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Part-II: Understanding Incontinence

2. What is Incontinence?

When you are not able to control your urination, it is urinary incontinence. It is the same as uncontrollable urination or loss of bladder control. Such inability could occur on rare occasions or you could have a total inability to control your urination.

The first time I had incontinence was after my 9 pound 9 ounce son was born.

For months, every time I laughed, tried to run or jump or sneeze, I'd wet.

There is no elegant way to say it, really. You simply cannot control your bladder. My doctor told me it would go away on its own. Then I found out about Kegel exercise and those helped a lot. Still, my doctor said that they would go away.

I wanted to study more about it, as I found it inconvenient and embarrassing.

The main organs controlling your urination are your bladder, muscles and nervous system. Muscular tissues of your bladder and urethra combine with different voluntary muscles of your skeletal system and nervous system.

Together they regulate passage of urine. Sometimes these muscles are unable to function normally due to certain physiologic, pathologic, or anatomical abnormalities. You may also encounter problem of urinary incontinence due to different specific muscular disorders or congenital disorders like multiple sclerosis, spina bifida, and ALS. Hence, you are unable to store or control passage of urine.

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Urinary incontinence in infants and children below six years old is normal, as they are yet to develop complete toilet habits. Such young children may also wet their beds at night. Some children suffer from infections and anatomical irregularities in the urinary tract, nervous disorders, or spinal injuries resulting in urinary incontinence. Some young girls may have slight urinary seepages while laughing.

The majority of the problem of urinary incontinence is high among elderly people, especially with women. Though this is not a major problem, yet it is better to seek advice of urologists and gynecologists. They can assess the severity of the issue and treat it accordingly.

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3. Physiology and Function of

the Bladder and Urinary Tract?

Your urinary system with the help of different organs ensures normal

excretion of urine from your body. When such normal excretion does not take place, you suffer from urinary incontinence.

Physiology of Urinary System

Kidneys, bladder, ureters, and urethra constitute your urinary system. Your hipbones in your pelvis region encompass the urinary bladder behind the pubic bone. This muscular and hollow sac in the shape of a balloon stores urine.

Strong and fibrous tissue keeps your urinary bladder intact maintaining contact with other pelvic organs. Normal storage capacity of your bladder is around sixteen ounces for around two to five hours. The urethra is a tubular structure, which flushes out your urine through the bladder. It opens into the bladder through bladder neck.

Male and Female Urethra

The urethra in women is approximately four centimeters long, starting from the bladder neck to the vaginal opening. It has many smooth muscular fibers, sphincter fibers, mucous membrane, and a layer of elastic tissue. Collagen tissue keeps all these fibers together.

The male urethra is around eight to nine inches long from the bladder neck to the end of the penis. Three main parts of the male penis are prostatic, spongy, and membranous.

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Ö Membranous part is around three-quarter of an inch between triangular parts of pelvis region.

Ö Prostatic, widest part of penis consists of muscular fibers, fibrous tissue, and many glandular openings connecting to prostate gland.

Ö The longest part of male urethra is the spongy part, through the entire penis until the glands at the tip of penis. Corpus spongiosum

encompasses and protects the male urethra.

Working of your Urinary System

Your body absorbs essential nutrients from

your food to maintain your health, provide

energy, and restore injured tissues. Your

body absorbs the moisture content from

your solid and liquid diets. Your urinary

system removes waste products, specifically urea from your body fluids.

Digestion of protein rich foods like poultry, some vegetables, and meat forms urea, which passes into your kidneys through blood. They combine with other waste products and water to form urine. Kidneys are bean shaped organs mainly responsible for excretion of waste products from your body.

A human adult forms and excretes around one and half quarts of urine every day. This quantity varies from individual to individual. It depends on intake of fluids and food, fluids lost through breathing and sweat, and intake of diuretics and other medicines.

The urine flows out from kidneys into ureters to enter the urinary bladder.

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bladder. When the bladder becomes full and round, your body needs to excrete urine. The brain signals the urinary system to relax to allow flow of urine out of your body through the urethra. This is a normal process in continent persons, who can control excretion of urine.

Urethral sphincter muscles keep the urethra closed until you are free to urinate.

Pubococcygeus (PCG) muscles enclose the urethra to stop unwanted seepage of urine. Bladder muscles tighten and contract to push out urine from your body only when you feel the pressure of urination. Relaxed sphincter and pubococcygeus muscles allow normal urination. However, if you are unable to control the urination process, you suffer from urinary incontinence.

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Kidney Stones

Your Kidneys

Your kidneys are bean-shaped and each is about fist-size. They sit near the middle of your back, just below the rib cage. They gather your body’s waste.

Every day, your kidneys ‘harvest’ about 2 quarts of waste products and extra water from your bloodstream which becomes urine.

That goes through ureter tubes to your bladder where it is stored until expelled.

Your kidneys also help control blood pressure and to make red blood cells.

What is a Kidney Stone?

A kidney stone is a lump formed in the kidney from waste in the urine.

Small stones may be expelled in the urine without much pain. But larger stones may stick in a ureter, the bladder, or the urethra and then block the flow of urine, causing intense pain.

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Types of Kidney Stones

There are four main types.

1. The most common type contains calcium (KAL-see-um). Calcium is an essential part of your healthy diet but any which isn’t used by your body for your bones and muscles goes to your kidneys.

a. Mostly, they flush it out in your urine. If all the calcium is not flushed, it combines with other waste products and calcium

kidney stones result.

2. A struvite stone sometimes forms after a urinary system infection.

They contain magnesium and waste ammonia.

3. A uric acid stone may form if there is too much acid in the urine. If you get uric acid stones, you may need to cut down on the meat you

eat.

4. Cystine stones are uncommon. Cystine is a component needed for you to build muscles, nerves etc., but it can build up in the urine to become a stone. This condition is hereditary.

Examples of Kidney Stones

Kidney stones may be smooth or bumpy, are usually yellow or brown and vary in size from a small grain to pearl-size though occasional ones can be as big as a golf-ball. These examples are not to size:

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Some Available Treatments

If you have a stone and cannot pass it, consult your doctor as soon as possible.

Surgery used to be the only way to remove it. However, research is ongoing.

Here are some of the current methods;

Shock Waves

Doctors send shock waves to the kidney stone. They break large stones down to a size which will pass with your urine.

With some machines, you sit in a tub of water, while you lie on a table with other machines.

This method is called extracorporeal lithotripsy. Lithotripsy is a Greek word that means stone crushing.

Tunnel Surgery

The doctor makes a small cut in your back and a narrow tunnel through the skin to the stone in the kidney. Then, the doctor puts a special instrument through the tunnel, finds the stone and removes it. This is percutaneous nephrolithotomy.

Ureteroscope

A ureteroscope is like a long wire. The doctor puts it into the patient's urethra, up through the bladder to the ureter where the stone is. The instrument has a camera that lets the doctor see the stone. Then, either a cage is used to catch the stone and pull it out, or the doctor may destroy it right there.

How Doctors Identify the Stone

If you know that you are passing a stone, try to catch it in a strainer. Seeing the stone is the best way for your doctor to identify what kind of stone you have and it is also the easiest on you.

Your doctor may ask for a urine sample (or you may need to collect your urine for a 24-hour period) or take blood to find out what causes your stones. These tests help your doctor suggest how you might avoid stones in future.

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The Type of Stone Indicates the Best Treatments

The therapy your doctor gives will depends on the type of stone. Treatment to prevent calcium stones will not work on struvite stones. Diet changes to help prevent uric acid stones might not affect calcium stones.

Avoid More Stones

Drink more water. Try to drink 12 full glasses of water a day. This helps to flush your kidneys more thoroughly and has other benefits for your whole system.

You can drink ginger ale, lemon-lime sodas, and fruit juices but water is best.

Limit coffee, tea, and cola to one or two a day - the caffeine may cause too much fluid loss.

Your doctor may advise increasing your intake of some foods and cutting back on others. If you have a uric acid stone, you may have to eat less meat.

The doctor may give you medicines to prevent calcium and uric acid stones.

Important Points

• Most stones will pass out of the body without a doctor's help.

• See your doctor if you have severe pain in your back or side that will not go away.

• See your doctor if you have blood in your urine (it will appear pink).

• Drink plenty of water every day to prevent more kidney stones.

• If you pass a stone, try to collect it with a strainer to show your doctor.

• Talk to your doctor.

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4. Signs of Incontinence

When you are unable to control the passage of urine, be it a small leakage or a total lack of control over urination, it is urinary incontinence. This can occur in men, women, or children. However, children below six years old do not fall under this category, as they are yet to develop total toilet habits. Elderly people encounter this frequently.

Urinary incontinence occurs due to various reasons. These can be tumors, kidney stones, infections of the urinary tract, nervous disorders, spinal cord injuries, weak pelvic muscles, prostate cancer, or due to different medications.

Signs of Incontinence

There are many symptoms or signs of urinary incontinence. These depend on your stress levels, urges to urinate, or due to certain weak muscles of the pelvic region of your body. The many symptoms are:

Ö Leakage of urine while laughing, coughing, exercising, running, lifting heavy things, or sneezing

Ö Urine continues to trickle even after urinating and leads to a continual leakage of urine

Ö Urge for urination continues even after urinating

Ö Very difficult to control flow of urine as soon as you feel the urge to urinate

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Ö Feeling of urination during sexual intercourse

Ö Frequent toilet visits during daytime and nighttime

Ö Frequency of urination is higher

Ö Urge to urinate even when the bladder is not full

Ö Feel pain while urinating or also while filling the bladder

Ö When you change your sitting or any posture, you feel the urge to urinate Ö Urine leakages after major surgeries like Cesarean, prostate surgery, hysterectomy, and others

Ö Urinary changes after neurological disorders like spinal cord injuries, multiple sclerosis, or strokes

Ö Frequent urinary bladder infections

Ö Unable to retain urine even for short periods

Ö Urine leakages causing much embarrassment and hinder your normal

functioning

Ö Gradual weakening of urinary system and its functioning

Ö Urinating with stoppages thereby restricting continuous flow of urine Ö Constant feeling that bladder is full and you want to urinate

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Ö Weak pelvic floor muscles put a strain on your urinary system and you feel like urinating, situation is common in obese people, after childbirth and with age.

Ö Enlarged prostate gland also causes problems in urination.

Normally signs of incontinence have many cures and treatments. Medications, minor surgeries, and exercises for pelvic muscles offer much relief. You can use pads. The pads that are made nowadays are so much better than the old days. They are thinner, and absorb more.

You can easily change them and you can wear them undetected.

However in some cases, the problem is quite bad, and a urinary catheter can be used in those extreme cases. Sometimes overall improvement in your health may improve these signs of incontinence.

The incontinence signs also differ for men and women. Normally women

suffer from urinary incontinence due to various stresses while men suffer problems of incontinence due to weak muscles and other functional stress.

Functional stress does not allow you to reach the toilet due to certain medical conditions like physical infirmities, dementia, or other problems. Women suffer soon after childbirth or other stressful periods. Obese people often encounter problems of urinary incontinence. Hence symptoms or signs of incontinence depends more on the type of incontinence.

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5. Types of Incontinence

Urinary incontinence is your inability to control the passage of urine. There are many different types of urinary incontinence. Different types have different medications to relieve you of the problem. The two broad classifications of urinary incontinence are:

1. Short-term or Acute Incontinence

2. Long-term or Chronic Incontinence

Constipation, urinary tract infections, side-effects of medication or diets, or kidney stones could cause acute urinary incontinence. This is a temporary phase and finds easy remedy in simple medications. This is the same as transient incontinence.

Long-term or chronic incontinence is over a longer period. Such chronic incontinence could be due to stress, urge, overflow, functional, reflex, anatomical, surgery-induced, or mixed urinary incontinence.

Stress Incontinence

This is common incontinence in women. When you have slight and

involuntary urine leakages while doing any physical activity, it is stress incontinence. The stress here does not refer to any emotional stress, instead is the physical exertion in the abdomen regions. Simple activities like sneezing, coughing, laughing, exercising, hugging, lifting anything, walking, changing positions like getting up from a chair or lying on a bed, and sexual actions Copyright 2005 All rights reserved

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could cause such involuntary urinary leakages. You may have to visit the toilet often to prevent such urinary leakages.

Causes

1. The main cause behind this incontinence is unequal abdominal pressure upon urinary bladder and urethra. This cause urethra and bladder neck

to proceed downwards and weak pelvic floor muscles change direction

of the urethra. This keeps the urethra open and urine leaks out. Pelvic muscles normally support the urinary bladder.

2. Weak urethral sphincter muscles are unable to absorb abdominal

pressure and thereby cannot prevent urinary flow. This weakness is due to neurological injuries, side effects of certain medicines on the urethral region and surgeries. This causes incontinence in men after prostate

surgery while in women after pelvic surgery. Women with multiple

pregnancies or vaginal childbirths, or when the urethra or bladder or

rectal wall extends into vaginal space, stress incontinence is common.

3. Chronic asthma and bronchitis cause incessant coughing leading to

stress incontinence.

4. Menopause- During menopause there is a decrease in female hormones leading to weakening of supporting muscles of the pelvic region.

Incontinence is also evident during the week before a menstrual period.

The low estrogen levels in your body now lead to less muscular

pressure in the urethra region, which leads to involuntary urinary

leakages.

5. Increasing age, smoking, and obesity are other factors.

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Classification of Stress Incontinence

Urologists normally classify stress incontinence into three main types.

In the Type I category the bladder neck and urethra open and the urethra moves down by less than two centimeters during any stress. Hence, the urethra angle is unchanged. Such categories of patients do not exhibit any cystocele signs.

In the Type II category, the bladder neck and urethra close and urethra moves down by more than two centimeters during any stress. Hence, the urethra angle increases and such patients could have a cystocele. If such a cystocele is within the vagina, it is Type II A and if it is outside the vagina, it is a Type II B.

In the Type III category, stress incontinence is not due to the urethral position. It is normally due to weak urethral sphincter muscles, which could be due to past surgeries.

Treatments

Stress incontinence is fully treatable and there are many simple cures for the same.

Pelvic floor exercises: Such exercises according to your doctor’s instructions give immense relief from incontinence to both men and women.

Surgery: A hysterectomy by a gynecologist can provide relief.

Pessary: This device in the vagina provides support to the urinary tract and other organs. Often, this is an alternative for surgery.

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Hormone Replacement Therapy: This is useful for menopausal women.

Application of hormone replacement therapy cream around the urinary opening also provides relief.

Urge Incontinence

This incontinence is common in both elderly and healthy men and women.

This is a type of incontinence where you are unable to control your urine as soon as you feel the urge to visit the bathroom. Your urinary bladder becomes overactive and gives less warning for you to go to the toilet. The bladder squeezes itself involuntarily and may empty itself fully or you might have little urine leakages. The bladder may or may not be full at the time of such an occurrence.

You feel the urge to urinate when you drink a little quantity of water, or hear the sound of running water as in a shower, running tap, washing dishes, or flushing sound, or even touch running water. You need to visit the bathroom two or three times in the night. Additionally you might also wet your bed at night.

Causes

The common causes are:

1. Inappropriate bladder contractions due to severe nervous damage to your bladder- Such damage occurs due to spinal cord and nervous

injuries, Alzheimer's disease, Parkinson's disease, stroke, multiple

sclerosis, and other surgical injuries. These cause harm to the bladder nerves and muscles.

2. Constipation also causes urge incontinence.

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3. Infections of the urinary tract cause irritation producing muscular spasms in the urethra and bladder regions.

4. Enlarged Prostate gland

5. Change in sitting or sleeping positions

Bladder retraining is the most common treatment for urge incontinence.

Overflow Incontinence

This type of incontinence is common among elderly men and rare in women.

You do not feel the urge to urinate although your bladder is full. Hence, urine leaks out in small quantities continuously and your bladder never empties fully. It is always partially full.

You wake up many times to urinate at night and at times pass a constant stream of urine although you have been to the toilet for a long time. Hence, you never feel that your bladder is empty.

