Stress Incontinence
Stress urinary incontinence is loss of urine that occurs at the same time as physical activities that increase abdominal pressure (such as sneezing, coughing, laughing, and exercising). These activities can increase the pressure within the bladder, which behaves like a balloon filled with liquid. The rise in pressure can push urine out through the urethra, especially when the support to the urethra has been weakened; this is what we call stress urinary incontinence.
Pregnancy and delivery can have significant effects on the mechanisms of continence. Obstetricians are becoming more and more aware of the risks of injury to the pelvic floor caused by vaginal delivery. Excessive stretching of the supportive tissues, muscles and nerves, can cause permanent defects even after post-pregnancy healing. This may lead to various pelvic floor support problems for the surrounding organs. Although the urinary incontinence often resolves in the first few months after delivery, its initial presentation may signal the development of more troublesome incontinence in the future.
Some women with stress incontinence may note only occasional leaks, only with aggressive exercise, colds or allergies, or at times when the bladder is especially full. Other women have a great deal of leakage with simple activities such as getting up out of a chair, or simple walking. Although the severity may vary, many women find that these symptoms begin to limit their physical or social activities, and can have a serious impact on quality of life.
Urge Incontinence
The term “overactive bladder” is sometimes used to refer to any of the following conditions:
- Frequency (more than 8 voids in each 24 hours)
- Urgency (a powerful urge to urinate, that is difficult to put off)
- Nocturia (waking up twice or more at night to urinate)
- Urge incontinence (leakage of urine associated with an urge to urinate, or not making it to the bathroom in time)
When leakage of urine is accompanied by a sensation of the need to urinate, or the impending sense that a large leak is going to happen, this is often what is known as urge incontinence. Unlike stress incontinence, this usually represents a bladder "squeeze" or contraction, occurring at an unwelcome time. Often, people with urge incontinence also have increased urinary frequency, have to rush to the bathroom frequently, or wake up more than once or twice at night to urinate. You may also notice severe urgency and leakage when driving into the driveway, placing the key in the front door, running water or with temperature changes.
These are very common conditions, and their impact can vary widely. Their causes are less well understood than in stress incontinence. Occasionally, there may be an underlying reason, like neurologic or inflammatory conditions; in most cases, no particular cause can be identified. Whether or not an underlying cause is identified, the effects of overactive bladder and urge incontinence can be significant.