acts as a sedative.
- Cranberry is an acidic known to benefit the bladder.
- Saw Palmetto has shown exceptional results for bladder control problems in both males and females.
- Zinc is effective in improving bladder function.
URINARY INCONTINENCE SUPPLEMENTAL PRODUCTS
Information, supplements and products for urinary incontinence, the involuntary release of urine.
NUTRITIONAL SUPPLEMENTS
NUTRIENTS Supplement Suggested Dosage Comments Very Important Free-Form Amino Acid Complex As directed on label. Helps to strengthen bladder muscle. Use a product made from a vegetarian source. Branched Chain Amino Acid Powder, Now Foods, 12 oz., Branched Chain Amino Acids, Free Form, 120 Caps Important Calcium
And
Magnesium1,500 mg daily.
750 mg daily.To aid in controlling bladder spasms. Just An Ounce Calcium & Magnesium Liquid Supplement, Almond Flavor, 16 oz. Helpful Vitamin E 200 IU daily or 400 IU every other day. Use d-alpha-tocopherol form. Vitamin E d-alpha tocopherol, Nature's Way, 400 IU, 100 Softgels Vitamin A
Plus
Natural beta-carotene
Or
Carotenoid complex (Betatene)As directed on label. If you are pregnant, do not exceed 10,000 IU daily. Antioxidants that enhance immunity and to aid in normalizing bladder muscle function. Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels, Beta Carotene (Natural Dunaliella salina), Nature's Way, 100% Nature, 25,000 IU, 100 Softgels, Multi-Carotene Antioxidant Complex, Nature's Way, 60 Softgels Zinc 80 mg daily. Do not exceed a total of 100 mg daily form all supplementst. Important for improved bladder function. Also enhances the immune system. Use zinc gluconate lozenges or OptiZinc for best absorption. Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps, Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges, Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz. Potassium 99 mg daily. Aids in balancing sodium and potassium in the body. Potassium, 100% Natural, Nature's Way, 99 mg, 100 Caps, Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz.
Opuntia (Prickly Pear), Nature's Way 250 mg, 100 Caps
Nature's Way Opuntia prickly pear flowers (Opuntia ficus-indica) were traditionally used as medicine for male urinary discomforts. It was also used externally as an ointment.Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.U I Check, Urinary Incontinence Product, 100% Natural, 500 mg, 60 Caps
U-I-Check consists of 38 natural herbs to relieve the Low-Yang symptoms including: involuntary urine leaks such as Urinary Incontinence, Bed-Wetting, etc. related to symptoms of aging and stress.Kidney Bladder Formula w/ Uva Ursi, Nature's Way, 465 mg, 100 Caps
Nature's Way Kidney Bladder Formula contains Uva Ursi ( Bearberry ) and Juniper berry, two historically popular for kidney and bladder complaints.Kidney / Bladder Formula Tincture, 100% Organic, 2 fl. oz.
Use the Kidney Bladder Formula for Auto-immune Diseases, Bladder, Cancer, Cold Sores and deposits.Urinary Formula w/ Cranberry Fruit, 480 mg (per cap), 100 Caps
Urinary formula uses concentrated cranberry fruit, to maintain a healthy urinary tract and Dandelion leaf, traditionally used for supporting regular urination.Prostate Formula w/ Saw Palmetto, 60 Caps
Prostate Formula promotes prostate health by utilizing a host of beneficial supplements. Including, Saw Palmetto extract, a widely researched phyto-medicine that promotes prostate health. Zinc, an essential nutrient abundantly found in reproductive and prostate fluids, and Dandelion leaf, a popular herb traditionally used for supporting regular urination.Leak Control, Incontinence Treatment, TCM Formula Ludi Kongquan, 100% Natural, 500 mg, 60 Caps
A formulation of Chinese herbs used to strengthen the urinary muscles and enhance urine withholding power providing help for those suffering from incontinence.Prostol Prostate Formula Nature's Way, 120 Softgels
Prostol is the only prostate proven to be a "dual enzyme inhibitor," and to be more effective than Saw Palmetto alone.Cranberry Extract STD w/ Ester C, Nature's Way, 400 mg, 120 Tabs
Cranberry Extract with Ester is primarily useful for female adults and those with chronic or recurrent urinary tract infection. used to prevent urinary tract infection and relieve cramps and spasms. It also helps maintain a healthy urinary tract by inhibiting the adhesion of E. coli bacteria to the lining of the bladder.Vitamin A, 10,000 IU, 100% Natural, 100 Softgels
Nature's Way Vitamin A is an important nutrient in maintaining cell membrane integrity. It also plays an important role in proper bone formation, reproduction and vision.Manganese Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz.
WaterOz Ionic Manganese is a pure liquid Manganese supplement. Manganese, also called the "brain mineral," is important in the utilization of all mental facilities/functions.Saw Palmetto Standardized Extract, 160 mg, 60 Softgels
A liposterolic extract of the fruit of Saw Palmetto is the most popular herbal supplement for the promotion of prostate health in Europe. Saw Palmetto is the ideal supplement for men interested in supporting normal urinary flow.Grape Seed Extract, Standardized, Nature's Way, 100 mg, 30 Caps
Grape seeds (Vinis vinifera) are an excellent source of oligomeric proanthocyanidins (OPCs) and have been the subject of clinical research in France for their antioxidant activity. Antioxidants play an important role in the development of collagen including skin, connective tissue and vascular walls.Fem-Mend Formula w/ Blessed Thistle, Nature's Way, 430 mg, 100 Caps
Fem-Mend combines herbs like Uva Ursi, Cramp bark, Blessed thistle and others made for women to maintain a healthy lifestyle. The herbs found in Nature's Way Fem-Mend are used in herbal combinations world-wide and are valued by the modern women who use them.Horsetail Herb Grass, Nature's Way, 440 mg, 100 Caps
Horsetail herb is rich in "beauty" nutrients that nourish the nails, skin, hair, bones and the body's connective tissue. It is also benefits the glands and urinary tract. Horsetail helps heal fractured bones because of its rich supply of nutrients.Corn Silk, Nature's Way, 425 mg, 100 Caps
Corn Silk (Zea mays) was used traditionally as a mild diuretic. It is often included in herbal preparations for the bladder and urinary tract. Used by Native Americans for urinary complaints.Energy Drink, Ola Loa Vitamin Energy Supplement Powder Drink Mix, Orange Repair, 30 Packets
Ola Loa is the most extensive vitamin and mineral supplement available in a great tasting effervescent energy drink.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Click Here To Visit Herbal Remedies Product Page
HELPFUL INCONTINENCE PRODUCTS
(Amazon.com has approximately 2,500 products listed under incontinence. I have tried to select an assortment of various products. If you don't see something in a correct size or brand, most likely they have it, but I didn't include it here for lack of space. You can contact me if you have specific needs and I will try to locate it and send you the link to the product. You can email me at moondragon2@aol.com. Put incontinence products needed in the subject line.)
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of stress incontinence.
Signs of infection: fever, pain on urination, frequent urination or a general ill feeling.
Symptoms don't improve after 3 months of Kegel exercises, or they become intolerable and you wish to consider alternatives (e.g., surgery).
