Urinary Incontinence in Women

incontinenceIncontinence: What Is It?

Urinary incontinence, or loss of bladder control, is a frustrating problem for more than 13 million Americans. Never knowing when and where you might have an accident can impact everything from work to exercise to your social calendar. Urinary incontinence affects people of either gender but is twice as common in women. Research suggests that half of older women may have some form of incontinence.

Stress Incontinence: Symptoms

The main symptom of incontinence is the unplanned release of urine — when and how depends on the type of incontinence. If you leak a bit when you laugh, cough, sneeze, jog, or lift something heavy, you may have stress incontinence. This is the most common bladder control problem in younger women.

Stress Incontinence: Causes

Stress incontinence results when the muscles and tissue that help support the bladder become weak. When there is increased pressure against the bladder and the sphincter does not stay closed, leakage occurs. Pressure from motions like coughing or laughing may be all it takes to leak urine. There are several reasons why these muscles can lose strength: They may be stretched by weight gain, a sports injury, or pregnancies and vaginal childbirths.

Urge Incontinence: Symptoms

If you’re often struck by a desperate need to urinate but you can’t reach the toilet in time, you may have urge incontinence. The sudden urge may be triggered by the sound of running water, by sipping a drink, or by nothing at all. With this type of incontinence, you may leak large amounts of urine. You may also find yourself running to the bathroom even when your bladder is mostly empty.

Urge Incontinence: Causes

The sudden, overwhelming need to urinate is thought to be caused by spasms of the bladder muscles. These spasms may stem from nerve or muscle damage. In some cases, the damage is associated with an illness, such as a stroke or irritation of the bladder caused by an infection or inflammation.

Overactive Bladder

Overactive bladder is another name for urge incontinence. There is the same sudden, frequent need to urinate. But not everyone with overactive bladder has incontinence; many women are able to “hold it” until they reach the toilet. Rather than leaking urine, the main challenge for these patients is constantly having to interrupt their activities for trips to the bathroom.

Medications That Worsen Incontinence

There are several medications that can trigger or worsen incontinence. In women, certain high blood pressure medicines tend to relax the bladder muscles, contributing to stress incontinence. Some types of antidepressants may relieve incontinence, but others can make the symptoms worse. And diuretics or “water pills” create more urine, which can intensify any type of incontinence.

Emotional Toll of Incontinence

Though incontinence is not dangerous, it can take a significant toll on emotional well-being. Research suggests women with incontinence have lower self-esteem, reduced sexuality, and higher levels of depression compared to those with healthy bladders. Fear of accidents may lead to social isolation, but it doesn’t have to be that way. Incontinence can be effectively managed or even reversed.

Diagnosing Incontinence

The first step is to diagnose the specific type of incontinence. Your health care provider will discuss your medical history and probably ask for a urine sample to check for a urinary tract infection. He or she may ask you to stand and cough, a way of identifying stress incontinence. You may also be asked to keep a diary detailing how much you drink, how much you urinate, and how often you leak.

Diagnosing Incontinence: Tests

There are several tests to help pinpoint the cause of incontinence. Ultrasound imagery can show how the bladder and urethra change position during urination, coughing, or other activities. The pad test shows how much urine you pass throughout the day. The bladder stress test helps check for stress incontinence. Cystometry measures bladder pressure and is useful in diagnosing urge incontinence. An MRI scan (seen here) may show problems that cannot be seen with other imaging methods.

Managing Mild Incontinence

Many women with mild incontinence are able to stop leaks by drinking less. Try pouring your cups half-full, and avoid coffee, tea, and caffeinated sodas. Caffeine is a diuretic, which creates more urine. Another strategy is to empty your bladder regularly, every two to four hours, even if you don’t feel the need.

Kegel Exercises

Because stress incontinence stems from weak pelvic muscles, an excellent defense is to strengthen the muscles around the urethral closure. You can do this through Kegel exercises: Clench the muscles you would use to stop the flow of urine. Hold the squeeze for 10 seconds, then relax. Do three or four sets every day. As these muscles grow stronger, so will your bladder control.

Biofeedback

Biofeedback is a method that provides you real-time information about activity in your bladder and pelvic muscles. As you gain awareness of these functions, you may be better able to control them. Biofeedback is often used in combination with Kegel exercises

Pessary

When lifestyle adjustments are not successful in preventing leakage, a device called a pessary can help. This is a device that is inserted into the vagina to help reduce urinary leakage caused by stress incontinence. Patients can wear it continuously or only as needed, such as during strenuous exercise.

Collagen Injections

Another way to prevent leakage is to inject collagen or other bulking agents into the tissues around the urethra. This boosts the size of the urethra lining and creates resistance against the flow of urine from the bladder. Injections must be repeated every 12 to 18 months and are only helpful against stress incontinence.

Bladder Training

Bladder training can be effective against stress incontinence and urge incontinence. The first step is to make a chart of what times you urinate and when you leak. After observing the patterns, you can avoid accidents by heading to the bathroom before a leak is likely to occur. It’s also possible to train the bladder to hold out for longer and longer periods between bathroom visits.

Medications for Incontinence

For urge incontinence, doctors often prescribe anticholinergic medications. These pills or patches block the nerves that trigger contractions in the bladder muscle. Studies suggest the combination of medication and bladder training is particularly effective.

Surgery for Incontinence

Surgery for stress incontinence is often done as an outpatient procedure. One option for stress incontinence is to place the bladder in a “sling” — a piece of tissue or material that holds the bladder up and prevents leaks. Another procedure pulls the bladder up to a more normal position without a sling. For urge incontinence, surgery may be used to boost the bladder’s storage capacity or to implant a device that controls bladder spasms with electrical signals (shown here).

Incontinence Products

For some, urinary incontinence products are a temporary strategy until surgery for urinary incontinence can be done or medications take effect. But for others, products become long-term options for relief. These include panty liners, adult diapers, and plastic-coated underwear — available in drugstores or medical supply stores. Protective bedding, such as a plastic mattress protector, may also be useful.

Preventing Incontinence

There are ways to reduce your risk of developing incontinence. Maintaining a healthy weight and doing daily Kegel exercises top the list. If you smoke, try to quit. Smoking can lead to chronic coughing, which can stress the bladder and trigger leaks.

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