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The Health Blog
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WOMEN’S BODIES: URINARY PROBLEMS. HOW THE BLADDER WORKS
To understand incontinence we must know something of the normal control of urination. The bladder is a muscular t that drains to the outside through the urethra. Urine produced by the kidneys flows through the ureters into the bladder, where it is stored. Urine only escapes when pressure inside the bladder is greater than the pressure that keeps the urethra closed. Most of the time the urethra is compressed and kept closed by its sphincter and the pelvic-floor muscles that support it. A sphincter is a muscular cuff that acts like a rubber band or valve when it’s contracted to close off the tubular organ it surrounds.
When the amount of urine in the bladder reaches about 400 ml (though the amount varies from person to person and in certain circumstances), its muscle wall begins to stretch. Nerve endings in the muscle tell you that your bladder’s full and you feel the urge to pass urine. In childhood you slowly learn to consciously control this urge until it’s convenient to urinate. When you feel you want to go but must wait a while, your sphincter muscle and the pelvic-floor muscles tighten their hold around the urethra to help you hold on.
When you decide that it’s the right time to empty your bladder (which is usually when you’re seated on the toilet), you consciously release control and a series of muscle activities begins:
• the muscles that keep the urethra closed relax
• the muscles in the bladder wall contract so that urine is pushed out through the urethra
The most common causes of incontinence in women are things that upset the balance or strength of the muscles that keep the bladder outlet closed, and the muscles that cause the bladder to empty. The two types that commonly affect women are stress incontinence and urge incontinence, or a combination of both.
Incontinence can also result from anything that affects the nerves controlling urination such as spinal injury and some other nerve disorders such as strokes, multiple sclerosis and Parkinson’s disease.
Myra’s story
Myra is 55 years of age. During a recent routine checkup, she mentioned that she had put on more weight than she liked since her menopause at the age of 51 years. ‘I suppose it’s because I’ve had to give up my tennis,’ she said. Knowing that she was a good player who really enjoyed a game with her friends, I asked ‘Why?’. ‘Oh, bladder problems,’ replied Myra, blushing. ‘I’ve had a bit of a weakness for ages, but until I was about 50 I could control it pretty well. In the last few years it’s really got the better of me. Now, every time I serve or run for a return, I wet my pants. It’s so embarrassing. I’ve heard about the operations but I’d prefer not to have surgery, so I guess I’ll just have to put up with it.’
Myra’s story is like that of many women who suffer some pelvic-floor damage during childbirth but don’t develop troublesome symptoms until after the menopause. If she had been doing pelvic-floor exercises since her first baby was born, it’s unlikely that she’d have had these problems. She commenced pelvic-floor exercises the next day and decided to start hormone replacement therapy. Three months later she was playing tennis twice each week without fear of accidents, and had lost 4 kg.
*284/31/5*
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