Bladder problems
URINARY incontinence is marked by a woman’s inability to control her urine, and though the problem is not as pronounced here as it is abroad, it is still worthy of exploration.
“This is a very common problem in Jamaica, but it is probably less so than in European women. This is because it has been shown that many Jamaican women have stronger muscles than their European counterparts. Partly because they are more physically active and partly because of genetics,” says Gynaecologist Professor Horace Fletcher.
“However many Jamaican women have a large number of vaginal deliveries and this can damage the bladder support.”
Women who suffer from this disorder can expect to experience involuntary loss of urine with just the least amount of pressure to the bladder, such as with coughing, sneezing or exercising. In other cases, women who have delivered a large baby or have a history of many children might find that the bladder neck muscles become weakened. Another group of women the doctor says, who are severely incontinent, are those who are always wet because they have a hole in between the bladder and the vagina.
“Urine loss is embarrassing; it challenges the woman as she may have a strong urine smell on her in very bad cases, or urine running down on her clothes. This may prevent her from carrying out her normal functions at work and at home. The urine also can chafe the skin and be very uncomfortable, requiring creams and powders to keep dry,” explains Dr Fletcher.
While urinary incontinence is also found in men, it is more evident in women for a number of reasons. Conditions such as pregnancy, childbirth, menopause, and just the general structure of the female’s urinary tract accounts for this. A weakening of the muscles or nerves that holds and releases the urine can also cause a woman to urinate frequently. Health problems such as Alzheimer’s disease, stroke, Parkinson’s disease, brain tumours and pelvic surgery can cause a woman to face this issue. The need to urinate also occurs during sexual intercourse for some women, causing further distress.
While urinary incontinence is found in women in different age groups, Dr Fletcher says it is most common in older women. And some medications have been found to result in urinary incontinence.
“Some medications can cause the bladder to fill too quickly such as diuretics. Others can cause the bladder neck to relax. Alcohol also causes a diuretic-like action, filling the bladder,” explains Dr Fletcher.
There are different types of urinary incontinence which are caused by varying factors. The commonest ones are:
1. Stress or anatomic incontinence: This is the commonest form among women and results from exercising, coughing, laughing or lifting a heavy piece of equipment. Involuntary leakage usually occurs as a result of the weakening of the pelvic muscles, the urethral sphincter muscle or the wall between the bladder and the vagina. A reduction in oestrogen levels following menopause can also help to weaken these muscles.
2. Over-flow incontinence: In this case, a woman might not be able to empty her bladder completely resulting in frequent visits to the restroom or a constant dribbling of urine. A weakened bladder muscle caused by certain health problems such as diabetes has been found to cause this type of incontinence. A blocked urethra due to tumours, a birth defect or kidney or urinary stones can also lead to a person not being able to empty their bladder frequently.
3. Overactive bladder: This is the need to frequently urinate resulting in a visit to the restroom eight or more times daily. Women who find themselves affected by this form of Urinary Incontinence might find it difficult to get a good night’s sleep since they have to go to the bathroom very often.
4. Urge incontinence: This is usually the case for elderly women. It is characterised by the sudden urge to urinate with the inability to control the bladder. This might result from certain disorders of the nervous system, infection in the bladder or kidney, or cancer of the uterus or bladder.
5. Temporary incontinence: As the name suggests, this form of incontinence is not long-term and might be brought on by a current problem such as severe constipation, an infection of the urinary tract or the use of certain medications such as anti-depressants, narcotics or diuretics (water tablets).
A doctor after doing the necessary examinations will be able to determine what type of urinary incontinence a patient has. Following the diagnosis of urinary incontinence in the patient, a number of treatment options can be offered. These include behavioural changes, medication and surgery. A doctor might instruct a patient to go to the bathroom at particular times of the day by changing their frame of mind. As control is gained over the body, the times per day that the woman goes to the bathroom might be decreased. Eventually the patient would be able to gain control of their bladder.
Kegel exercises can also be done which allows the woman to exercise the pelvic muscles. This can be done up to five minutes per day. Within the space of a month, the muscles would have been strengthened resulting in the reduction in urine leakage.
“If these exercises do not work, the physiotherapists can aid the patient by giving a mild electric current to stimulate the muscles to contract and get a similar result,” explains Dr Fletcher.
If behavioural changes are not being effective, then medications can be prescribed. If the bladder has been moved out of its normal position, surgery can be done to fix this problem.
