Incontinence & Kegel Strength
Urinary Incontinence & Kegel Strength
Urinary Incontinence is the inability to control the release of urine from the bladder, and it is a common and often embarrassing problem for many women. The severity can range from occasionally leaking small amounts of urine to leaking urine frequently or leaking large amounts of urine. Urinary incontinence can affect women of all ages, and although it may feel quite awkward, a woman need not hesitate to discuss the issue with her doctor. In most cases, simple lifestyle changes or medical treatment can ease the discomfort or put an end to the issue.
Kegel exercises and kegel products can help with incontinence. MedAmour carries many useful products specifically designed to help a woman strengthen her pelvic floor muscles.
Kegel products that can help with incontinence
- Vibrance Kegel Device (FDA-approved!)
- Incontrol Medical Apex
- Je Joue Ami Balls
- Pelvic Concept Kegel Kit
- Natural Contours Energie Kegel Exerciser
There are several types of urinary incontinence.
This is the loss of urine when pressure is exerted on the bladder as occurs with laughing, sneezing or coughing, exercising or lifting something heavy. A weakening of the tissues that support the bladder, or the muscles of the urethra, causes stress incontinence, and is the most common type in younger women.
This is strong and sudden urge to urinate that often results in the leakage of urine before one is able to get to a restroom. It is also called overactive bladder, and it happens when the muscles of the bladder contract too often. It can be caused by urinary tract infections, bladder irritants, bowel problems, stroke, injury or problems with the nerves that send signals to the bladder.
This is a combination of both stress and urge incontinence, and it causes more urine loss than would be caused by either type alone.
This is a condition characterized by a steady leak, or dribble, of urine. This is due to the inability to empty the bladder when voiding (aka urinating). This type of incontinence may occur in people with damage to their bladder, a blocked urethra or nerve damage due to diabetes, multiple sclerosis or spinal cord injury. In men, overflow incontinence can be associated with prostate gland problems.
Additional Symptoms of Incontinence
In addition to leaking urine, the following symptoms may also be experienced:
- A strong urge to urinate whether or not the bladder is full
- Urinating more often than one considers normal
- The urge and need to urinate while sleeping, known as nocturia
- Painful urination, known as dysuria
- Bed-wetting or leaking urine while sleeping, known as enuresis
Causes of Incontinence
There are various causes of urinary incontinence. Some are easier to treat than others and there may be multiple causes involved as follows:
Urinary tract infection
A urinary tract infection can cause a loss of bladder control. Signs of infection include pain, frequent urination and/or blood in the urine. Urinary tract infections are treated with antibiotics. Once the infection is cured, loss of urine usually ceases.
Loss of bladder control may be a side effect of some medications such as blood pressure medications, diuretics, some anti-depressants and, occasionally, sleeping pills. If a medication is the cause of urine leakage, the prescription can often be changed or the dosage adjusted by a health care provider.
Polyps or bladder stones
Abnormal growths like polyps and bladder stones can cause urinary incontinence. Other symptoms might include blood in the urine or abnormally dark urine, pelvic pain, penile or scrotal pain in males, getting up at night to urinate, and urination that stops and starts while voiding. These symptoms might indicate urge incontinence, but less commonly, they might signal the presence of bladder cancer. Any time there is blood in the urine, one must contact a health care provider immediately.
Pregnancy, childbirth, surgery and aging
Weakening or stretching of muscles and ligaments that support and hold the pelvic organs in place can lead to incontinence. Pregnancy, childbirth, surgery and aging can all result in weakness or damage to the tissues that support the bladder, urethra, uterus or rectum causing them to drop down and result in urine leakage or difficulty passing urine.
A fistula can leave a woman incontinent of her urine or feces, or both. A fistula is a hole between the vagina and rectum, or between the vagina and bladder, that is caused by pelvic surgery, radiation treatment, advanced cancer of the pelvis, or in rare cases, a prolonged, obstructed labor, Certain neuromuscular diseases (i.e. diabetes mellitus, stroke, Parkinson’s disease, multiple sclerosis) can result in urine leakage because the nerve impulses that originate in the brain and spinal cord do not connect properly with the bladder and urethra.
Talk to your doctor
When dealing with incontinence, being open and honest with one’s health care provider will be helpful in determining the exact cause and the best treatment for resolving the problem. (See How to Talk to Your Doctor About Sexual Issues). Be prepared to discuss past medical history and urination habits in detail including: the time, the amount of leakage, how much liquid was consumed prior and the activity at the time leakage occurred.
Keep track of the problem
Keeping a voiding diary, or daily log of urination habits, for 3 days helps to ensure the information related to the doctor is accurate. A pelvic exam will be performed to detect any physical issues that might be causing, or contributing to, the incontinence. Lab tests may also be performed to determine the presence of a urinary tract infection.
