Urinary Incontinence in Women

What is Urinary Incontinence?

Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

Women experience UI twice as often as men due to the following:

• Pregnancy
• Childbirth
• Menopause
• Structure of the female urinary tract

But both women and men can become incontinent from:

• Neurologic injury
• Birth defects
• Stroke
• Multiple sclerosis
• Physical problems associated with aging

Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery. Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. Obesity, which is associated with increased abdominal pressure, can worsen incontinence. Fortunately, weight loss can reduce its severity.

The Types of Urinary Incontinence

1. Stress - leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
2. Urge - leakage of large amounts of urine at unexpected times, including during sleep.
3. Overactive bladder - urinary frequency and urgency, with or without urge incontinence.
4. Functional - untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
5. Overflow - unexpected leakage of small amounts of urine because of a full bladder.
6. Mixed - usually the occurrence of stress and urge incontinence together.
7. Transient - leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing).

How is Incontinence Evaluated?

See a Specialist

1. The first step toward relief is to see a doctor who has experience treating incontinence to learn what type you have. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary incontinence, pelvic organ prolapse, and associated pelvic problems in women. A urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract. Any of these doctors may be able to help you. In addition, some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.
2. To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Often you can begin treatment at the first medical visit.
3. Your doctor will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. This condition is also important to diagnose at the time of an evaluation.

Recommended Tests

Your doctor may do additional bladder testing to understand how your bladder holds and empties urine. Your doctor may also recommend other tests:

• Bladder stress test - You cough vigorously as the doctor watches for loss of urine from the urinary opening.
• Urinalysis and urine culture - Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
• Ultrasound - This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.
• Cystoscopy - The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.

How is Incontinence Treated?

Behavioral remedies:

• Bladder retraining
• Kegel exercises

Your doctor may suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.

How do you do Kegel exercises?

1. The first step is to find the right muscles. One way to find them is to imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine sucking or drawing the marble into your vagina.
2. Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.
3. Repeat, but don’t overdo it. At first, find a quiet spot to practice—your bathroom or bedroom—so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.
4. Be patient. Don’t give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.

Overactive Bladder

If you have an overactive bladder, your doctor may prescribe a medicine to decrease frequent urination and urgency.

Biofeedback

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, stimulation of nerves to the bladder leaving the spine can be effective in some patients. Neuromodulation is the name of this therapy. The FDA has approved a device called InterStim for this purpose. Your doctor will need to test to determine if this device would be helpful to you.

Injections for stress incontinence

A variety of bulking agents, such as coaptite and carbon spheres, are available for injection near the urinary sphincter. The doctor injects the bulking agent into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence, which takes about a half hour. Over time, the body may slowly eliminate certain bulking agents, so you may need repeat injections. Your doctor will discuss which bulking agent may be best for you.

Surgery for stress incontinence

In some women, how the urethra is supported can be affected, especially following childbirth. Surgeons have developed different techniques for supporting the urethra. The three main types of surgery are retropubic suspension and two types of sling procedures.

Other tips to manage incontinence

Many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Talk to your Doctor!

Finally, many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments or diapers. This practice is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises.