Urinary Incontinence in Women
Millions of women experience incontinence. Women are especially prone to incontinence due to pregnancy and childbirth, menopause, and their urinary tract structure. Women can also become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems from aging.
No single treatment works for everyone, but many women improve without surgery. Treatment depends on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options.
Many women regain urinary control by changing a few habits and exercising to strengthen muscles that hold urine in the bladder. If behavioral treatments fail, we may consider medicines. For some women, surgery is the best choice. We first seek to use minimally invasive procedures when possible.
Incontinence: For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Urinary incontinence (UI) is loss of bladder control and the accidental loss of urine. Some people may experience mild leaking while others may have uncontrollable wetting.
- Stress incontinence — loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs when the bladder’s sphincter muscle weakens. In women, physical changes from pregnancy, childbirth and menopause can cause stress incontinence. In men, removing the prostate can lead to this type of incontinence.
- Urge incontinence – a sudden, intense urge to urinate, followed by an involuntary urine loss. Your bladder muscle contracts. This alert may be a few seconds to a minute. You may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson’s disease, Alzheimer’s disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there’s no known cause, urge incontinence is also called overactive bladder.
- Overflow incontinence – being unable to empty your bladder, resulting in frequently or constantly dribbling urine. You may produce only a weak urine stream when trying to urinate. This incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes and in men with prostate problems.
- Mixed incontinence – symptoms of more than one type of incontinence may be diagnosed as mixed incontinence.
At different ages, males and females have different risks for developing UI. In childhood, girls usually develop bladder control at an earlier age than boys, and bedwetting – or nocturnal enuresis – is less common in girls than in boys. However, adult women are far more likely than adult men to experience UI because of differences in the pelvic region and changes from pregnancy and childbirth.
- Using medications such as diuretics, estrogen, benzodiazepines, tranquilizers, antidepressants, hypnotics, and laxatives.
- Poor overall general health – specifically diabetes, stroke, high blood pressure, smoking history, Parkinson’s disease, back problems, obesity, Alzheimer’s disease and pulmonary disease.
- Nerve Problems – Any disease, condition, or injury that damages nerves can lead to urination problems. Nerve problems can occur at any age.
- People who have had diabetes for many years may develop nerve damage that affects their bladder control.
- Stroke, Parkinson’s disease, and multiple sclerosis affect the brain and nervous system, so they can also cause bladder-emptying problems.
- Spinal cord injury may affect bladder emptying by disrupting nerve signals needed for bladder control.
- Women who have given birth (either via cesarean section or vaginal delivery) have much higher rates of stress incontinence than women who never delivered a baby.
- Women who developed incontinence during pregnancy or shortly after delivery have higher risk of sustained incontinence than those who did not.
- Having more babies also increases the risk.
- Menopausal women can also suffer from urine loss due to decreased estrogen levels.
- Vaginal infections
- Certain weak pelvic muscles
- Pregnancy and childbirth
- Bladder diary – We may ask you to keep a bladder diary for several days. You will record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate, and the number of incontinence episodes.
- Urinalysis (urine test) — A urine sample is examined for signs of infection and traces of blood or other abnormalities.
- Blood test – A blood sample is checked for various chemicals and substances related to incontinence causes.
- Post void residual (PVR) measurement – You urinate (void) into a container that measures urine output. We will then check the amount of leftover (residual) urine in your bladder using a catheter or ultrasound. A large amount of leftover urine may mean a blockage in your urinary tract or a problem with your bladder nerves or muscles.
- Pelvic ultrasound — may be used to view other areas of your urinary tract or genitals and examine for abnormalities.
- Stress test – a test in which you cough vigorously or bear down so we can watch for urine loss.
- Urodynamic testing — measures pressure in your bladder when resting and filling. We insert a catheter into your urethra and bladder to fill your bladder with water. A pressure monitor measures and records the pressure within your bladder.
- Cystogram — In this X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, we inject a special dyed fluid. As you urinate, X-ray images help to show problems with your urinary tract.
- Cystoscopy — A thin tube with a tiny lens (cystoscope) is inserted into your urethra to check for — and possibly remove — abnormalities in your urinary tract.
Treatment depends on the type of problem and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures. In most cases, we will suggest the least invasive treatments first.
- Behavioral Treatment — For some people, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom — a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips. Bladder training also includes Kegel exercises to strengthen the pelvic muscles, which help hold urine in the bladder.
- Medicines can affect bladder control in different ways. Some medicines help prevent incontinence by blocking abnormal nerve signals that make the bladder contract at the wrong time, while others slow urine production. Still others relax the bladder. Before prescribing a medicine to treat incontinence, we may look at changing a prescription you already take. For instance, diuretics are often prescribed to treat high blood pressure because they reduce fluid in the body by increasing urine production. Some people may find switching from a diuretic to another blood pressure medicine take care of incontinence.
- Biofeedback — uses measuring devices to help you become aware of your body’s functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
- Neuromodulation — For urge incontinence not responding to behavioral treatments or drugs, stimulating nerves to the bladder leaving the spine can be effective in some patients. We will need to test to determine if this device would be helpful to you.
- Catheterization — If you are incontinent because your bladder never empties completely — overflow incontinence — or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube you insert through the urethra into the bladder to drain urine.
- Mid-urethral sling — Treats female stress incontinence by placing a narrow strip of mesh within the body to support the urethra. Continence can be achieved immediately following the procedure.
- Urethral bulking involves injecting natural bulking agents around the urethra to increase outlet resistance and achieve continence. Bulking can be done in our office without the need for an anesthetic.