Female Incontinence
Stress incontinence is by far the most prevalent form of Urinary Incontinence, especially among women. It occurs when the pressure inside the bladder exceeds the resistance produced by the external bladder sphincter muscle. Urine loss of this nature commonly arises when there is a sudden increase in bladder pressure, or stress, during coughing, sneezing, laughing, or physical activity. The problem is exacerbated in women by the pelvic muscle strain experienced during childbirth as well as from the estogen loss that accompanies menopause.
In women, the levator muscles or their supplying nerves can be damaged in pregnancy or childbirth. This occurs more commonly after a normal vaginal delivery, but can also occur following a c-section. There is some evidence that these muscles may also be damaged during a hysterectomy. Pelvic surgery using the "perineal approach" (between the anus and coccyx) is an established cause of damage to the pelvic floor. This surgery includes coccygectomy.
In female high-level athletes, perineal trauma is rare and is associated with certain sports (each with a distinct type of trauma): water-skiing, bicycle racing, and equestrian sports.
Damage to the pelvic floor not only contributes to urinary incontinence but can lead to pelvic organ prolapse. Pelvic organ prolapse occurs in women when pelvic organs (e.g. the vagina, bladder, rectum, or uterus) protrude into or outside of the vagina. The causes of pelvic organ prolapse are not unlike those that also contribute to urinary incontinence. These include inappropriate (asymmetrical, excessive, insufficient) muscle tone and asymmetries caused by trauma to the pelvis. Age, childbirth, family history, and hormonal status all contribute to the development of pelvic organ prolapse. The vagina is suspended by attachments to the perineum, pelvic side wall and sacrum via attachments that include collagen, elastin, and smooth muscle. Repair of lost vaginal support may involve surgery.
When the bladder and urethra are in their proper anatomical place, any pressure increases in the abdominal cavity, from strain or any other cause, will also affect the urethra, preventing leakage.
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