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Urinary Incontinence: Leakage of Urine Problem

By Dr. Bela Makhija in Obstetrics And Gynaecology

Mar 07 , 2022 | 2 min read

Leakage of urine is a fairly common problem in women however some women ignore it while others choose not to talk about it as they find it embarrassing. It needs to be differentiated from increased frequency when there is need to go for passing urine again and again but there is no leakage.

Why it happens?

Normal urination is controlled by the following factors:
  1. The pressure in the urethra (i.e the tubular outlet of the urinary bladder) is much higher than in the bladder itself.

  2. The normal urethra is at an angle with the urinary bladder this give the sphincteric effect.

  3. When the urine in the bladder reaches a certain volume, there is an urge to void, these signals are controlled by the nervous system.
Whenever there is a disturbance of any of these mechanisms there may be urinary dysfunction.

Types of Incontinence

It may broadly be of the following types:

  1. When a small quantity of urine leakage happens specially on coughing, sneezing or laughing, it is called stress urinary incontinence this is involuntary i.e not in your control and the quantity is small.

  2. Sometimes there is inability to hold urine, once the urge comes and urine may pass before actually be in the proper position to do so, even while trying to control it, this is called urge incontinence. Here the quantity of urine passed is large.

  3. At other times there may be the feeling of fulness however only a small quantuty of urine may be passed each time even after a very long interval, where one would expect to pass a normal quantity of urine. This is called overflow incontinence.

  4. Least common is due to a small hole in the urinary passage called fistula, this is true leakage of urine and it occurs all the time without interval of dryness.

When is it common

  1. During the latter part of pregnancy, due to the effect of pregnancy hormone progesterone, which causes the urinary sphincter to become relaxed. This is a type of stress incontinence and will correct itself when pregnancy is over.

  2. After childbirth- due to stretching of the birth and urinary passages during labor, even the nerves may be slightly damaged, it may also be due to the pain in the birth canal due to a tear or cut. However it recovers within a few weeks, if it lasts more than 4-6 weeks it needs medical attention.

  3. Around or after menopause- this is most common. It is due to advancing age, decreased of hormones and weakness of musculature which results in the laxity of urinary and birth canals. It causes sagging which in turn disturbes the angle between the urethra and urinary bladder, it causes stress urinary incontinence, it is often associated with decent or prolapse of the uterus.

  4. Rarely there may be fistula formation after surgery or radiotherapy. This will require surgical correction

Mostly women need to consult a doctor for stress incontinence. If it is mild it may be controlled by proper perineal exercises. If more severe it requires surgical correction.

How it can be prevented?

  1. Adequate perineal exercise after child birth and around menopause. 
  2. Proper spacing of the child birth
  3. Ensure all deliveries are institutional 
  4. Avoidance of chronic constipation and cough.
  5. Avoid vaginal and urinary infections
  6. Control obesity.
  7. Regular check-ups.