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Urinary incontinence in women
Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference.
But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.
While urinary incontince affects older women more often than younger women, the onset of incontinence is not inevitable with age.
Incontinence is treatable and often curable at all ages.
Women with incontinence may not seek medical assistance due to embarrassment.
Incontinence in women usually occurs because of problems with muscles that help to hold or release urine.
The body stores urine - water and wastes removed by the kidneys - in the urinary 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.
Types of Urinary incontinence (Bladder Infection)
Stress urinary incontinence
Stress incontinence is urinary incontinence that is caused by actions such as coughing, laughing, sneezing, exercising or other movements that increase intrabdominal pressure and thus increase pressure on the bladder.
Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence.
It is the most common form of incontinence in women and is treatable.
The bladder is supported by muscles of the pelvic floor. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. 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.
Stress incontinence can worsen during the week before the menstrual period. 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.
Urge incontinence
Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is inappropriate bladder contractions.
Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." It may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder.
Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower).
Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves.
Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury--including injury that occurs during surgery--all can harm bladder nerves or muscles.
Functional incontinence
People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet.
A person with Alzheimer's disease, for example, may not think well enough to plan a timely trip to a restroom.
A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women in nursing homes.
Overflow incontinence
Overflow incontinence occurs when the patient's bladder is always full so that it frequently leaks urine. Weak bladder muscles or a blocked urethra can cause this type of incontinence.
Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra.
Overflow incontinence is rare in women.
Other types of incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence - and this combination in particular - are sometimes referred to as "mixed incontinence." "Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.
Treatment of incontinence
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles
and sphincter muscles can reduce or cure stress leakage. Women of all
ages can learn and practice these exercises, which are taught by a
health care professional.
Most Kegel exercises do not require equipment. However, one
technique involves the use of weighted cones. For this exercise, the
patient stands and holds a cone-shaped object within her vagina. As the
patient becomes accustomed to the weight, cones of increasing weight
are substituted to strengthen the muscles that help keep the urethra
closed.
Electrical stimulation
Brief doses of electrical stimulation can strengthen muscles in the
lower pelvis in a way similar to exercising the muscles. Electrodes are
temporarily placed in the vagina or rectum to stimulate nearby muscles.
This will stabilize overactive muscles and stimulate contraction of
urethral muscles. Electrical stimulation can be used to reduce both
stress incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your
body's functioning. By using electronic devices or diaries to track
when your bladder and urethral muscles contract, you can gain control
over these muscles. Biofeedback can be used with pelvic muscle
exercises and electrical stimulation to relieve stress and urge
incontinence.
Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that
use biofeedback. In timed voiding, you fill in a chart of voiding and
leaking. From the patterns that appear in your chart, you can plan to
empty your bladder before you would otherwise leak. Biofeedback and
muscle conditioning--known as bladder training--can alter the bladder's
schedule for storing and emptying urine. These techniques are effective
for urge and overflow incontinence.
Medications
Medications can reduce many types of leakage. Some drugs inhibit
contractions of an overactive bladder. Others relax muscles, leading to
more complete bladder emptying during urination. Some drugs tighten
muscles at the bladder neck and urethra, preventing leakage. And some,
especially hormones such as estrogen, are believed to cause muscles
involved in urination to function normally.
Medications can produce harmful side effects if used
for long periods. In particular, estrogen therapy has been associated
with an increased risk for cancers of the breast and endometrium
(lining of the uterus).
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Pessaries
A pessary is a medical device that is inserted into the vagina. The
most common kind is ring shaped, and is typically recommended to
correct vaginal prolapse. The pessary compresses the urethra against
the symphysis pubis and elevates the bladder neck. For some women this
may reduce stress leakage. If you use a pessary, you should watch for
possible vaginal and urinary tract infections and see your doctor
regularly.
Implants
Implants are substances injected into tissues around the urethra.
The implant adds bulk and helps to close the urethra to reduce stress
incontinence. Collagen
from cows and fat from the patient's body have been used. Implants can
be injected by a doctor in about half an hour using local anesthesia.
