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Though incontinence and sexual dysfunction in women are not uncommon, DON'T LET ANYONE TELL YOU IT'S NORMAL. It isn't. |
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The following information was used with permission from The National Women's Health Information Center (www.4women.gov) and The National Kidney and Urologic Diseases Information Clearinghouse (http://kidney.niddk.nih.gov). The bladder control system
Most of your bladder control system lies inside your pelvis. Stand with your hands on your hips. The bones under your hands are the pelvic bones. Your pelvis is shaped like a big bowl. The bottom of this "bowl" is the area between your legs. The muscles across this area are the pelvic floor muscles. Your bladder is another muscle. It is a balloon-shaped organ inside your pelvis, just below your belly button. Your pelvic floor muscles should be strong and tight to hold up your bladder in its proper place. Your bladder should stay relaxed when it is full of urine. But when you go to the bathroom, the bladder muscle should tighten. This squeezes urine out of the bladder. The sphincter (SFINK-tur) muscles are two muscles that surround the tube that carries urine from your bladder down to an opening in front of the vagina. The tube is called the urethra (yoo-REE-thrah). Urine leaves your body through this tube. The sphincters keep the urethra closed by squeezing like tight rubber bands. The pelvic floor muscles also help keep the urethra closed. |
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| Urine stays inside your body when the pelvic floor and sphincter muscles are tight and the bladder is relaxed.
When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to go to the bathroom. Once you reach the toilet, your brain sends a message down to the sphincter and pelvic floor muscles. It tells them to relax. The brain signal also tells the bladder muscles to tighten up. That squeezes urine out of the bladder. Bladder control means you urinate only when you want to. For good bladder control, all parts of your system must work together.
Top of PageWhat causes bladder control problems?Most bladder control problems happen when muscles are weak or too active. Problems may also happen when nerve signals don't work properly. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh, or lift a heavy object. This is called stress incontinence. It is the most common type of bladder control problem. Stress incontinence often occurs when women are pregnant or after childbirth. The pelvic floor muscles stretch and weaken in pregnancy or childbirth. The same muscles become weak after a woman stops having periods (menopause). They weaken because they no longer get female hormones. Sometimes, the bladder muscles become too active. Then you have a different problem. You may feel strong, sudden urges to go to the bathroom, even if your bladder has little urine. This kind of bladder problem is called urge incontinence or overactive bladder. Several things can cause your bladder to be too active:
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Before
exercises: |
After exercises: |
Bladder training. You can train your bladder to hold urine better. Follow a timetable to store and release urine. You can also learn to decrease the urge to urinate.
Weight loss. Sometimes extra weight causes bladder control problems. A good meal plan and exercise program can lead to weight loss.
Food and drink. Some drinks and foods may make urine control harder. These include foods with caffeine (coffee, tea, cola, or chocolate) and alcohol. Your health care team can suggest how to change your diet for better bladder control.
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Muscle Therapy
Electrical stimulation. Certain devices stimulate the muscles around the urethra. This makes the muscles stronger and tighter.
Biofeedback. This takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a TV screen. You watch the screen to see if you are exercising the right muscles. The therapist will help you. Soon you learn to control these muscles without the patch or screen.
Medical Treatments
Medicines. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles and nerves. A skin patch can be worn to treat symptoms of overactive bladder.
Surgery. Some bladder control problems can be solved by surgery.
Many different operations can improve bladder control. The operation depends on what is causing the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder control muscles work better.
Devices
Pessary. Your doctor can place a special device called a pessary (PESS-uh-ree) in the vagina. The device will hold up the bladder to prevent leakage.
Urethral inserts. Your doctor may give you a small device that goes directly in the urethra. You can learn to insert the device yourself. It's like a little plug. You remove the device when it is time to go to the bathroom and then replace it until it's time to go again.
Urine seals. This is a small foam pad you place over the urethra opening. There it seals itself against your body to keep urine from leaking. When you go to the bathroom, you remove the pad and throw it away.
Soon you will be able to buy new products to help control leaks. However, they do not cure the causes of bladder control problems.
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Dryness Aids
Pads or diapers. Pads or diapers help many people. But diapers do not cure bladder control problems. See a doctor or nurse, even if diapers are working for you.
