When you tell your friends and family “don’t make me laugh,” are you someone who really means it? Or, do you dread coughing or sneezing too hard, or being too far away from a bathroom in case the urge to go becomes overwhelming? Many women experience loss of bladder control as they age, for a variety of reasons. The condition can range from mild urinary leaking to uncontrollable wetting, and can affect anyone, although it becomes more common with age. One in three women is likely to experience urinary incontinence at some point in their lifetimes.
“Urinary incontinence can seem like an embarrassing problem, but it’s not an uncommon one, especially for women over the age of 50,” says Dr. Bela Kudish, founder of Florida Hospital Medical Group’s Urogynecology Center for Women. “For most women, the loss of bladder control begins with childbirth/childbearing resulting in weakening of the supports and muscles around the urethra and bladder. As we age the bladder muscles may also become too weak or too active.”
How does it happen?
Of course, you know the function of the bladder is to store urine until you find an appropriate time and place to urinate. A normal bladder acts like a reservoir and can hold around two cups of urine. The muscles of the bladder wall remain relaxed while the bladder fills. When it’s full, it signals your brain to head to the bathroom. When you urinate, the bladder empties through the urethra, where three sets of muscles – the internal and external sphincters and the pelvic floor muscles — work together like a dam, keeping urine in the bladder between trips to the bathroom.
“When you urinate normally, the brain signals the bladder to squeeze urine out and signals the sphincters to relax so the ‘dam’ can open and urine can flow out,” says Dr. Kudish. “Incontinence occurs when the signals between the brain and the bladder get crossed, or the sphincters do not squeeze strongly enough, or both. The bladder muscle may contract too much or not enough. If the sphincter muscles or the nerves controlling them are damaged, it may mean the sphincter muscles are functioning poorly.” These issues can be exacerbated, Dr. Kudish says, by factors unique to women, such as pregnancy, childbirth, obesity, pelvic organ prolapse, or hormonal changes.
What’s your type?
There are several types of urinary incontinence, including:
Stress incontinence: This is the most common type of incontinence in women, after delivering kids, in their 20s and 30s and occurs when there is the leakage of urine during exercise, coughing, sneezing, lifting heavy objects, laughing, or other body movements that put pressure on the bladder.
Urge incontinence: This type of urinary incontinence usually presents later in life. It is characterized by the inability to hold urine long enough to make it to the bathroom and is often found in women as we age and those of us with conditions such as stroke, dementia, multiple sclerosis, Parkinson’s disease and diabetes.
Mixed incontinence: This is a combination of urge and stress incontinence, and is more common among older women.
There is hope.
Advancements in urogynecology — a women’s health subspecialty focusing on disorders of the female pelvic floor such as pelvic organ prolapse, incontinence, constipation and painful intercourse – mean improved outcomes for women dealing with these disorders. Depending on the underlying cause of the urinary incontinence, treatments could include medications, therapeutic bulking injections, nerve stimulation, acupuncture-like therapy, and a range of minimally invasive surgical solutions. “It’s not like when your mother and grandmother were going through this,” Dr. Kudish says. “Today, there are more treatments for urinary incontinence than ever before — everything from exercises that can be performed at home to drug therapies and surgeries. Using these advanced techniques, a urogynecologist can diagnose your condition and help restore your quality of life.”
About Dr. Kudish
Bela Kudish, MD, FACOG, FPMRS, helps lead the Urogynecology Center for Women, a flagship medical practice. She is board-certified and fellowship-trained in urogynecology and offers a multidisciplinary approach for pelvic floor disorders. For more information, visit UrogynOrlando.com or call 407-357-0688.