Implants have a partial success rate. Injections must be repeated
after a time because the body slowly eliminates the substances. Before
you receive collagen, a doctor must perform a skin test to determine
whether you would have an allergic reaction to the material.
Surgery
Doctors usually suggest surgery to alleviate incontinence only after
other treatments have been tried. Many surgical options have high rates
of success.
Most stress incontinence results from the bladder dropping down
toward the vagina. Therefore, common surgery for stress incontinence
involves pulling the bladder up to a more normal position. Working
through an incision in the vagina or abdomen, the surgeon raises the
bladder and secures it with a string attached to muscle, ligament, or
bone.
For severe cases of stress incontinence, the surgeon may secure the
bladder with a wide sling. This not only holds up the bladder but also
compresses the bottom of the bladder and the top of the urethra,
further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a
doughnut-shaped sac that circles the urethra. A fluid fills and expands
the sac, which squeezes the urethra closed. By pressing a valve
implanted under the skin, you can cause the artificial sphincter to
deflate. This removes pressure from the urethra, allowing urine from
the bladder to pass.
Catheterization
If you are incontinent because your bladder never empties completely
(overflow incontinence) or your bladder cannot empty because of poor
muscle tone, past surgery, or spinal cord injury, you might use a catheter
to empty your bladder. A catheter is a tube that you can learn to
insert through the urethra into the bladder to drain urine. Catheters
may be used once in a while or on a constant basis, in which case the
tube connects to a bag that you can attach to your leg. If you use a
long-term (or indwelling) catheter, you should watch for possible
urinary tract infections.
Other procedures
Many women manage urinary incontinence with pads that catch slight
leakage during activities such as exercising. Also, you often can
reduce incontinence by restricting certain liquids, such as coffee,
tea, and alcohol.
Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers--especially
elderly women in nursing homes. This is unfortunate, because diapering
can lead to diminished self-esteem, as well as skin irritation and
sores. If you are an elderly woman, you and your family should discuss
with your doctor the possible effectiveness of treatments such as timed
voiding, pelvic muscle exercises, and electrical stimulation before
resorting to absorbent pads or undergarments.
Hospitals often use some type of incontinence pad, a small but highly absobant sheet placed beneath the patient, to deal with incontinence or other unexpected discharges of bodily fluid. These pads are especially useful when it is not practical for the patient to wear a diaper.
Urinary incontinence in children
Babies are incontinent, some older children also.
In the United States, at least 13 million people have problems
holding urine until they can get to a toilet. This loss of urinary
control is called "urinary incontinence" or just "incontinence."
Although it affects many young people, it usually disappears naturally
over time, which suggests that incontinence, for some people, may be a
normal part of growing up. No matter when it happens or how often it
happens, incontinence causes great distress. It may get in the way of a
good night's sleep and is embarrassing when it happens during the day.
That's why it is important to understand that occasional incontinence
is a normal part of growing up and that treatment is available for most
children who have difficulty controlling their bladders.
How Does the Urinary System Work?
Urination, or voiding, is a complex activity. The bladder is a
balloonlike muscle that lies in the lowest part of the abdomen. The
bladder stores urine, then releases it through the urethra, the canal
that carries urine to the outside of the body. Controlling this
activity involves nerves, muscles, the spinal cord, and the brain.
The bladder is made of two types of muscles: the detrusor, a
muscular sac that stores urine and squeezes to empty, and the
sphincter, a circular group of muscles at the bottom or neck of the
bladder that automatically stay contracted to hold the urine in and
automatically relax when the detrusor contracts to let the urine into
the urethra. A third group of muscles below the bladder (pelvic floor
muscles) can contract to keep urine back.
A baby's bladder fills to a set point, then automatically contracts
and empties. As the child gets older, the nervous system develops. The
child's brain begins to get messages from the filling bladder and
begins to send messages to the bladder to keep it from automatically
emptying until the child decides it is the time and place to void.
Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.
Incontinence happens less often after age 5: About 10 percent of
5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds
experience episodes of incontinence. It is twice as common in boys as
in girls.
Causes of nighttime incontinence
After age 5, wetting at night--often called bedwetting
or sleepwetting--is more common than daytime wetting in boys. Experts
do not know what causes nighttime incontinence. Young people who
experience nighttime wetting tend to be physically and emotionally
normal. Most cases probably result from a mix of factors including
slower physical development, an overproduction of urine at night, a
lack of ability to recognize bladder filling when asleep, and, in some
cases, anxiety. For many, there is a strong family history of
bedwetting, suggesting an inherited factor.
Slower physical development
Between the ages of 5 and 10, incontinence may be the result of a small
bladder capacity, long sleeping periods, and underdevelopment of the
body's alarms that signal a full or emptying bladder. This form of
incontinence will fade away as the bladder grows and the natural alarms
become operational.
Excessive output of urine during sleep
Normally, the body produces a hormone that can slow the making of
urine. This hormone is called antidiuretic hormone, or ADH. The body
normally produces more ADH at night so that the need to urinate is
lower. If the body doesn't produce enough ADH at night, the making of
urine may not be slowed down, leading to bladder overfilling. If a
child does not sense the bladder filling and awaken to urinate, then
wetting will occur.
Anxiety
Experts suggest that anxiety-causing events occurring in the lives
of children ages 2 to 4 might lead to incontinence before the child
achieves total bladder control. Anxiety experienced after age 4 might
lead to wetting after the child has been dry for a period of 6 months
or more. Such events include angry parents, unfamiliar social
situations, and overwhelming family events such as the birth of a
brother or sister.
Incontinence itself is an anxiety-causing event. Strong bladder
contractions leading to leakage in the daytime can cause embarrassment
and anxiety that lead to wetting at night.
Genetics
Certain inherited genes appear to contribute to incontinence. In 1995,
Danish researchers announced they had found a site on human chromosome
13 that is responsible, at least in part, for nighttime wetting. If
both parents were bedwetters, a child has an 80 percent chance of being
a bedwetter also. Experts believe that other, undetermined genes also
may be involved in incontinence.
Obstructive sleep apnea
Nighttime incontinence may be one sign of another condition called
obstructive sleep apnea, in which the child's breathing is interrupted
during sleep, often because of inflamed or enlarged tonsils or
adenoids. Other symptoms of this condition include snoring, mouth
breathing, frequent ear and sinus infections, sore throat, choking, and
daytime drowsiness. In some cases, successful treatment of this
breathing disorder may also resolve the associated nighttime
incontinence.
Structural problems
Finally, a small number of cases of incontinence are caused by
physical problems in the urinary system in children. A condition known
as urinary reflux or vesicoureteral reflux, in which urine backs up
into one or both ureters, can cause urinary tract infections and
incontinence. Rarely, a blocked bladder or urethra may cause the
bladder to overfill and leak. Nerve damage associated with the birth
defect spina bifida can cause incontinence. In these cases, the
incontinence can appear as a constant dribbling of urine.
Causes of daytime incontinence
Daytime incontinence that is not associated with urinary infection
or anatomic abnormalities is less common than nighttime incontinence
and tends to disappear much earlier than the nighttime versions. One
possible cause of daytime incontinence is an overactive bladder. Many
children with daytime incontinence have abnormal voiding habits, the
most common being infrequent voiding.
An overactive bladder
Muscles surrounding the urethra (the tube that takes urine away from
the bladder) have the job of keeping the passage closed, preventing
urine from passing out of the body. If the bladder contracts strongly
and without warning, the muscles surrounding the urethra may not be
able to keep urine from passing. This often happens as a consequence of
urinary tract infection and is more common in girls.