Bedside urinal. Some people use a bed pan or a bedside chair urinal (YOOR-uh-nul) or commode.
Assistance. If you are disabled, health care workers can help you move more easily to a toilet. Your doctor or nurse may teach you to urinate on a schedule that prevents wetting.
Renovations. Sometimes, you just need a carpenter to make changes to your house. Perhaps you need a hallway light. Or a downstairs bathroom. Another solution could be widening a bathroom door to fit a wheelchair.
Points to Remember
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Many women have bladder control problems.
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Bladder control problems do not have to be a normal part of aging. Many medical conditions can cause bladder problems.
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Try not to let embarrassment about bladder control problems keep you from talking to your health care team.
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Most cases of poor bladder control can be improved greatly. Ask your health care team for help.
Your Pelvic Floor Muscles:
Pelvic Fitness in Minutes a Day
Exercising your pelvic floor muscles for just 5 minutes a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.
The part of your body including your hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvis bone.
Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. These muscles prevent leaking of urine and stool
.
Find the right muscles. This is very important. Your doctor, nurse, or physical therapist will help make sure you are doing the exercises the right way.
You should tighten the two major muscles that stretch across your pelvic floor. They are the "hammock" muscle and the "triangle" muscle. Here are three methods to check for the correct muscles.
- Try to stop the flow of urine when you
are sitting on the toilet. If you can do it, you are using the right
muscles.
- Imagine that you are trying to stop
passing gas. Squeeze the muscles you would use. If you sense a
"pulling" feeling, those are the right muscles for pelvic
exercises.
- Lie down and put your finger inside your
vagina. Squeeze as if you were trying to stop urine from coming out.
If you feel tightness on your finger, you are squeezing the right
pelvic muscle.
Don't squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscle. Don't hold your breath.
Hold the Squeeze 'til After the Sneeze
You can protect your pelvic muscles from
more damage by bracing yourself. Think ahead, just before sneezing,
lifting, or jumping. Sudden pressure from such actions can hurt those
pelvic muscles. Squeeze your pelvic muscles tightly and hold on until after
you sneeze, lift, or jump.
After you train yourself to tighten the pelvic muscles for these moments, you will have fewer accidents.
Pregnancy and Childbirth
Do pregnancy and childbirth affect bladder control?
Yes. But don't panic. If you lose bladder control after childbirth, the problem often goes away by itself. Your muscles may just need time to recover.
When do you need medical help?
If you still have a problem after 6 weeks, talk to your doctor. Without treatment, lost bladder control can become a long-term problem. Accidental leaking can also signal that something else is wrong in your body.
Bladder control problems do not always show up right after childbirth. Some women do not begin to have problems until later, often in their 40's.
You and your health care team must first find out why you have lost bladder control. Then you can discuss treatment.
After treatment, most women regain or improve their bladder control. Regaining control helps you enjoy a healthier and happier life.
Can you prevent bladder problems?
Yes. Women who exercise certain pelvic muscles have fewer bladder problems later on. These muscles are called pelvic floor muscles. If you plan to have a baby, talk to your doctor. Ask if you should do pelvic floor exercises. Exercises after childbirth also help prevent bladder problems in middle age.
How does bladder control work?
Your bladder is a muscle shaped like a balloon. While the bladder stores urine, the bladder muscle relaxes. When you go to the bathroom, the bladder muscle tightens to squeeze urine out of the bladder.
More muscles help with bladder control. Two sphincter (SFINK-tur) muscles surround the tube that carries urine from your bladder down to an opening in front of the vagina. The tube is called the urethra (yoo-REE-thrah). Urine leaves your body through this tube. The sphincters keep the urethra closed by squeezing like rubber bands.
Pelvic floor muscles under the bladder also help keep the urethra closed.
When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to go to the bathroom. Once you reach the toilet, your brain sends a message down to the sphincter and pelvic floor muscles. The brain tells them to relax. The brain signal also tells the bladder muscles to tighten up. That squeezes urine out of the bladder.