Causes

Possible causes of Overflow incontinence are:

1. Enlarged prostate gland stops the flow of urine in many men.

2. Tumors or kidney stones block the urethra and hence the flow of urine.

3. Diabetes and other nervous system diseases like Parkinson’s disease, Alzheimer’s disease, strokes, and multiple sclerosis damage the nerves of the bladder muscles and make them weak, causing such

incontinence.

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4. Nervous system disorders and spinal cord injuries cause such

incontinence.

5. Urinary bladder dysfunction causes malfunctioning of bladder muscles and as a result, the bladder does not empty itself.

6. Rare occurrences in women are due to tumors in the ovaries and also due to fibroids.

Although there is no total treatment for overflow incontinence, urologists, and gynecologists can help you lessen your problem to some extent.

Functional incontinence

This type of incontinence is mainly in individuals who have total urinary control and a perfectly functioning urinary system. However, they are unable to visit the bathroom at appropriate times due to certain physical, mental, and cognitive disabilities. Such incontinence is common among individuals with multiple sclerosis, Parkinson's disease, Alzheimer's disease, dementia, arthritis and elderly men and women. These people are unable to plan the bathroom trip at the appropriate time.

Mixed incontinence

This type of incontinence is a combination of stress and urge incontinence in 60:40 ratios. Hence, it is a mixed incontinence. It is common in elderly women. Doctors need to evaluate every aspect of this disorder to give proper medication.

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Reflex Incontinence

This type of incontinence is due to lack of control of over functioning of the urinary bladder and is common in people with neurological problems. This occurs without any warning and you are unaware of the need to urinate. There could also be an abnormal opening between the bladder and other urinary organs and urine leaks out from the urethra, ureter, or bladder. Physicians term the bladder as unstable, spastic, or overactive as bladder nerves become overactive and empty.

Surgery-induced Incontinence

Specific operations like cesareans, hysterectomies, lower intestinal or rectal surgeries, and prostatectomies lead to incontinence problems.

Anatomical Incontinence

Certain structural problems in urinary tracts cause this type of incontinence.

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6. Common Causes of Incontinence

Urinary incontinence could be temporary or acute incontinence or chronic and long-term incontinence. Various factors affect your incontinence.

Main causes for temporary incontinence:

1. Infections of the urinary tract leads to incontinence until such infections are cured. These also include vaginal irritations and infections.

2. When you stretch your pelvic muscles during childbirth, you might

experience urinary incontinence for some time. The problem is usually

nonexistent a few months after childbirth.

3. Constipation leads to incontinence as impact of the stool pushes against the urinary tract and obstructs the flow of urine.

4. Diuretics, sedatives, muscle relaxants, painkillers, antidepressants, and other specific medicines cause incontinence as side effects. These

effects reduce after stopping such medications.

5. Excessive caffeine, chocolate, and cola have diuretic effects. A few more bladder irritants are citrus fruit juices, spicy foods, milk and its products, and artificial sweeteners. These lead to short-term

incontinence. These irritants do not allow the urinary bladder to

function normally. Low intake of fluids could concentrate your urine

and cause irritation in the urinary tracts.

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6. Temporary illnesses cause incontinence in the short-term. Total

weakness of your body does not allow you to reach the bathroom in

time to urinate.

7. Alcohol and other intoxicants reduce your ability to recognize your need to urinate and act accordingly.

8. Certain surgeries could result in temporary incontinence. The problem usually resolves when you recoup from the effects of surgery.

The incontinence disappears when you discontinue consumption of such

irritants and change your diet habits or after the infection is cured.

Main causes for Chronic Incontinence

Pelvic muscles and bones keep your urinary tract and its organs in their proper positions. Weakening of such muscles and the urinary bladder leads to

irreparable damages and consequent incontinence.

The urethral sphincter muscles control functioning of your urinary system.

They help in free and voluntary passage of urine. However, weakening of such muscles can lead to chronic incontinence. Normally your bladder contracts and dilates at the same time as the sphincter muscles. When there is a lack of coordination between the bladder and the sphincter muscles, it results in urine leakages.

