Urinary Incontinence in Women

What is urinary incontinence?

Urinary incontinence is the accidental release of urine. This leakage often occurs when you cough, laugh, sneeze, or have sudden urges to go to the bathroom and can't get there in time. Incontinence is not a disease but a symptom of a problem with the lower urinary tract , and it is very common, especially among older adults. Typically, urinary incontinence does not cause major health problems, but it can be embarrassing and can affect a woman's self-esteem and confidence.

Are there different types of urinary incontinence?

The following are the most common types of urinary incontinence in women:

Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other activities that put pressure on your bladder . It is the most common type of urinary incontinence in women.

Urge incontinence, also called overactive bladder, occurs when the sensation to urinate is so strong that you cannot reach the toilet in time, even when your bladder contains only a small amount of urine. Conversely, other women may have no warning before they accidentally leak urine, and in some women, drinking water or hearing or putting their hands under running water causes accidents.

Mixed incontinence is a combination of different types of incontinence, usually stress and urge incontinence. Stress and urge incontinence often occur together in older women.

Incontinence can be a temporary problem caused by a urinary tract infection, a medication, or constipation, which is solved when the problem causing it is successfully treated. This topic focuses on long-term (chronic) urinary incontinence, in particular urge, stress, and mixed incontinence.

What causes urinary incontinence?

Chronic urinary incontinence may be caused by muscle weakness in the lower urinary tract or by damage or a malfunction either in the urinary tract or in the nerves that control urination. See an illustration of the female pelvic anatomy.

Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles no longer support your bladder properly, the bladder drops downward and pushes against the vagina, preventing tightening of the muscles that ordinarily close off the urethra. Leakage can then occur when extra pressure is put on the bladder by coughing, sneezing, laughing, lifting, exercising, or other activities.

Urge incontinence is caused by overactivity of the bladder muscle that pushes urine out of the bladder. This overactivity may be caused by irritation of the bladder, emotional stress, or neurological conditions such as Parkinson's disease or stroke. In many cases, the cause of urge incontinence is unknown.

What are the symptoms?

Symptoms differ in the two most common types of urinary incontinence in women.

The main symptom of stress incontinence is the involuntary loss of urine while coughing, sneezing, laughing, exercising, or doing similar activities. This usually results in a small to moderate amount of urine loss.

Symptoms of urge incontinence include a sudden, urgent need to urinate and/or the need to urinate frequently. It often results in a moderate to large amount of urine leaked, possibly soaking clothing or running down legs.

Women with mixed incontinence may have symptoms of both stress and urge incontinence.

How is urinary incontinence diagnosed?

A medical history and a physical examination, along with simple diagnostic tests, often provide enough information to identify the cause of a woman's urinary incontinence. If incontinence is caused by more than one problem, additional testing may be needed.

How is it treated?

Most cases of incontinence can be improved if not cured. Kegel exercises to strengthen pelvic floor muscles help many women with stress incontinence. For some women, a removable device called a pessary (which is placed inside the vagina) can help decrease stress incontinence by putting pressure on the urethra. Learned techniques to retrain the bladder are often helpful for women with urge incontinence. Medications may also help, although they may have bothersome side effects.

There are many types of surgery to treat urinary incontinence that produce good results. The tension-free vaginal tape (TVT) surgery is growing in popularity among women whose stress incontinence cannot be corrected with exercises. TVT surgery can be done on an outpatient basis with only small incisions.

If incontinence has more than one cause, the most significant cause is treated first, followed by treatment for the secondary cause, if necessary.

How can I prevent urinary incontinence?

You can lessen your risk for developing urinary incontinence by strengthening your pelvic muscles with pelvic floor (Kegel) exercises and by keeping your weight at a healthy level. If you smoke cigarettes, quit, because smoking is a major cause of chronic cough, which contributes to stress incontinence.

If you are in need of a physician, visit our Baptist Medical Group Urology practice for caring providers.