Strong sphincter (bladder control) muscles prevent urine leakage in pregnancy and after childbirth. You can exercise these muscles to make them strong. Talk to your doctor about learning how to do pelvic floor exercises.
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What do pregnancy and childbirth have to do with bladder control?
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Unborn
babies push down on the bladder, urethra, and pelvic muscles. |
The added weight and pressure of pregnancy can weaken pelvic floor muscles. Other aspects of pregnancy and childbirth can also cause problems:
- changed position of bladder and urethra
- vaginal delivery
- episiotomy (the cut in the muscle that
makes it easier for the baby to come out)
- damage to bladder control nerves
Which professionals can help you with bladder control?
Professionals who can help you with bladder control include
- your
primary care doctor
- a
gynecologist (guy-nuh-CALL-uh-jist): a women's doctor
- a
urogynecologist (YOOR-oh-guy-nuh-CALL-uh-jist): an expert in women's
bladder problems
- a
urologist (yoor-ALL-uh-jist): an expert in bladder problems
- a
specialist in female urology
- a
nurse or nurse practitioner
- a
physical therapist
Points to Remember
- Temporary
bladder control problems are common during and after pregnancy.
- Exercising
pelvic floor muscles can help prevent bladder control problems.
- Bladder control problems may show up months to years after childbirth. Talk to your health care team if this happens to you
| Urinary
Incontinence
What is urinary incontinence and what causes it? When you are not able to hold your urine until you can get to a bathroom, you have what's called urinary incontinence (also called loss of bladder control). In contrast, bladder control means you urinate only when you want to. Incontinence can often be temporary, and it always caused by an underlying medical condition. More than 13 million Americans experience loss of bladder control. However, women suffer from incontinence twice as often as men do. Both women and men can have trouble with bladder control from neurological (nerve) injury, birth defects, strokes, multiple sclerosis (MS), and physical problems associated with aging. Older women have more bladder control problems than younger women do. The loss of bladder control, however, is not something that has to happen as you grow older. It can be treated and often cured, whatever your age. Don't let any embarrassment about incontinence prevent you from talking to your health care provider about your condition. Find out if you have a medical condition that needs treatment. What does the bladder system look like and how does it work? Bladder control means more than just telling yourself to wait to urinate until you get to the bathroom. It is not that simple. It takes teamwork from many organs, muscles, and nerves in your body. Are there different types of urinary incontinence? Yes, there are different types of incontinence. They include:
Does pregnancy, childbirth and menopause affect urinary incontinence? Yes. During pregnancy, the added weight and pressure of the unborn baby can weaken pelvic floor muscles, which affects your ability to control your bladder. Sometimes the position of your bladder and urethra can change because of the position of the baby, which can cause problems. Vaginal delivery and an episiotomy (the cut in the muscle that makes it easier for the baby to come out) can weaken bladder control muscles. And, pregnancy and childbirth can cause damage to bladder control nerves. After delivery, the problem of urinary incontinence often goes away by itself. But if you are still having problems 6 weeks after delivery, talk to your health care provider. Bladder control problems don't always show up right after childbirth. Some women do not have problems with incontinence until they reach their 40's. Menopause (when your periods stop completely) can cause bladder control problems for some women. During menopause, the amount of the female hormone estrogen in your body starts decreasing. The lack of estrogen causes the bladder control muscles to weaken. Estrogen controls how your body matures, your monthly periods, and body changes during pregnancy and breastfeeding. Estrogen also helps keep the lining of the bladder and urethra plump and healthy. Talk with your health care provider about whether taking estrogen to prevent further bladder control problems is best for you. Tell him or her if you or your family has a history of cancer. If you face a high risk of breast cancer or uterine cancer, your health care provider may not prescribe estrogen for you. How is urinary incontinence treated? There are a number of ways to treat
incontinence. Your health care provider will work with you to figure out
which way(s) is best for you. Don't give up or be embarrassed! Remember,
many women have incontinence and all types of incontinence can be treated,
