Urinary incontinence in women
Instructions for the prevention and self-care of urinary incontinence
Urinary incontinence occurs in one in five adult females. The mild form is much more common than the severe form, which can be debilitating. In young women, the most common form is stress incontinence, in which urine leaks on exertion, such as when coughing, sneezing, laughing, running or jumping.
Another form of urinary incontinence is urge urinary incontinence. In this case, the bladder is over-irritated, causing a sudden and strong need to urinate. The bladder may then empty quickly and completely. Mixed incontinence (a combination of stress and urge incontinence) and overflow incontinence may also occur.
Causes of urinary incontinence
- Urinary functions are regulated by a complicated neurological system. Problems in the different phases of this regulation may lead to urinary incontinence. Sustained tension in the pelvic floor muscles may impair the function of the sphincter muscles of the bladder.
- Overweight increases the risk of urinary incontinence
- Pregnancy and vaginal delivery, drinking plenty of fluids and smoking may predispose to urinary incontinence
- Different illnesses may cause urinary incontinence to develop with age
Treatment and prevention
- The primary treatment and prevention of urinary incontinence involves lifestyle changes and training
- Regular pelvic floor muscle training
- Pelvic floor muscle training during pregnancy and after delivery
- Weight loss (even 5% to 10% weight loss decreases the symptoms)
- Stopping smoking
- Balancing bowel function (elimination of constipation)
- Bladder training, scheduled toilet visits ("timed voiding")
Urge urinary incontinence is treated by means of medication.
Stress and mixed incontinence are treated surgically if sufficiently long-term independent training or guided physiotherapy fail to solve the problem.
Muscle training as support
Strengthening the pelvic floor muscles by training is an important part of the treatment and prevention of urinary incontinence. Pelvic floor muscle exercises can be felt inside the pelvis, while abdominal, buttock and thigh muscles remain relaxed. As the pelvic floor muscles contract, the vagina, urethra and rectum move up and in. You can check with a finger test (picture 1) whether the muscles contract correctly in the pelvic floor.
Muscles can be contracted in different ways (strong, quick or lighter long-lasting muscle contraction) to train the pelvic floor comprehensively. Relaxation between the contractions is very important. The exercises are performed 1 to 2 times daily. The effects of regular training can be seen within 1 to 3 months.
- Tighten the muscles lightly and hold for 10 to 20 seconds (10 times). Relax. You can do this exercise when you stand up from a sitting position or while walking.
- Tighten and relax the pelvic floor muscles as quickly and strongly as you can (10 to 20 times) and repeat the set 5 times. A good time to do this exercise is when you cough.
- Tighten the muscles strongly and hold for 5 to 10 seconds (5 to 8 times). Relax for 20 seconds. You can combine this exercise with lifting.
The recommended types of exercise enable the contraction and control of pelvic floor muscles. Good forms of exercise include walking, riding, biking, body control sports (e.g. yoga, pilates) and different dance forms.
Caution is advised in sports that burden the pelvic floor muscles, such as jogging/running, ball games (basketball, volleyball), aerobics and artistic gymnastics.
Finger test: insert 1 or 2 fingers into the vagina and contract the pelvic floor muscles. If you feel an upward suction with your fingers, you are doing the contraction correctly. If you feel a downward push towards the pelvic floor, you are not doing the contraction correctly. Try doing the test standing or lying down.
Star jumps with a full bladder also serve as a pelvic floor muscle test. The pelvic floor muscles are usually in good shape if urine does not leak when you jump.
It is useful to combine pelvic floor muscle training with all kinds of physical activity and daily activities, e.g. lifting and carrying.
In the example exercise, (lying on your back, knees bent, pelvis on the surface) tighten the pelvic floor muscles, keep the buttocks, thighs and abdomen as relaxed as possible. You can blow air through the narrow gap between your lips by exhaling and feel the pelvic floor move inward. Inhale and relax. You can also lift your pelvis into a horizontal position, activate the buttocks and thighs and tighten and relax the pelvic floor muscles in this position.
The article was written by Päivi Hamari/1 February 2012
Key words: Urinary incontinence