One of the common problems that women, especially older women face is a leaky bladder. Called urinary incontinence in medical parlance it is the accidental passing of urine. It can happen when the woman coughs, laughs, sneezes, or jogs. There may be a sudden urge to go to the bathroom but the woman can't get there in time. Or there may be no warning before the accidental spill-over which may happen even when the bladder is not full. Some women may leak urine even at the sight or sound of running water.
A leaky bladder can be a short-term problem caused by a urinary tract infection, a medicine, or constipation. Medicines that increase urine production (such as diuretics) or relax the bladder (such as anticholinergics and antidepressants) can cause a temporary incontinence. When the infection is treated or the medicine discontinued or constipation tackled, the condition almost always gets better. However, in most cases the incontinence is ongoing.
What causes this continuous condition of a leaky bladder? In older women the muscles or nerves of the lower urinary tract get weakened. The pelvic floor muscles cannot support the bladder properly, the bladder slips down against the vagina and you cannot voluntarily tighten the muscles that close the external urinary opening. So urine leaks when you laugh or jog. This is called stress incontinence.
This is very common in women who are elderly or have had multiple childbirths. Other causes include obesity, pelvic organ prolapse, chronic cough, diabetes, having bladder stones, having had a hysterectomy or chronic bladder infections.
Another type of incontinence is when the bladder is over active because of irritation or emotional stress. This causes the bladder to push urine out. This also happens if the woman has suffered a stroke or has certain brain conditions like Alzheimer's, Parkinsonism, Multiple Sclerosis or spinal cord injury. There may be a sudden and recurrent urge to urinate. The urine may leak in large amounts and run down one's legs. This is called urge incontinence.
Treatment depends upon the cause of the incontinence. This may include simple pelvic floor exercises called Kegel exercises to strengthen the pelvic floor muscles. Squeeze and release the muscles that are used to hold in our urine. Other treatments include medications, bladder training, the use of a pessary. Sometimes surgery may be required.
In many cases, certain lifestyle changes can be enough to control incontinence.
Cutting back on caffeine drinks, coffee, tea, colas and alcohol.
Eating foods high in fiber to help avoid constipation.
No smoking to prevent and treat chronic cough.
Staying lean and fit.
Doing pelvic-floor exercises regularly.
Going to the bathroom at regular intervals.
Wearing clothes that can be removed easily.
If home treatment is not effective or if the continence happens suddenly or if it is interfering with your life then you need to see your doctor. Do not let embarrassment stop you from seeking help as the condition can certainly improve with medical advice.
In some cases of urge incontinence certain medications such as Darifenacin, Mirabegron or
Oxybutynin may be prescribed. Sometimes local oestrogen cream or gel may help.
If other other medicines don't work sometimes Botox is given as a shot to help relax the bladder muscles. You may need to get a shot every 3 months. Side effects may include having pain when you urinate, not being able to urinate easily, and getting a urinary tract infection (UTI). If you get a Botox shot, you may need to take antibiotics to reduce your risk for getting an infection.
Various types of surgeries to correct stress incontinence, seek to lift the urethra, the bladder, or both into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.
Surgery may be the best option if other ways to beat incontinence have not worked. This is especially true for stress incontinence. The kind of surgery you have depends on your preference, your health, and your doctor's experience.
Unfortunately, surgery does not work for urge incontinence. Surgery may help women who have mixed incontinence which means that they have both stress and urge incontinence, but only by rectifying the stress component.