no matter what your age. Pelvic muscle exercises - Simple exercises to strengthen the muscles near the urethra, also called Kegel exercises. Taking a few minutes each day to do these exercises can help to reduce or cure stress leakage. Electrical Stimulation - Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Special devices called electrodes are temporarily placed inside the vagina or rectum to stimulate nearby muscles. This treatment can be used to reduce both stress incontinence and urge incontinence. Biofeedback - Biofeedback used measuring devices to help you become aware of your body's functioning. A therapist trained in biofeedback places an electrical patch over your bladder and urethral muscles. A wire connected to the patch is linked to a TV screen. You and your therapist watch the screen to track when these muscles contract, so you can learn to gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress incontinence and urge incontinence. Timed Voiding or Bladder Training - Two techniques that help you to train your bladder to hold urine better. In timed voiding (urinating), you fill in a chart of when you urinate and when you leak urine. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Bladder training---biofeedback and muscle conditioning---can change your bladder's schedule for storing and emptying urine. These techniques are effective for urge incontinence and overflow incontinence. Weight Loss - Extra weight can cause bladder control problems. If you are overweight, talk with your health care provider about a diet and exercise program to help you lose weight. Dietary Changes - Certain foods and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. You can often reduce incontinence by restricting these liquids in your diet. Medicines - Medications can reduce
many types of leakage. They can also help tighten or strengthen pelvic
floor muscles and muscles around the urethra. Some drugs can also calm
overactive bladder muscles. Some drugs, especially hormones such as
estrogen, are believe to cause muscles involved in urination to function
normally. Implants - Substances are injected
(through a needle) into tissues around the urethra. The implant adds bulk
and helps the urethra to stay closed. This treatment reduces stress
incontinence. Collagen (a natural fibrous tissue from cows) and fat from a
person's body have been used. This procedure takes about 30 minutes and
can be done in a provider's office using local anesthesia. Surgery - This treatment is primarily used only after other treatments have been tried. Different types of surgery can be done, depending on what kind of incontinence problem you have. Some surgeries raise, or lift, the bladder up to a more normal position. Other surgeries use implants to help the bladder function better. Catheterization - A catheter is a small tube that you can learn to insert yourself through the urethra into the bladder to drain urine. Catheters can be used once in while or all the time. If used all the time, the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you need to watch for signs of urinary tract infection. Pessary - A pessary is a stiff ring that is inserted by a health care provider into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps to hold up the bladder and reduce stress leakage. If you use a pessary, watch for signs of vaginal and urinary tract infections. Visit your provider right away if you think you have an infection. Have your provider check the pessary on a regular basis. Urethral Inserts - A urethral insert is a small device that you place inside the urethra, a technique that you can learn to do yourself. You remove the device when you go to the bathroom and then put it back into your urethra until you need to urinate again. Urine Seals - Urine seals are small foam pads that you place over the urethra opening. The pad seals itself against your body, keeping you from leaking. You remove and throw it away after urinating. You then place a new seal over the urethra. Dryness Aids - Absorbent pads or
diapers help many women, but they do not cure bladder control problems.
They can also cause low self-esteem (how you feel about yourself) and
irritate the skin. Some women use urinals (pans) beside their beds when
they sleep if they suffer from urge incontinence. |
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Department
of Obstetrics and Gynecology What Are Kegel Exercises? Kegel, or pelvic floor muscle exercises are done to strengthen the muscles which support the urethra, bladder, uterus and rectum. Why Do Kegel Exercises? Often the pelvic floor muscles are weak which contributes to problems with losing urine. Doing the exercises correctly and regularly can strengthen the muscles. Stronger muscles lead to little or no urine loss for many women. It is also risk-free, low cost and painless! How Do You Do Them? Over one-third of women start out squeezing the wrong muscles. Therefore, it is helpful to work with a doctor or nurse who can teach you the correct technique. You can also check yourself by placing a finger in your vagina and squeezing around it. When you feel pressure around your finger, you are using the correct muscle. Try to keep everything relaxed except the muscles right around the vagina. At the same time, do not bear down or squeeze your thigh, back or abdominal muscles. And breathe slowly and deeply. At first you can do the exercises with your knees together (lying or sitting). How Often Should I Do The Exercises? Be sure you are doing them correctly before you start. We recommend doing the exercises for five minutes twice a day. You should squeeze the muscle for a count of four and relax for a count of four. At first, you may not be able to do the exercises for a whole five minutes or hold the squeeze for a count of four. With practice it will become easier as the muscles get stronger. When Should I Expect Improvement In My Symptoms? It takes from six to twelve weeks for most women to notice a change in urine loss. Remember, if you do the exercises regularly you could cure yourself and avoid surgery! How Should I Do The Exercises? If you read that these exercises can be done anywhere, anytime - that is not necessarily true. We have studied different ways of doing the exercises to see what works best to decrease urine loss. What we found worked best was five minute sessions done twice a day. So doing them while watching television or wherever you think of it usually will not work as well. Many women report that five minutes before they get up in the morning and five minutes before they sleep is a helpful routine. Is There Anything I Should Change Once The Exercises Become Easy? Once the exercises become easy, you can further strengthen the muscles by squeezing to a count of eight and relaxing to a count of eight. Repeat this for five minutes two times a day. It will also work the muscle more to do the exercises with your knees apart. How Long Do I Have To Do The Exercises? Once you have attained your goal, you can do the exercises for five minutes three times a week. If you start having problems again with urine loss, you may need to go back to five minutes two times a day. Helpful Hints Listen to music when you do the exercises - this can make it more fun! Keep a calendar and give yourself a check mark or star each time you do the exercises. This will help you keep track of when you started and keep you motivated. If you stop doing the exercises, start again! Just remember it takes regular practice to See results. |
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Prolapse
What is prolapse and what causes it? The uterus, bladder, and rectum are all located around the vaginal canal. Because of the way these organs are arranged, it is possible for them to herniate or bulge into the vaginal canal when supportive tissues in the pelvic region become weak. Such bulges are called prolapses. Prolapse can lead to discomfort and heaviness in the vagina, difficulties using the toilet, or the unwanted leakage of urine, called urinary incontinence. When a prolapse is large, tissue may even be seen hanging outside the vagina. Some of the causes of Prolapse are:
What are some of the symptoms of Prolapse? Although your symptoms may differ slightly, you may notice any of the following with a prolapse:
What are the different types of prolapse?
How is prolapse treated? There are a number of ways to treat prolapse. Your health care provider will work with you to figure out which way(s) is best for you. Treatments include: Avoid constipation and straining during bowel movements. Use Kegel exercises to strengthen the muscles that support the pelvic organs - Kegel exercises help to strengthen the muscles that support the vagina, uterus, bladder, and rectum. Greater support can be helpful in several ways:
Use biofeedback therapy to retrain your pelvic muscles - Biofeedback is a learning process where you become more aware of and more able to control your own body’s functioning. In urology and gynecology, biofeedback is typically used to help patients locate and strengthen their pelvic floor pubococcygeus (PC) muscle. During biofeedback therapy, special measuring devices are placed in your vagina, rectum, or on your skin to monitor your pelvic floor. You are then asked to contract your PC muscle while watching the strength of each contraction on a computer screen. This interactive approach allows you to adjust each squeeze to make it stronger and more effective. Wear a pessary inside the vaginal canal to support the prolapsed tissue - A pessary is a ring-like device that can be placed in the vagina to support structures such as the uterus or bladder. Some women find that wearing a pessary can help alleviate the discomfort caused by pelvic organ prolapse. They may also find that they have better bladder control and less urinary incontinence. A urologist can almost always fit a patient with a pessary in one office visit. Pessaries come in various sizes, so it is important to find one that provides good support but also feels comfortable to the patient. Once a month, patients either remove their pessaries themselves or have their pessary removed by a physician. The pessary is then thoroughly cleaned and reinserted. Add a hormone replacement therapy (HRT) medication or topical cream - Evidence has clearly demonstrated that estrogen can make skin thicker, softer, and smoother. It can also “plump up” the pelvic floor tissues and help women sustain their vaginal moistness. We carry a natural estrogen with progesterone cream and a topical vaginal cream containing some natural estrogen that may help.. Surgery can restore your prolapsed
pelvic tissues to their normal position. The decision to have prolapse
surgery is an important one that should be made only after receiving all
the options and facts from your physician. Ultimately, it is up to you to
decide when your quality of life could be improved with surgery.
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