Urinary Incontinence

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What is urinary incontinence?

Leakage of urine is called urinary incontinence. Some women leak small amounts of urine. At other times, leakage of urine is frequent or severe.

Are there different types of urinary incontinence? 

There are several types of urinary incontinence:

  • Stress urinary incontinence-Loss of urine when a woman coughs, laughs, or sneezes. Leaks also can happen when a woman walks, runs, exercises, or even just getting out of a chair. It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra.
  • Urge incontinence-Leakage or urine caused by overactive bladder muscles that contract too often or problems with the nerves that send signals to the bladder.
  • Mixed incontinence-A combination of both stress and urge incontinence symptoms.
  • Overflow incontinence-Steady loss of small amounts of urine when the bladder does not empty all the way during voiding.  It can be caused by an underactive bladder muscle or blockage of the urethra.

What are the symptoms of urinary incontinence? 

In addition to leaking urine, a woman with incontinence also may have other symptoms:

  • Urgency-A strong urge to urinate whether or not the bladder is full, often with pelvic pressure
  • Frequency-Voiding more often than she considers usual
  • Nocturia-The need to void during hours of sleep
  • Dysuria-Painful voiding
  • Enuresis-Bed-wetting or leaking while sleeping

What causes urinary incontinence?

Urinary incontinence can have short-term causes and long-term causes. Short-term causes are easier to treat and include the following:

  • Urinary tract infection-Loss of bladder control may be caused by an infection of the urinary tract.  Infections of the bladder (cystitis) are common in women.  These infections are treated with antibiotics.
  • Medications-Loss of bladder control may be a side effect of medications, such as diruetics.
  • Long-term causes include the following:
  • Pelvic support problems-The pelvic organs are held in place bu supportive tissues and muscles.  These supporting tissues may become torn or stretched, or they may weaken because of aging.  If the tissues that support the urethra, bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making it hard to pass urine.
  • Urinary tract abnormalities-A fistula is an abnormal opening from the urinary tract into another part of the body, such as the vagina.  It can allow urine to leak out through the vagina.  This is often a result or poor healing after a hysterectomy, prior radiation treatment to the pelvis, or some diseases such as inflammatory bowel diseases.
  • Neuromuscular problems-These disorders can interfere with the transmission of signals from the brain and spinal cord to the bladder and urethra, such as multiple sclerosis.

How is urinary incontinence diagnosed?

A number of steps may be needed to find the cause of urinary incontinence. In some cases, there may be more than one cause.

You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage. You should note how much liquid you drank and what you were doing when a leak occurred.

A pelvic exam will be done to detect physical conditions that might be linked to the problem.  Lab tests also may be done to detect a urinary tract infection.  Other tests that assess how your bladder functions include the following:

  • Urodynamic test-The bladder is filled through a catheter. These tests check the function of the urethra and bladder.
  • Postvoid residual volume test-The amount of urine that is left in the bladder after urinating is measured.
  • Stress test-You are asked to cough a few times with a full bladder.  Any loss of urine is recorded.
  • Cystoscopy-A thin, lighted camera is used to look inside the bladder and urethra.
  • Dye test-A pad is worn after a nontoxic dye is put in the bladder.  If the pad gets stained with the dye, there was a loss of urine.

How is urinary incontinence treated?

There are many options for treatment.  Often treatments are more effective when used in combination.  Treatment options include lifestyle changes, bladder training, physical therapy, devices, medication, bulking agents, and surgery.

What are some of the lifestyle changes that are used to manage urinary incontinence?

Making the following changes in your lifestyle, if they apply to you, may help the problem:

  • Lose weight.  In overweight women, losing weight has been shown to decrease the frequency of urine leakage.
  • Avoid constipation.  Repeated straining may damage the pelvic floor.
  • Drink less fluid and limit intake of caffeine, which is a diuretic.
  • Seek treatment for chronic coughing.
  • Stop smoking.

What is bladder training?