The following tests for incontinence may also be performed:
This is an expensive test typically done only if surgery is being considered, or if previous treatment has been unsuccessful. It is an advanced way to check the function and efficiency of the bladder and urethra. Typically, the patient is instructed to arrive for testing with a full bladder. While she urinates into a container, the volume of urine and the rate at which the bladder empties is measured. A thin, flexible narrow tube (catheter) is then inserted into the bladder through the urethra, and the volume of any urine remaining in the bladder is measured. A slight burning sensation may occur when the catheter is inserted. The bladder may be filled with water through the catheter until the patient has the first urge to urinate. The amount of water in the bladder is measured at this point. Then, more water may be added while the patient resists urinating until involuntary urination occurs.
Post-Void Residual Volume Test
This test measures the amount of urine that remains in the bladder after urinating. It is measured by inserting a catheter into the bladder or by using an ultrasound machine.
This measures any loss of urine when the patient is asked to cough a few times with a full bladder.
This test allows a doctor to look inside the bladder and urethra by using a thin-lighted tube called a cystoscope. The cystoscope is inserted in the urethra and then slowly into the bladder to illuminate areas that do not usually show up well on X-rays. Tiny surgical instruments can also be inserted through the cystoscope. This allows for tissue biopsy and urine samples. Also, small bladder stones and growths can be removed during cystoscopy, eliminating the need for more extensive surgery later.
This test involves wearing a pad after a non-toxic dye has been inserted into the bladder. If the pad gets stained with the dye, it indicates a loss of urine.
Treatment options for incontinence
- Lose weight if overweight
- Avoid constipation
- Drink fewer fluids and limit intake of caffeine. Guidelines recommend that a person consume eight 8 ounce glasses of water per day. This, however, does not take into consideration the individual’s age, body weight, activity or the outside temperature. A good way to assess if one is drinking the right amount of fluids is to monitor one’s urine. If the urine appears very pale or colorless, one may be drinking too much water. If the urine is dark and has a strong smell, one is likely not drinking enough water. Also, caffeine found in coffee, tea, some sodas and even over-the-counter medications, can act as a diuretic and worsen the issue.
Bladder training helps manage stress incontinence, urge incontinence, or a combination of both types. Bladder training can help lengthen the amount of time between bathroom trips (3 to 4 hours during the day, and every 4 to 8 hours at night); increase the amount of urine the bladder can hold; and gain more control over the urge to urinate. Bladder training can take from 3 to 12 weeks, but after a few weeks a person usually finds he or she is experiencing significantly fewer leaks.
Performing Kegel Exercises (aka Pelvic Floor Exercises) helps strengthen the muscles that are used to stop the flow of urine. Doing these exercises regularly may improve incontinence. (Click here to learn more about kegel exercises) The combination of doing Kegel exercises, modifying fluid intake and bladder training is often successful in treating stress and urge incontinence.
If a woman’s muscles are very weak and she cannot do a Kegel contraction at all, electro-stimulation can be tried. In electro-stimulation, the pelvic muscles are made to contract via special electrodes. These contractions strengthen the muscles so that Kegel exercises become possible.
A pessary is a rubber device that is inserted into the vagina to support the urethra and pinch it closed. This helps retain urine in the bladder and decrease stress incontinence. Although many pessaries can be worn all the time, some women with stress incontinence prefer to use them only during rigorous activities like jogging. Pessaries are not for everyone, but for many women they provide relief of symptoms without surgery.
Several drugs are available that increase sphincter or pelvic muscle strength and that help control unwanted bladder contractions. While medications are prescribed for all kinds of incontinence, they are generally most helpful for urge incontinence. A healthcare provider will help decide which drug is best for the patient.
Bulking Agents may be used when the urethra is very weak and surgery is not an option or has not worked. A substance is injected into the tissues around the urethra to add bulk and cause the urethra to become narrow, thereby decreasing urine leakage. This procedure can be done in a doctor’s office or a clinic. Many substances have been used as bulking agents such as silicone beads, a person’s own fat, collagen, carbon particles and the chemical constituent found in Teflon. So far, collagen seems to offer the most promise with the fewest side effects.
For some women, symptoms of stress incontinence or overactive bladder do not respond to conservative treatment. If urinary incontinence is disrupting one’s life, surgery may provide the solution. When choosing the appropriate surgery, or deciding if surgery is even an option, consider the following:
- Need for a hysterectomy or treatment of other pelvic issues
- Medical history (history of radiation therapy for pelvic cancer or prior surgery for incontinence)
- General health
- Cause of the problem
There are two surgical approaches for the correction of urinary incontinence:
These involve surgically inserting a sling to provide lift and support to the urethra. There are several different types of slings made from various materials such as strips of synthetic mesh, one’s own tissue, animal tissue or tissue from a deceased donor. Each type has its advantages and disadvantages. A health care provider will discuss the best option as well as risks and benefits of surgery.
Bladder Neck Suspension Procedure (Colposuspension)
This type of surgery reinforces the urethra and neck of the bladder so they won’t sag. It also provides something for the urethra to compress against to prevent urine leakage. Suspension surgery requires an abdominal incision and involves stitching the bladder neck to a ligament on, or the cartilage of, one’s pubic bone.
