Female urinary incontinence

Overview

More than 13 million people in the United States experience urinary incontinence. Incontinence can range from slight losses of urine to severe, frequent wetting.

This problem is not limited to older women. In fact, it can occur in patients as young as 13 and as old as 100. We believe women should not accept urinary incontinence as a way of life. It does not have to be a normal part of aging. It is often caused by specific changes in body function that may result from diseases, use of medications, childbirth, trauma, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. 

Causes and risk factors

Causes and risk factors associated with urinary incontinence include:

  • Pregnancy and childbirth
  • High-intensity exercise
  • Neurologic Problems
  • Obesity
  • Heavy lifting
  • Menopause
  • Prior surgeries
  • Urinary tract infections
  • Constipation
  • Health conditions, such as diabetes
  • Medications
  • Dietary habits

Types

There are several types of urinary incontinence. Some of the most common include:

  • Stress incontinence — refers to the loss of urine with increases in abdominal pressure, such as in jumping, coughing, straining, lifting or even laughing. Stress incontinence is associated with any physical exertion that increases your abdominal and bladder pressure and leads to the unintentional leakage of urine. This type of incontinence is usually short, as it starts and ends with the event that caused it.
  • Urgency incontinence / Overactive bladder / Detrusor overactivity — Urgency is the sensation of a sudden and strong need to urinate. Urgency incontinence is the loss of urine associated with this strong urge that is not due to exertion , lifting or other stress maneuvers. This type of incontinence feels like the bladder is in a rush or like the bladder is impatient and will not wait until you reach the bathroom before emptying.   
  • Overflow incontinence — Overflow incontinence occurs when your bladder never completely empties properly, which leads to involuntary leakage. The bladder essentially spills over when retaining too much urine. 

Symptoms

Symptoms of urinary incontinence include:

Stress incontinence

  • Involuntary leakage of urine, especially when you laugh, cough, sneeze or lift something heavy

Urge incontinence / Overactive bladder  / Detrusor overactivity

  • Sudden, intense urge to urinate
  • Involuntary loss of urine

Overflow incontinence

  • Sudden release of urine
  • Fullness in bladder after urination
  • Difficulty urinating, even when feeling urge 

Diagnosis and testing

Typically, your doctor will be able to diagnose your urinary incontinence by evaluating your medical history, conducting a physical examination, and obtaining a urine specimen for analysis. If your condition isn’t clear following these steps, your doctor may recommend further testing.

Urodynamics is a test performed in the office that allows your physician to assess your bladder muscle and nerve function as your bladder fills and empties. It helps to distinguish between the different types of incontinence described above, and allows for a more focused treatment plan. During this test, your bladder is filled with water through a tiny flexible catheter while pressure readings from the bladder and the abdomen are taken. You may be asked to cough, bear down, or perform other activities that elicit leakage. Once your bladder is filled, we then take measurements to ensure proper bladder emptying. Your clinician may also recommend a bladder diary, which involves you keeping track of your habits, such as fluid intake, types of fluid you drink and how often you urinate, or a urinalysis. 

Treatment

There are several treatment approaches to urinary incontinence. The list below shows the many options for treatment.  Most notably, all but the last section are nonurgical options. Depending on your specific condition, your doctor may recommend:

  • Behavioral treatments — Simple lifestyle changes could help relieve your urinary incontinence. Limiting how much you drink, avoiding overhydration,  and avoiding certain food and beverages such as coffee could help improve your symptoms.
  • Bladder retraining and timed voiding -- For some patients, the message of the need to urinate is not strong enough, so they can be taught to recognize subtle sensations. For other patients, learning to use the bathroom on timed intervals is helpful to learn how long each person can go between bathroom visits.
  • Biofeedback techniques  — Biofeedback techniques help you be aware of and control specific physiological processes within your body. This is a visual feedback method used in one-on-one pelvic floor strengthening training.
  • Electrical stimulation of the pelvic floor  — A low-grade electrical current stimulates the muscles to contract. This is painless, FDA approved, and helps in addition to pelvic strengthening for some patients.
  • Per-cutaneous nerve stimulation -- This is an acupuncture-like treatment. Nerve endings that are shared by both the bladder and the ankle are stimulated with tiny acupuncture needles at the ankle along with an electric stimulation signal. This is FDA approved, extremely comfortable, and has excellent results.
  • Pelvic floor rehabilitation — For patients with incontinence, this program helps strengthen weak pelvic floor muscles and promotes muscle stability.
  • Medications
  • Absorbent products — Panty liners and protective pads can help protect against possible leakage.
  • Vaginal continence devices -- These devices are inserted easily by the patient and can be worn to prevent leakage episodes during daily activities.
  • Botox injection of the bladder:  This is a office-based, FDA approved procedure for patients suffering from overactive bladder. It has been shown to decrease urinary incontinence episodes, and in up to 30 percent of women leads to complete dryness for several months.​
  • Surgery — Depending on your condition, your doctor may recommend a surgical treatment, such as a sling procedure. For patients with stress incontinence, a sling procedure re-creates a supportive "hammock" under the urethra (the exit tube of the bladder).  This is a 15-30 minute noninvasive vaginal procedure. Most patients go home the same day. There are no incisions in the belly – this is performed through a very small vaginal incision. For patients with overactive bladders who have failed nonsurgical therapy, an outpatient procedure that calms the excited bladder nerve is available (medtronic neurostimulator). 

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Millions of Americans experience urinary incontinence. Are there treatment options for you?