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Urinary Incontinence – Types and its Causes

Urinary incontinence is  a common problem and is thought to affect millions of people worldwide. It’s not clear exactly how many people are affected, but it’s estimated that between 3 and 6 million people in the UK may have some degree of urinary incontinence.

What is urinary incontinence?

Urinary incontinence is a common problem that can affect both sexes – but women are more commonly affected.  Urinary incontinence is the involuntary leakage of urine from the bladder. It can range from a small dribble now and then, to large floods of urine. Incontinence may cause you distress as well as being a hygiene problem.

There are two main kinds of urinary incontinence. 

  • Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladdercamera.gif. It is the most common type of bladder control problem in women.
  • Urge incontinence happens when you have a strong need to urinate but can’t reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.

Causes of Urinary Incotinence

Stress incontinence is the most common type. It occurs when the pressure in the bladder becomes too great for the bladder outlet to withstand. This is usually caused by weak pelvic floor muscles. Pelvic floor muscles are often weakened by childbirth. Stress incontinence is common in women who have had several children, in obese people and with increasing age.

Urge incontinence (unstable or overactive bladder) is the second most common cause. The bladder muscle contracts too early and the normal control is reduced. In most cases, the cause of urge incontinence is not known. This is called idiopathic urge incontinence. It seems that the bladder muscle gives wrong messages to the brain and the bladder may feel fuller than it actually is.

Mixed incontinence. Some people have a combination of stress and urge incontinence.

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Maternal obesity ‘increases risk of infant death’

Recent studies have found conflicting evidence on whether there is an association between infant mortality and overweight and obesity in mothers. Some analyses found that there was an increased risk of infant mortality if the body mass index (BMI) of the mother was 30 or over, though others were inconclusive.

baby in womb
The researchers suggest that 11% of infant deaths in the study were associated with maternal overweight and obesity.
The researchers behind the new study analysed data from over 1.8 million births between 1992 and 2010 recorded as part of the Swedish Medical Birth Register. In the study, maternal BMI was classified as follows:

Underweight (BMI of 18.4 or less)
Normal weight (18.5-24.9)
Overweight (25-29.9)
Obesity grade 1 (30-34.9)
Obesity grade 2 (35-39.9)
Obesity grade 3 (40 or over).
During the study period, a total of 5,428 infant deaths occurred. The researchers found that two thirds of the deaths occurred during the first 28 days of life.

‘Rates of infant mortality increased with increasing maternal BMI’
Among “normal weight” women, there were 2.4 infant deaths per 1,000 births, and among women with obesity grade 3, there were 5.8 infant deaths per 1,000 births. Rates of infant mortality increased with increasing maternal BMI.

Compared with normal weight mothers, infant mortality was described as being “modestly increased” among overweight and mildly obese mothers. However, the study found that mothers with obesity grade 2 or 3 had more than doubled risks of experiencing infant death.

The majority of infant deaths in the sample group (81%) were caused by congenital anomalies, birth asphyxia, sudden infant death syndrome (SIDS) or infections.

Risk of birth asphyxia and other neonatal conditions increased in accordance with the BMI of the mothers. Infants of mothers who were classified as being in the obesity grade 2-3 groups were found to have increased risk of dying from congenital abnormalities and SIDS.

The researchers suggest that 11% of infant deaths in the study were associated with maternal overweight and obesity.

The association between maternal BMI and infant death was reported mostly in term births of at least 37 weeks gestation. Associations between maternal BMI and infant death in preterm births were only reported among obesity grade 2-3 mothers.

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Cons of regular low dose aspirin to stave off serious illness in women outweigh pros

The pros of giving healthy women regular low dose aspirin to stave off serious illness, such as cancer and heart disease, are outweighed by the cons, suggests a large study published online in the journal Heart.

But the balance begins to shift with increasing age, and limiting this form of primary prevention to women aged 65 and above, was better than not taking aspirin at all, or treating women from the age of 45 onwards, say the researchers.