Sometimes your bladder muscles are overactive and they empty the bladder before you reach the toilet. They do not give any warning to you before such emptying.

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Prostate enlargement in men puts pressure on the urinary tract and causes chronic incontinence. Such pressure blocks the urethra and urine leaks out without your knowledge.

Menopausal women experience imbalance in hormones. Such reduced estrogen levels cause urinary incontinence.

Various neurological disorders as in Parkinson’s disease, Alzheimer’s disease, strokes, multiple sclerosis, dementia, arthritis, and spinal cord injuries cause urinary incontinence.

When you are unable to reach the toilet in time due to functional disabilities like spastic muscles, and in patients of various nervous disorders, urinary incontinence is inevitable.

Sometimes childbirth causes stress incontinence, a type of chronic

incontinence. This is due to weakening of pelvic and neighboring muscles and resultant weakening of the bladder.

A hysterectomy and other gynecological surgeries could damage or weaken the pelvic muscles. This in turn leads to urinary incontinence.

Obese people put excessive pressure on their bladders. This results in weakening of the bladder and associated muscles leading to incontinence.

Tumors or scar tissue can cause obstructions in the urethra, which restricts the flow of urine. The urethra could become narrow due to inflammation of the urinary tract. This causes problems with urine retention and can cause incontinence.

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Intrinsic sphincter deficiency causes weakness in the bladder neck, urethra, and vaginal muscles. This is due to pelvic surgeries in women. In men, this is due to prostate surgeries, which cause such damage to the external urethral sphincter muscles. This leads to dysfunction of nerves and resultant

incontinence.

A urinary tract fistula after any gynecologic surgery or other obstetric trauma causes irreparable damage to the urethral sphincter muscles. Such damage leads to continuous incontinence. Leakage of urine is present always and in all positions. An ectopic ureter could enter your urethra or female genital organs causing such incontinence.

Fractures in pelvic regions and other major or minor surgeries can cause incontinence. These fractures can damage the bladder neck, and hence cause urinary leakages.

Urinary incontinence is a common occurrence in elderly persons and many hospital patients. Such cases are due to many varied reasons like hypnotics, diuretics, restricted mobility, delirium, urethritis, and stool implications.

The causes for urinary incontinence are manifold and varied. However, it is necessary for you to consult your doctor or urologist for proper medication and eradication of such incontinence problems. Timely medical help could provide immense relief and embarrassment. This could help you to lead a normal and healthy life.

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7. Childbirth and Incontinence

Urinary incontinence in women is many times due to pregnancy and

associated childbirth. Pelvic muscles support childbirth and these stretch, flatten, and weaken during childbirth. These same muscles also support your urinary system. They provide immense support to the urethra and bladder neck, which controls the process of urination. Hence, vaginal deliveries could cause incontinence in some women.

Does Childbirth cause Incontinence?

Pelvic muscles work the most during childbirth. The basic strength of these muscles and any associated deficiencies or injuries to these muscles affect childbirth. Consequently, it affects your incontinence. Difficult bowel movements regularly weaken the pelvic muscles. However, if you are young, your muscles have the ability and time to heal themselves from such exertions.

In elderly women, collagen deposits reduce, thereby affecting the working function of the pelvic muscles.

More vaginal deliveries and large babies weaken pelvic muscles leading to incontinence. Such deliveries can cause prolapse. The bladder, uterus, or rectum can bulge into vagina as you grow older. The incidence of such a prolapse is proportional to the number of vaginal deliveries. Similarly, when babies are large, you need to give more pushes to deliver through your vagina.

Such high number of pushes can cause a lot of injury to the pelvic muscles and nerves. These exertions in later years can lead to urinary incontinence.

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Labor and Incontinence

Natural process of giving birth is the best as long as it does not cause irreparable damage to your muscles and tissues. Hence, natural childbirth or vaginal delivery is the safest bet. However, sometimes you need to push the baby for long hours before it finally comes out. Such extended hours in labor results in permanent weakening of supporting muscles, nerves, and tissues of the uterus, bladder, and rectum. These pelvic muscles then droop down and can cause incontinence.

