Women’s Urinary Incontinence

Living with Incontinence

Leakage of urine is called urinary incontinence, and it is a common problem for women. Some women with urinary incontinence leak only small amounts of urine, while others experience frequent or severe leakage. Living with urinary incontinence can be difficult. You may find yourself skipping social events or limiting your activities. You may feel embarrassed to talk about your symptoms with a healthcare professional, but if incontinence is affecting your life, you can choose from many treatment options.

Signs and Symptoms

Urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder. It is common for other signs and symptoms to occur along with urinary incontinence:

• Urgency—Having a strong urge to urinate
• Frequency—Urinating more often than what is usual for you
• Nocturia—Waking from sleep to urinate
• Dysuria—Painful urination
• Nocturnal enuresis—Leaking urine while sleeping

Types of Urinary Incontinence

Based on these signs and symptoms, urinary incontinence in women can be divided into three main types:

1. 1. Stress urinary incontinence (SUI) involves leaking urine when coughing, laughing, or sneezing. Leaks can also happen when a woman walks, runs, or exercises.
   2. Urgency urinary incontinence is a sudden, strong urge to urinate that is hard to stop. Women with this type may leak urine on the way to the bathroom. If you have an overactive bladder (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
   3. Mixed incontinence combines symptoms of both SUI and urge urinary incontinence.

Causes

There are many causes of urinary incontinence, and often, there is more than one cause. Some causes are easily diagnosed, while others are more complex. Some of the causes include the following:

Urinary tract infection (UTI): Bladder infections are common in women, with signs including pain during urination (dysuria), frequent urination, and sometimes blood in the urine. UTIs can sometimes cause leakage and are treated with antibiotics.

Diuretic medications, caffeine, or alcohol: Incontinence may be a direct effect of substances that increase urine production. Your doctor may advise changing your medication or dosage, or limiting your intake of caffeine and alcohol to help improve symptoms.

Pelvic floor disorders: These disorders result from weakening of the muscles and tissues of the pelvic floor and include urinary incontinence, accidental bowel leakage, and pelvic organ prolapse. Pelvic organ prolapse occurs when one or more pelvic organs drop downward. In some women, pelvic organ prolapse masks incontinence symptoms, as the prolapsed part can prevent urine leakage while laughing, coughing, or sneezing by kinking the urethra, a condition sometimes referred to as hidden incontinence.

Constipation: Long-term constipation is often present in women with urinary incontinence, especially in older women. Treating constipation may help alleviate urinary symptoms.

Neuromuscular problems: When nerve signals from the brain to the bladder and urethra are disrupted, the muscles controlling those organs may malfunction, leading to urine leakage. Muscle control problems can occur in conditions such as diabetes, stroke, or multiple sclerosis.

Anatomical problems: The outlet of the bladder into the urethra can become blocked by bladder stones or other growths. The urethra may develop an abnormal pouch called a diverticulum that causes urine leakage or dribbling. A fistula is an abnormal connection from the urinary tract to another part of the body, such as the vagina, allowing urine to leak out. Pelvic surgery, radiation treatment, pelvic cancer, or childbirth may cause a fistula.

Diagnosis

The first steps in assessing urinary incontinence usually involve a medical history and physical exam. Sometimes, imaging tests and bladder function tests are performed if more information is needed.

Medical History

Your gynecologist or other healthcare professional will ask you to explain your signs and symptoms in detail. You may be asked to fill out a bladder diary for a few days. In it, you record the time and amount of leakage as well as the times you urinated. You also note how much liquid you drank and what you were doing when a leak occurred. A bladder diary can be downloaded from the internet, or your gynecologist may provide one for you to complete.

Physical Exam

A pelvic exam may be conducted to check for pelvic organ prolapse and other anatomical problems. A cough test may also be performed during the exam. During a cough test, you are asked to cough and bear down with a full bladder to see if urine leaks. Additionally, a pad test may be conducted, where you wear a pad that absorbs leaked urine, which is then weighed to measure the amount of leakage. A test to measure the support of the urethra may also be performed, as this is an important factor in planning treatment.

Treatment

Seeking treatment for urinary incontinence is a personal decision. For some women, even small amounts of urine leakage are problematic, while others simply make lifestyle changes such as wearing absorbent pads and taking steps to control odor. If urinary incontinence symptoms bother you and have a negative impact on your life, you may want to seek treatment.

Treatment depends on the type of incontinence you have and your treatment goals. The degree to which your symptoms bother you is an important factor in deciding on a treatment plan.

Your gynecologist or other healthcare professional may initially recommend nonsurgical treatments. These may include lifestyle changes, bladder training, physical therapy, and the use of certain bladder support devices. For urgency urinary incontinence, treatment may involve medication. Surgery may help certain types of incontinence, and often, several treatments are used together for the best effect.

Lifestyle Changes

Making certain lifestyle changes may help decrease urine leakage:

1. Lose weight: Even a small amount of weight loss (less than 10 percent of total body weight) may decrease urine leakage in overweight women.
2. Manage fluid intake: Limiting fluid intake several hours before bedtime and overall intake (no more than two liters total a day) may help, especially if leakage occurs in the early morning or at night. Limiting alcohol and caffeine intake may also be beneficial.

Bladder Training

Bladder training aims to control the urge to empty the bladder and increase the time between urinations to normal intervals.

Pelvic Floor Exercise and Physical Therapy

Kegel exercises can help strengthen pelvic muscles and are helpful for all types of incontinence. If you have difficulty performing Kegel exercises, you may be referred to a physical therapist specializing in women’s pelvic health. Biofeedback, a training technique that helps locate the correct muscles, may also be utilized.

Devices

Pessaries are devices inserted into the vagina to treat pelvic support problems and stress urinary incontinence (SUI). They support the walls of the vagina to lift the bladder and urethra. Support pessaries can be inserted and removed by the patient and may provide relief without surgery. Over-the-counter tampon-like devices (such as Poise Impressa) are also available to help prevent bladder leaks.

Medications

Several medications are available to reduce symptoms of urgency urinary incontinence and overactive bladder (OAB). These include drugs that control muscle spasms or unwanted bladder contractions, as well as mirabegron, which relaxes the bladder muscle.

Surgery

Surgical procedures for stress urinary incontinence include slings and colposuspension. For urgency urinary incontinence, nerve stimulation procedures such as sacral neuromodulation and percutaneous tibial nerve stimulation (PTNS) may be considered when other treatments have failed or are not an option.” Overall, your information is well-organized and provides a comprehensive overview of the treatment options for urinary incontinence.