They base their findings on almost 30,000 healthy women, who were at least 45 years old and taking part in the Women’s Health Study.

Participants were randomly assigned to take either 100 mg of aspirin or a dummy tablet (placebo) every other day, to see whether aspirin curbed their risk of heart disease, stroke, and cancer.

During the trial period, which lasted 10 years, 604 cases of cardiovascular disease, 168 cases of bowel cancer, 1832 cases of other cancers, and 302 major gastrointestinal bleeds requiring admission to hospital were diagnosed.

Over the subsequent seven years, a further 107 cases of bowel cancer and 1388 other cancers were diagnosed.

Compared with placebo, regular aspirin was linked to a lower risk of heart disease, stroke, bowel cancer, and in some women, other cancers, but only marginally so.

And this slight health gain was trumped by the prevalence of internal gastrointestinal bleeding, which affected two thirds of the women taking the non-steroidal anti-inflammatory drug.

The risk of gastrointestinal bleeding rose with age, but so too did the drug’s impact on lowering the risk of bowel cancer and cardiovascular disease, with the balance appearing to tip in favour of the drug for women aged 65 and above.

The researchers calculated that over 15 years, 29 over-65’s would need to be treated with aspirin to prevent one case of cancer or heart disease/stroke.

“Recent findings that both daily and alternate day aspirin can reduce cancer risk, particularly for colorectal cancer, have re-ignited the debate on aspirin in primary prevention,” write the researchers.

But they conclude that blanket treatment “is ineffective or harmful in the majority of women with regard to the combined risk of cardiovascular disease, cancer and major gastrointestinal bleeding.”

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Folic acid prior to conception may lower risk of small for gestational age offspring

Women who take folic acid prior to conception may be less likely to have offspring born small for gestational age, researchers say.

Babies are deemed small for gestational age (SGA) if their birth weight is in the lowest 10% of babies born.

SGA is primarily caused by fetal growth problems during pregnancy, such as intrauterine growth restriction (IUGR). This can develop when the fetus fails to receive the required nutrients and oxygen it needs to grow.

At birth, SGA can cause an array of complications, such as reduced oxygen levels, polycythemia (excess red blood cells) and low blood sugar. It can also increase the risk of health problems later in life, such as diabetes, high blood pressure, obesity, cardiovascular disease and mental health issues.

Folic acid – a type of B vitamin – is already highly recommended for women of a childbearing age due to studies claiming the vitamin can reduce the risk of a child developing neural tube defects, such as spina bifida. The American Pregnancy Association say prior to and during pregnancy, women should take around 400 mg of folic acid a day.

The researchers from this latest study – including Khaled Ismail of the University of Birmingham in the UK – set out to determine how folic acid supplementation before conception and during pregnancy affected offspring’s risk of SGA.

Risk of SGA lowest among women who start taking folic acid before conception

By analysing data from a UK regional database, the team identified 108,525 pregnancies whereby data on mothers’ folic acid supplementation was accessible.

Almost 85% of women had taken folic acid during pregnancy. Information on when women began taking folic acid was available for 39,416 women. Of these, 10,036 (25.5%) began taking folic acid prior to conception.

Overall, 19.3% of babies were born SGA; 13.4% of these babies had a birth weight in the lowest 10%, while 7% of babies had a birth weight in the lowest 5%.

Results of the study revealed that the highest rates of SGA occurred among babies whose mothers had not taken folic acid before conception or during pregnancy, with 16.3% of these babies born with a weight in the lowest 10% and 8.9% born with a weight in the lowest 5%.

Of the mothers who began taking folic acid during pregnancy, 13.4% had babies with a birth weight in the lowest 10%, while 7.1% had babies with a birth weight in the lowest 5%.

Among women who began taking folic acid prior to conception, however, the percentage of babies with a birth weight in the lowest 10% stood at 9.9%, while the percentage with a birth weight in the lowest 5% was 4.8%. This indicates that taking folic acid before conception can significantly reduce the risk of SGA.

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