What happens when you push while in Labor?

When the baby’s head reaches the pelvic region, it pushes against the pelvic muscles and other nerves in the vicinity. Dilation of the cervix starts the pushing session. You need to push hard after every contraction of the uterine muscles to push out your baby. Such pushing compresses the baby’s head against your muscles to such an extent that the region is devoid of any blood supply. Hence, your tissues do not receive any oxygen or nutrition and are now easily susceptible to damage. Besides, these pushes are much stronger than the usual muscular strains. The periods between contractions allow blood to rush in with nutritive oxygen for your nerves and muscles. This helps your tissues to recover and undergo the same process until your baby is born.

Some women undergo extensive hours in labor when the process repeats

innumerable times. Pudenal and pelvic nerves on either side of birth canal enclose your baby’s head. These same nerves signal functioning of your urinary system. Prolonged stress periods during such long labor hours weaken these muscles. They are then unable to transmit brain signals for further functioning. With age, these muscles do recover. However, extreme cases render these muscle inoperative leading to incontinence of urine, prolapse, or stool.

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Such incontinence and prolapse is less when you allow your uterus to function normally without exerting extra pressure to push down your baby. Obviously, natural working of uterus lowers the incidence of damage of the pelvic muscles and nerves.

Vaginal Delivery and Incontinence

When finally your baby’s head comes out of the vagina, the supporting pelvic muscles and ligaments can suffer damage. At times doctors cut through the vaginal muscles to enforce faster delivery. This is an episiotomy, which is a risk for anal incontinence. Such damaged or cut ligaments and muscles heal naturally with time. However, in some women the healing process does not take place resulting in incontinence in later years. Doctors cannot examine the healing of your muscles and hence cannot offer any medication. Hence,

women with vaginal deliveries stand a higher risk of incontinence than women with cesarean births.

Forceps Delivery and Incontinence

Forceps are spoon-shaped instruments used to ease the delivery process in women with long hours of labor. These instruments are placed around the baby’s head during delivery, initially inserted into the vagina. The doctor pulls the forceps, which pushes away the pelvic muscles and tissues. This eases the path for the baby to come out. Such delivery through forceps does save the life of women during difficult childbirths.

Such forceps being metallic instruments press against supporting pelvic tissues. It can also stretch and tear the vagina resulting in long-term damage such as urinary incontinence. Nowadays forceps deliveries are rare as

sometimes they cause skull fractures in babies leading to permanent

disabilities.

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“Understanding INCONTINENCE’ by G. Fairweather

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Well, it seemed with my large baby I had it all. Anyway, my doctor was not telling me much. I suffered for over three years, though not as bad as the first year once I found the exercises. Then I had my second son. Another elephant.

And, I cannot tell you why, but after he was born, my incontinence completely went away. It was like whatever was pushed out of place at the first birth, was pushed back into place with the second. (I do not know if it was a simple timing process or if something moved and the pressure was taken off. And, I have not been able to find anyone to tell me.) I did continue my Kegel exercises during pregnancy, so you can see how the below may relate.

Is Incontinence a sure happening after childbirth?

No, childbirth does not necessarily lead to incontinence. Your body is flexible and can endure innumerable muscular pressures and nervous strains. The many damages and injuries during childbirth heal with time and most of you are fine within a few months of childbirth, be it vaginal or non-vaginal. However, in a few women muscles and tissue do not gain the previous strength and

flexibility. They have a greater incidence of incontinence and prolapse.

The rate of recovery differs from woman to woman. It depends on the inbuilt strengths, number of deliveries, and size of the babies.

Does childbirth weaken the urinary system?

Labor and delivery causes strain on pelvic muscles, associated nerves, and ligaments. Such strain can cause damage to your muscles, weakening their functioning. Some of you are able to recoup from the strain after a few months, while some are unable to regain the lost strength and flexibility.

However, bladder and vaginal injuries due to delivery may cause organs to sag down. This muscular relaxation or bulging into the vaginal region is called Copyright 2005 All rights reserved

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“Understanding INCONTINENCE’ by G. Fairweather