Female Urinary Incontinence: What You Need to Know
Millions of women will experience incontinence in their lifetime. In fact, of the 25 million adult Americans suffering from some form of urinary incontinence, 75 to 80 percent of those are women!
While urinary incontinence may be caused by a variety of factors, and can affect both men and women, women are especially prone to this issue. This is largely due to factors such as pregnancy, childbirth, and menopause. However, the structure of the urinary tract also makes women more prone to incontinence than men.
No single treatment works for everyone, but many women can see improvements without surgery. Treatment depends on the type and severity of your problem, your lifestyle, and your preferences.
There are several types of incontinence and a variety of treatment options, but first, what is incontinence?
What is Urinary Incontinence?
Urinary Incontinence (UI) is a loss of bladder control and the accidental loss of urine. Some people may experience mild leaking while others may have uncontrollable wetting. 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. When this process is weakened or disrupted the results may include the symptoms of incontinence.
There are several different types of incontinence based on what symptoms you may be experiencing. These include:
Types of Urinary Incontinence:
- Stress Incontinence- loss of urine happens 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.
- Urge Incontinence- a sudden, intense urge to urinate, followed by an involuntary urine loss. Your bladder muscle contracts, which acts as an alert that may last several seconds to one 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- The inability 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.
- Mixed incontinence- Symptoms of more than one type of incontinence may be diagnosed as mixed incontinence.
Factors That Put You at Higher Risk for Urinary Incontinence:
There can be several different risk factors, or causes, for urinary incontinence, including:
- Childbirth (risk is increased with each pregnancy and birth experience)
- Other traumatic injury
- Parkinson’s Disease
- Alzheimer’s Disease
- High blood pressure
- History for smoking
- Back, Lung, and/or Nerve problems
- Neurologic (brain or spinal cord) injury
- Birth defects
- Multiple sclerosis
- Physical problems from aging.
- Chronic use of some medications (including diuretics, estrogen, benzodiazepines, tranquilizers, antidepressants, hypnotics, and laxatives)
Tests Used for Diagnosing Urinary Incontinence:
Testing for urinary incontinence in women will usually involve several different types of testing to determine the severity and type of incontinence you may be experiencing. This may include:
- Keeping a Bladder diary – Your provider may ask you to keep a bladder diary for several days. For this, you would 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 collected and examined for signs of infection and traces of blood or other abnormalities.
- Blood test – A blood sample is collected and checked for various chemicals and substances related to incontinence causes.
- Post void residual (PVR) measurement – For this test, you would urinate (void) into a container that measures urine output. Your provider 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 — An ultrasound used to view other areas of your urinary tract or genitals and examine for abnormalities.
- Stress test – For this test, you would be asked to cough vigorously or bear down so your provider can watch for urine loss.
- Urodynamic testing — Measures pressure in your bladder when resting and filling. A catheter is inserted 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, a special dyed fluid is injected. As you urinate, the X-ray images help to show possible 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 Options for Urinary Incontinence:
The good news is, many women regain urinary control by changing a few habits and exercising to strengthen muscles that hold urine in the bladder. Treatment depends on the type of problem and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures. If behavioral treatments fail, your provider may consider medicines. For some women, surgery is the best choice. In most cases, treatment will start with the least invasive options first.
What can you expect with the different treatment options?
- Behavioral Treatment — For some, avoiding urinary 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.
- Only 25% of women can perform a Kegel correctly so make sure you ask your provider to show you how to perform this exercise to avoid causing further injury.
- Medication- Medication can affect bladder control in different ways, depending on your individual needs. Some medication helps to prevent incontinence by blocking abnormal nerve signals that make the bladder contract at the wrong time. Others slow urine production or relax the bladder.
- Before prescribing a medicine to treat incontinence, your provider 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 that switching from a diuretic to another blood pressure medicine alleviates their issues with incontinence.
- Biofeedback — This option uses measuring devices to help you become aware of how your body is 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 that does not respond to behavioral treatments or drugs, stimulating certain nerves to the bladder can be effective in some patients. You would need to have testing done, in order to determine if this device would be helpful to you.
- Catheterization — If you are incontinent because your bladder never empties completely, such as in overflow incontinence. Or your bladder cannot empty because of other reasons such as: 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 — This option is specific for female stress incontinence because it places a narrow strip of mesh within the body to support the urethra. Resolving incontinence issues, can be achieved immediately following the procedure.
- Urethral bulking- Also specific to female incontinence, this procedure involves injecting natural bulking agents around the urethra to increase outlet resistance and achieve continence. Bulking can be done in the office without the need for an anesthetic.
While urinary incontinence issues can be extremely common among women, it is highly treatable and can be managed to give you back your quality of life. We at Western Michigan Urological Associates want to help develop a treatment plan, specific to your needs, and help you effectively deal with your symptoms of urinary incontinence. Ask Your Primary Care Provider for a Referral.