WOMEN’S BODIES: URINARY PROBLEMS. STRESS INCONTINENCE
Stress incontinence is mainly the result of weakening and/or damage to the sphincter and pelvic-floor muscles or their nerve supply during childbirth.
Anything that increases the pressure in the abdomen, such as coughing, sneezing, lifting or pushing things, jumping or bursting out laughing, can also increase the pressure on the bladder. Just before you start these activities you unconsciously tighten your pelvic-floor muscles around your urethra to prevent urine from leaking.
If your sphincter muscles aren’t strong enough to keep your urethra closed, urine can leak through it when you do anything that increases pressure in the abdomen. This leakage is called stress incontinence, and it affects about 20 per cent of adult women. Whether the leak is just a few drops or a lot depends on how much your pelvic floor is weakened and how active you are (for example, jogging or playing tennis) when it happens.
Many things, in addition to damage during childbirth, can take their toll on the strength of the pelvic-floor muscles.
• After the menopause lack of oestrogen causes further weakening of the pelvic floor.
• All our muscles lose some tone and strength with age. The pelvic floor is no exception.
• Chronic constipation and constant ‘straining at stool’ (the term for having to bear down hard when trying to empty the bowel) weakens the pelvic floor and may damage its nerves.
• During pregnancy lots of the hormone relaxin is produced. This hormone relaxes muscles and softens ligaments and other tissues of the pelvic floor in preparation for delivery. This makes bladder control more difficult during pregnancy and soon after delivery.
• Our bodies prepare for the possibility of pregnancy by starting to release some relaxin towards the end of each menstrual cycle. This, plus the added muscle-relaxing effect of progesterone, is why bladder control can be a bit more difficult just before periods.
• During breast-feeding, oestrogen levels are very low, making it harder to regain good bladder control after childbirth. It’s very important to keep up pelvic-floor exercises while you’re lactating.
• Some drugs used to control high blood pressure can paralyze part of the sphincter muscle.
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