What causes incontinence?
Causes for urinary incontinence can be anatomic, medical, disease oriented, or physiologic in nature. The exact causes of urinary incontinence remain unknown, but doctors believe that urinary incontinence most commonly results from physical changes in a woman’s body - possibly from a combination of weight gain, loss of hormones through aging, lingering effects of childbirth (especially multiple deliveries), and previous gynecologic surgery. Furthermore, loss of bladder control can result from different medical conditions, such as neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging. In general, urinary incontinence is due to:
Chronic incontinence - Ongoing medical conditions can cause incontinence. During menopause, for example, some women develop bladder control problems perhaps because loss of estrogen weakens the vaginal tissue. Other causes of chronic incontinence include other medical conditions or disorders such as:
- back injuries
- brain injury
- damage to nerves that control the bladder due to conditions like Parkinson’s disease, multiple sclerosis, and disorders involving muscle innervations (spina bifida and Lou Gehrig’s disease)
- pelvic floor muscle weakness
- multiple sclerosis
- parkinson's disease
- spinal cord injury
- weak or overactive bladder muscles
Stress incontinence (SUI) - When pelvic muscles that support the bladder and urethra weaken, or if a dysfunction of the urethral sphincter develops, stress incontinence may result. When the urethral sphincter is weak, any motion that puts pressure on the bladder (like sneezing) causes the urethra to lose its seal and urine escapes. Bodily changes resulting from pregnancy, childbirth, and menopause often create stress incontinence. It also occurs if the squeezing muscles weaken. Stress incontinence can worsen the week before a menstrual period. This is because lowered estrogen levels can lead to lower muscular pressure around the urethra, which increases the chance of leakage. Incidences of stress incontinence usually increase after menopause.
- dysfunction of the urethral sphincter
- lower estrogen levels
- weakened urethral sphincter
Urge urinary incontinence (UUI) - Although UUI may be associated with stroke or neurologic disorders, the exact cause is often unknown in most women suffering from this problem. One common cause of urge incontinence is inappropriate bladder contractions due to abnormal nerve signals that create bladder spasms. Involuntary spasms of the bladder muscles can also result from damage to the bladder nerves, the nervous system (spinal cord and brain), or the muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, and injury—including injury that happens during surgery—all can all impact bladder nerves or muscles negatively. Certain fluids and medications such as diuretics can worsen this condition, along with emotional states such as anxiety. Medical conditions like hyperthyroidism and uncontrolled diabetes can also lead to or worsen urge incontinence.
Temporary incontinence - Root causes of incontinence are often temporary and can be managed with simple treatment. Urinary tract infections, mental impairment, medications, and restricted mobility can bring on transient incontinence. Severe constipation can cause transient incontinence as well. Impacted stool pushes against the urinary tract, obstructing outflow. Colds can trigger incontinence, which subsides once coughing spells cease. Some causes of temporary incontinence are:
- colds (repeated coughing)
- mental impairment
- severe constipation
- urinary tract infection (UTI)
- vaginal infection or irritation
Risk factors increase the likelihood of experiencing a disease or condition. Although some of the following factors can increase a woman’s risk of developing urinary incontinence, they do not necessarily cause the disease. Some women with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
Urinary incontinence affects women across all age groups, and can be brought on by many physical conditions. The likelihood of becoming incontinent increases as one ages. Urinary tract infections, medicines, or constipation can also produce short-term incontinence. Women who are obese, have excessive fluid in the abdomen (ascites) or who have a chronic cough from asthma or emphysema may also be at risk. Women who regularly lift heavy objects may also develop SUI. The following factors increase one’s risk of developing urinary incontinence:
Age - Younger women experience UI far less than older women. In fact, Bladder control problems are common among older adults. Over time, the muscles in the bladder and urethra lose a portion of strength. Changes from aging reduce how much the bladder can hold and increase the chances of involuntary urine release. Aging doesn't necessarily mean that incontinence is a certainty. Incontinence isn't normal for any age — except infants.
Being overweight - Obesity or excess weight increases pressure on the bladder and surrounding muscles, weakening them and allowing urine to leak out during a cough or sneeze.
Gender - Females are more likely than males are to contract stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy are the reasons for this difference. However, men with prostate gland problems may suffer urge and overflow incontinence. However, women and men alike can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems connected to aging.
Medical conditions - Women who have given birth or who are experiencing menopause are more at risk of developing urinary incontinence that those who are not.
Other diseases - Kidney disease or diabetes can increase the risk of incontinence.
Smoking - Chronic coughing associated with smoking may cause episodes of incontinence or aggravate incontinence from other causes. Persistent coughing puts stress on the urinary sphincter, leading to stress incontinence. Smokers are at increased risk of developing overactive bladder.
To better understand the symptoms of female urinary incontinence and to know when to ask for help, continue reading here. The next section on Female Urinary Incontinence Symptoms outlines the signs and symptoms of female urge incontinence.
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