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Urinary Incontinence in young women

The International Continence Society has defined urinary stress incontinence (USI) as "the complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing." The problem is one of the most underreported problems in gynecology, can occur at any age, and occurs two times more often in women than in men. It also differs in frequency by geographic regions and populations. Although quality of life may be altered, many women will not seek medical help often due to the belief that little can be done to improve the condition. The highest prevalence of incontinence usually occurs in the fifties and sixties, but it has been reported in younger women in the range of approximately 15% prior to age fifty. A recent Australian study reported that the incidence of USI in women age 16-30 was one out of every eight women who had never been pregnant. In this study, approximately 6% of the women described the incontinence as stress incontinence, approximately 5% as urge incontinence, and 2% as a combination of both types.

Stress incontinence is often caused by weakening of the pelvic floor muscles, being overweight or damage to pelvic floor muscle from pregnancy. Urge incontinence is the feeling or urge to void but not making it to the bathroom soon enough, and is often caused by neurological conditions. A recent study from China of women age 30-50 showed an incidence of reported incontinence of 37.5%, which was higher in women in their forties with advance weight. The study also reported that the younger the patient, the greater the response to conservative therapy.

What are the causes of urinary incontinence?
Causes of temporary urinary incontinence:

  • Alcohol − it acts as a bladder stimulant and a diuretic thus leading to a strong urge to void.
  • Overhydration − with large consumption of liquids, there is a large amount of urine in the bladder to deal with and leakage may occur.
  • Bladder irritation − often caused by carbonated drinks, tea, coffee (either caffeinated or decaffeinated), artificial sweeteners, corn syrup, spicy foods, citrus, tomatoes and sugar, which may irritate the bladder wall and produce leakage.
  • Medications − blood pressure medications, heart medications, pain medications, sedatives and muscle relaxers may increase risk of leakage.
  • Urinary tract infections − these irritate the bladder to give a strong urge to void and can be a warning sign of infection being present.
  • Dehydration − increases problems with constipation. Straining to have a bowel movement may cause leakage.

Causes of persistent urinary incontinence:

  • Pregnancy − due to hormonal changes and increased weight of pregnancy, incontinence is more likely to occur. After delivery, the muscles may be weakened or damaged. A recent study showed that carrying two pregnancies ending in Cesarean Section can damage the pelvic muscles as much as one vaginal delivery.
  • Aging − aging of the bladder muscles may lead to a decrease in the bladder's ability to store urine, leading to leakage. This is usually aggravated by smoking, being overweight, decreased estrogen and taking blood pressure medications.
  • Hysterectomy − the uterus and bladder are supported by the same muscle system, so with removal of the uterus there is a risk of damage to the muscles, leading to leakage.
  • Interstitial cystitis − painful bladder syndrome − causes painful and frequent urination that sometimes can lead to leakage.
  • Bladder cancer or bladder stones − can produce symptoms of incontinence, urgency, burning with urination, blood in the urine and pelvic pain.
  • Neurological disorders − incontinence can be seen in such disorders as Parkinson’s disease, stroke, multiple sclerosis, brain tumors or spinal cord injuries.

What therapies are available for USI?
The therapies listed are some of the current therapy approaches available:

  • Bladder training − you are instructed to urinate to the clock rather than waiting for the need to void. Starting with every two hours and slowly increasing the time between can give more control of the bladder.
  • Pelvic floor exercises − Kegel exercises − using to muscles as if you are attempting to stop the flow of urine. If you have a sense of a pulling-up feeling when you squeeze, the right muscles are being worked. Repeat three to ten times and do these at least two times daily.
  • Medications − several different medications are available and you will need to discuss these with you physician.
  • Surgery − usually used when other methods have not worked. This will need to be discussed with your physician.

Even if you are young, when incontinence occurs, discuss it with your physician and develop an approach to the problem.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.