Infrequent voiding
Infrequent voiding refers to a child's voluntarily holding urine for
prolonged intervals. For example, a child may not want to use the
toilets at school or may not want to interrupt enjoyable activities, so
he or she ignores the body's signal of a full bladder. In these cases,
the bladder can overfill and leak urine. Additionally, these children
often develop urinary tract infections (UTIs), leading to an irritable
or overactive bladder.
Other causes
Some of the same factors that contribute to nighttime incontinence
may act together with infrequent voiding to produce daytime
incontinence. These factors include
- a small bladder capacity
- structural problems
- anxiety-causing events
- pressure from a hard bowel movement (constipation)
- drinks or foods that contain caffeine, which increases urine output
and may also cause spasms of the bladder muscle, or other ingredients
to which the child may have an allergic reaction, such as chocolate or
artificial coloring
Sometimes overly strenuous toilet training may make the child unable
to relax the sphincter and the pelvic floor to completely empty the
bladder. Retaining urine (incomplete emptying) sets the stage for
urinary tract infections.
Treatments for childhood urinary incontinence
Growth and development
Most urinary incontinence fades away naturally. Here are examples of what can happen over time:
- Bladder capacity increases.
- Natural body alarms become activated.
- An overactive bladder settles down.
- Production of ADH becomes normal.
- The child learns to respond to the body's signal that it is time to void.
- Stressful events or periods pass.
Many children overcome incontinence naturally (without treatment) as
they grow older. The number of cases of incontinence goes down by 15
percent for each year after the age of 5.
Bladder training and related strategies
Bladder training consists of exercises for strengthening and
coordinating muscles of the bladder and urethra, and may help the
control of urination. These techniques teach the child to anticipate
the need to urinate and prevent urination when away from a toilet.
Techniques that may help nighttime incontinence include
- determining bladder capacity
- stretching the bladder (delaying urinating)
- drinking less fluid before sleeping
- developing routines for waking up
Unfortunately, none of the above has demonstrated proven success.
Techniques that may help daytime incontinence include
- urinating on a schedule, such as every 2 hours (this is called timed voiding)
- avoiding caffeine or other foods or drinks that you suspect may contribute to your child's incontinence
- following suggestions for healthy urination, such as relaxing muscles and taking your time
Moisture alarms
At night, moisture alarms can awaken a person when he or she begins
to urinate. These devices include a water-sensitive pad worn in
pajamas, a wire connecting to a battery-driven control, and an alarm
that sounds when moisture is first detected. For the alarm to be
effective, the child must awaken or be awakened as soon as the alarm
goes off. This may require having another person sleep in the same room
to awaken the bedwetter.
Incontinence is also called enuresis
- Primary enuresis refers to wetting in a person who has never been dry for at least 6 months.
- Secondary enuresis refers to wetting that begins after at least 6 months of dryness.
- Nocturnal enuresis refers to wetting that usually occurs during sleep (nighttime incontinence).
- Diurnal enuresis refers to wetting when awake (daytime incontinence).
Points to remember
- Urinary incontinence in children is common.
- Nighttime wetting occurs more commonly in boys.
- Daytime wetting is more common in girls.
- After age 5, incontinence disappears naturally at a rate of 15 percent of cases per year.
- Treatments include waiting, dietary modification, moisture alarms, medications, and bladder training.
We'd advise using EFT on child. Often there are psychological reasons child wets. For example, I had known a 5 year old girl, who had always been dry whilest at kindergarten, yet as soon as her bossy, overly controlling and cleanliness & order-freak mother picked her up, she would "not be able" to keep dry. Either it was a form of punishment or rebelion towards her mom. Her mom had to change the bedding every night, wash loads of clothes every day, iron... It would drive her mom nuts.
Wetting during dreams of pee: Often even teenagers can wet themselves, whilest dreaming a very real dream where they need a pee, and go through the whole proccess of relieving themselves in an enourmous flood... only to awake finding it in their own bed - how embarrasing!
Learning to recognise these perilous dreams and awakening at first sign of a pee dream is something to learn subconsiously - use
hypnosis and
EFT.
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