(NOTE FOR READERS: Content for this article is derived from answers at the McLeod Women’s Health Forum “Straight Talk.” This article contains straightforward discussions of women’s health problems and is designed for mature readers.)
Female urine leakage – or more gently, incontinence – can end up afflicting one out of 3 women. It’s not something you want to live with and it can be treated. As McLeod OB/GYN Marla Hardenbergh, MD, told the 100 women attending the Straight Talk forum, the first step is seeing your doctor for a proper diagnosis:
Here are the highlights of Dr. Hardenbergh’s comments:
When you see your Gynecologist and you’re having a problem with urinary incontinence, the causes can be complicated and it can have several origins. In order for us to fix in correctly, we have to diagnose it correctly.
There are two main types of incontinence.
Stress urinary incontinence is when the tube from the bladder (urethra) is not where it’s supposed to be. The correct position is about a 45-degree angle from horizontal. When you increase the pressure in your belly, the tube drops to the horizontal level and urine is released. If the tube is always sitting flat at the horizontal, it doesn’t take much pressure to cause urine to come out.
Urge incontinence involves the bladder muscle. In order to urinate, there’s a complex response process that must go through your spinal cord and nerves when you’re ready to go. These spinal nerves trigger the bladder muscle to contract. The muscles around the tube from the bladder relax and the urine comes out. With urge incontinence, the bladder muscle is contracting without the spine nerves telling it to. You feel like you need to go. And if you don’t get to the bathroom in time, you’re going to urinate anyhow.
Because Stress and Urge Incontinence are two different problems, treatment for the two types of incontinence is obviously different. Your Gynecologist needs a thorough history. So you’ll have to answer a lot of questions about your symptoms.
I have my patients keep a bladder diary to compile some more information. It’s important, because the information I give to a patient is only as good as the information the patient gives me.
In the office, I do a simple test. It involves inserting a tube (Foley catheter) into your bladder and filling it up with a measured amount of liquid. While you’re holding that liquid in your bladder, I’ll talk with you. Ask you some questions. All the while, I’ll be watching your bladder muscle to see if it’s contracting. I’ll have you hold your breath and strain (called Balsalva) in a few different positions. Then, I will have you pass the urine while I time it. And I measure how much urine remains in your bladder. I’ve learned that this process gives me enough information to be able to determine what’s going on.
Women who have stress urinary incontinence often also have some component of urge incontinence. It’s very common for there to be some mix of these two.
If it’s a pelvic organ prolapse problem, then the uterus may be dropping down behind the bladder after the uterus drops or the rectum comes up. If a woman has this problem, we have to reposition the bladder correctly before we do the test.
So there are a lot of elements involved in diagnosing which type of incontinence you have and what’s causing it.
As a sort of preventive measure, I ask all my patients during their annual exam if they’re having any trouble with incontinence. I believe that a lot of women just think, “It’s happening. I have it. There’s nothing I can do about it.”
That’s not true. We can do something about your incontinence, but we need to talk about it to determine what we can do.
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