Dr. Judith Reichman TODAY contributor • Profile • E-mail

Urinary incontinence and pelvic prolapse are problems that are rarely talked but are very common, especially with women.

We’ve all seen the euphemistic commercials for products that let you dance, jog and hug someone “safely” and for medications that help your “inner pipes” work better.

There are also surgical procedures that can correct continence problems.  

TODAY medical contributor and gynecologist Dr. Judith Reichman explains the different types of bladder control problems and what you can do to control your bladder better.

How common are bladder control problems?
The estimate is that at least twenty-five million Americans suffer from urinary incontinence or loss of bladder control.  Eighty percent of these individuals are women. Incontinence is a major cause for need of nursing care and decision to enter a nursing home facility.  The types of incontinence, their causes and symptoms are, of course, put into  categories: (We do this all the time in medicine.)

• Stress incontinence (SUI) — Leakage of urine when coughing, sneezing, laughing, straining or lifting (think of the phrase “I laughed so hard I wet myself”).  This type of incontinence often occurs as a result of stretching and weakening of the pelvic floor.  This is the most common form of bladder control problem experienced by women. SUI is often accompanied by pelvic prolapse.
• Urge incontinence — An urgent need to go with little or no warning so that there may not be time to get to the toilet.  The bladder muscles, called the detrussor muscles are over-stimulated and overactive.  One in five adults over age forty are affected by an overactive bladder and have recurrent symptoms of urgency, frequency, and on occasion, accidents... with  loss of urine.
• Overflow incontinence — This occurs when the bladder doesn’t properly empty and becomes over distended.  The bladder simply can’t hold the urine and some spills out.  Overflow incontinence can occur as a result of an obstruction (one of the things that causes this obstruction is a prolapse of the uterus or a large uterine tumor) or can be caused by nerve damage, especially in spinal injuries.
• Mixed incontinence — This signifies a combination of urge and stress incontinence symptoms.

What exactly is pelvic prolapse?
The definition of pelvic prolapse is a stretching and weakening of the ligaments, muscles and tissues that act as a hammock for the pelvic organs.  As a result, the bladder, uterus, cervix, rectum and the vaginal walls themselves may descend from their normal position.  When prolapse is significant, these organs “balloon” below the opening of the vagina especially after coughing, pushing down (which you do when you have a bowel movement) or simply from gravity when standing.  About 50% of women over the age of fifty have some degree of pelvic prolapse in addition to continence problems.  Symptoms from prolapse include feeling of pressure and discomfort from the bulge of the protruding organs.  Obviously this can cause sexual dysfunction.  Eleven percent of women who suffer from pelvic prolapse will end up having surgery to correct this problem.

What causes urinary incontinence?
The primary cause of SUI is pelvic prolapse.  Indeed, 50% of women are likely to develop this.  The most common risk factors are:

• Vaginal delivery —This is more likely to occur with vaginal delivery of large babies.
• Hysterectomy — This increases risk by 40 to 80% for women sixty years or older.  If the cervix is not removed (subtotal hysterectomy) risk of prolapse may be lower.
• Family history of pelvic prolapse
• Age — Getting old puts us at risk for both SUI and urge incontinence.
• Medications, smoking, alcohol and caffeine- Medications include tranquilizers, antidepressants, laxatives, antibiotics and estrogen ( although local vaginal estrogen is sometimes prescribed to help women with atrophy subsequent to menopause with bladder control)
• Other diseases — Diabetes, stroke, dementia and Parkinson’s (all these can cause damage to the nerves that are needed for bladder control).
• Excess weight — Abdominal weight pushes down on the pelvic organs and weakens their support.

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