A Prolapsed Uterus is an uncomfortable condition that typically affects women after childbirth and menopause. It occurs when weakened pelvic muscles allow the bladder, uterus or rectum to “drop’’ or sink into the vagina. Anything that puts constant or additional pressure on the abdomen can cause pelvic floor prolapse. Some causes include:
- A vaginal birth delivery versus a cesarean delivery
- History of four or more vaginal births
- Giving birth to babies heavier than nine pounds
- Family history
- Hysterectomy or other prior pelvic surgery
- Intense physical activity
- Being overweight or obese
- Chronic coughing
Many women have no, or minimal, symptoms and are not bothered by their prolapsed uterus. Symptoms of prolapse can, however, progress gradually over time as the muscles of the pelvic floor continue to weaken. Oftentimes, the condition goes un-diagnosed unless a health care provider discovers it during a routine physical exam or a woman detects a slight bulge of tissue in her vagina. The symptoms can range from mild to severe, with severe cases involving the uterus dropping so low as to be seen protruding outside of the vagina. Symptoms of a Prolapsed Uterus can include the following:
- Feeling bloated in the lower belly
- Achy, painful sensation in the lower abdomen or pelvis
- Lower backache
- Releasing urine accidently or difficulty urinating
- Pain during sexual intercourse
- Spotting or bleeding
- Recurring urinary tract infections
- Problems inserting tampons or applicators
- Pelvic pressure that worsens upon prolonged standing, lifting heavy objects or coughing.
There are several types of a Prolapsed Uterus:
This condition occurs when the ligaments that support the uterus weaken, or tear, allowing the uterus to drop down into the vagina. A mild degree of uterine prolapse is very common, and there is usually no presentation of symptoms and no need for surgery.
If, however, the prolapse worsens and a woman experiences vaginal pressure or discomfort, pelvic pressure, difficulty moving the bowels or painful intercourse, then treatment options will need to be considered.
Vaginal Vault Prolapse
When the upper 1/3 of the vagina (the “vaginal vault”) loses its ligamentous support and drops, it is called a vaginal vault prolapse. This issue is common in women who have had a hysterectomy. Women with this type of prolapse can have issues such as urinary urgency, frequency, and difficulty emptying the bladder as well as pelvic pain and painful intercourse. Corrective vault-suspension surgery may be indicated to correct this condition.
A cystocele occurs when the fascia, or connective tissue, that supports the bladder weakens or tears, and the bladder drops into the vagina. This can result in urine leakage whenever there is increased abdominal pressure from walking, laughing, coughing, lifting or sneezing. It could be a small amount of urine or enough to require a woman to change her clothes or wear pads. A cystocele can also cause pelvic/vaginal pressure, painful intercourse and a pulling sensation in the vagina.
Urethrocele is a condition in which the urethra bulges into the vagina. This usually occurs when there is a cystocele also present and results in similar symptoms.
Rectocele can result from a breakdown in the connective tissue that supports and separates the vagina from the rectum. A weakness, or tear, allows the rectum to push directly against the vagina, thus creating a bulge. A large rectocele could make it difficult to have a bowel movement, especially if constipation is already present. Some women must manually push down on the bulge in the vagina to enable a bowel movement.
Enterocele typically occurs as a result of a hysterectomy, although it can also occur together with a rectocele and/or other prolapse condition. An enterocele is a bulge of a portion of the small intestine that pushes directly into the top of the vagina. Symptoms are similar to those associated with other pelvic floor conditions.
It is imperative to talk with one's doctor! Proper diagnosis is key to treating pelvic support problems. The exact cause of the issue must be discovered before the best treatment can be recommended. Being open and honest with one’s healthcare provider will be helpful in determining the exact cause as well as viable treatment options.
Treatment for Prolapsed Uterus
Treatment will be based on the following factors:
- Desire to have children
- Sexual activity
- Severity of symptoms
- Degree of prolapse
- Other health issues
No form of treatment is guaranteed to resolve the entire problem, but there are steps one can take to help prevent or assist with specific symptoms. Changes in diet and lifestyle may be of benefit in ameliorating some symptoms.
Changes in diet and lifestyle
- Limit fluid intake
- particularly those drinks that contain caffeine (caffeine is a diuretic) if incontinence is an issue.
- Engage in bladder training (emptying the bladder at scheduled times).
- Gradually Increase fiber intake to ward off constipation. Consider a natural laxative or medication to soften stools.
- Lose weight to improve overall health and possibly improve prolapse symptoms.
- Do Kegel exercises (pelvic floor exercises) to strengthen the sphincter muscles that surround the openings of the urethra, vagina and rectum. Perform these exercises regularly to help improve incontinence.
- Consider using a pessary, a rubber ring inserted into the vagina, to support the organs. Pessaries need to be cleaned regularly and removed prior to sexual intercourse. Some pessaries can be removed, cleaned and reinserted by the user while others need to be removed by a health care provider.
- Try low-dose, bio-identical estrogen cream to strengthen pelvic connective tissue and slow the movement of prolapsed organs.
- Research surgery that helps restore normal depth and function of the vagina. Such surgery can be done through the vagina or laparoscopically through the abdomen depending on the nature and severity of the issue.
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