Time to seek help

WOMEN & WELLNESS Part I of a two-part series deals with ‘Urinary incontinence: the problem of leaking urine'

S aketha has had two children. Recently she has noticed that when she sneezes or coughs, she loses a few drops of urine. Saketha has stress incontinence. Stress incontinence, which is the most common type of urinary incontinence in younger women, occurs when a woman coughs, laughs, or sneezes. As the condition gets worse, she may lose urine when she walks, runs, or does aerobics. This kind of leakage occurs when the tissues that support the bladder or the muscles of the urethra (urinary passage) get weak.

Tarangini is in her early sixties. She finds that she has to rush to the bathroom when she gets the urge to pass urine and even loses a few drops of urine before she can reach the bathroom. She has urge incontinence. This is sometimes called overactive bladder. It occurs if the muscles of the bladder are too active and contract too often. This leads to leakage of urine. This can also occur when there are problems with the nerves that send signals to the bladder.

What is urinary incontinence?

Urinary incontinence is the involuntary leakage of urine. It is more common in women than in men. At some time or the other in their lives, many women will leak small amounts of urine. These leaks can occur with certain physical activities or with other stress, such as coughing, laughing or sneezing. Some women may lose urine when they hear the sound of running water or when their hands are in water. Some women feel the sudden urge to urinate and cannot control it. Others leak urine only when they are pregnant. When leaks become frequent or severe enough to be a problem, it is called urinary incontinence or loss of bladder control. Loss of bladder control is a common problem among women and there are several treatment options available. Urinary incontinence (leakage) can often be treated with success.

Unfortunately, women tend not to seek help from their doctors for this problem. More than one half of women who have symptoms do not seek medical care. They feel embarrassed or ashamed and try to hide the problem. Many women are depressed about it and avoid social occasions or long periods away from home.

Types of urinary incontinence

There are five types of urinary incontinence: stress incontinence, urge incontinence, mixed incontinence, overflow incontinence and functional incontinence. Stress and urge incontinence have already been described above. Mixed incontinence occurs when a woman has both stress and urge symptoms. This combination may cause more urine to leak than either type alone would. Overflow incontinence occurs when the bladder does not empty completely and keeps filling up. When it is overfilled, small quantities of urine will periodically leak. This is often associated with damage to the nerves supplying the bladder. Functional incontinence occurs when other health problems keep a woman from getting to the toilet in time. Conditions that cause it include arthritis, stroke and problems with mobility (inability to move or walk fast).

What are the causes of urinary incontinence?

Urinary tract infection

Commonly in women, loss of bladder control may be caused by an infection of the urinary tract. When there is a bladder infection, the woman may suffer severe pain when she passes urine, and have the urge to pass urine very frequently. Infections are easily treated and the symptoms of leakage will resolve with appropriate antibiotics.

Problems of pelvic support

The uterus, the bladder and the other organs in the lowest part of the abdomen (pelvis) are held in place by supportive tissues and muscles. These tissues are stretched or weakened by pregnancy, childbirth, and

ageing. This ultimately leads to sagging of the muscles supporting the pelvic organs. The muscles around the bladder and the urinary passage (urethra) are, therefore, unable to hold back urine.

Neuromuscular disorders

In conditions like severe diabetes, stroke, or multiple sclerosis, the nerve supply to the bladder is affected. The signals from the brain and spinal cord do not connect properly with the bladder and urethra.

The woman does not sense that her bladder is full and the urine will overflow when the bladder gets overfilled.

The second part will deal with diagnosis and treatment of urinary incontinence.


The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

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