Urinary incontinence

Urinary incontinence is when urine leaks out before you can get to the bathroom or during other activities.

Types of Urinary Incontinence

Stress incontinence

Stress incontinence is leakage with physical activity, due to coughing, sneezing, lifting, and strenuous exercise. Stress incontinence is the most common type of urinary incontinence seen in women who are younger or reproductive age, but it can occur in women of all ages.

Urgency incontinence

Urgency incontinence is leakage with urgency, identified as a sudden, unexpected need to void. Urgency incontinence is seen most often in women who are middle or older aged, but can occur in younger women as well.

For many women urgency incontinence is related to another condition, called overactive bladder. Overactive bladder refers to a problem with urgency, or sudden urges to urinate, often occurring with a frequent need to urinate during day or night.

Causes of Urinary Incontinence

There are many reasons why a woman may experience urine leakage, but it may be more common in women who have one or more of the following factors:

• Pregnancy or childbirth
• Physical problems associated with aging
• Menopause, due to less estrogen
• When the muscles that help to hold or release urine are weakened
• When a urinary passage is blocked
• When the nerves that control the bladder are damaged
• Family history

Urinary Incontinence Symptoms

Leaking urine is the most obvious symptom of urinary incontinence. However, it’s important to identify the circumstance that leads to urinary leakage so it can be treated appropriately.

• Leaking urine during movements, such as:
  • Coughing
  • Sneezing
  • Exercising
• Leaking urine with urgency – can’t make it to the bathroom in time
• Untimely urination because of:
  • Disability
  • External obstacles
  • Problems in thinking or communicating that prevent a person from reaching a toilet
• Leaking that occurs temporarily because of a situation that will pass, such as:
  • Infection
  • Taking a new medication
  • Colds with coughing

Urinary Incontinence Treatment Options

Treatment options for urinary leakage may depend on the type of incontinence.

Diet and fluid management

Small changes in your diet can help decrease urine leakage. Avoid acidic foods and juices, like tomatoes and orange juice, and limit alcohol, caffeine, and carbonated drinks.

Weight loss

Losing weight may decrease urine leakage, especially for those experiencing stress incontinence.

Kegel exercises

Pelvic muscle exercise, squeezing your pelvic floor muscles, helps strengthen the pelvic floor and reduce urine leakage. Stronger pelvic floor muscles can also help suppress urgency and urgency-related incontinence.

Bladder training

Your provider may recommend learning how to urinate according to a timetable rather than an urge. This helps train your bladder to limit the number of trips to the bathroom.

Vaginal devices

Vaginal pessaries are silicone rubber devices placed in the vagina to lift up and hold the urethra in place. Incontinence pessaries are a nonsurgical treatment used to treat stress incontinence. When properly fitted and cared for, pessaries can be worn comfortably and safely for many years.

Injections

Your provider may recommend using a bulking agent, which is injected behind the urethral wall so the urethra can better resist the pressure of a full bladder. This procedure is recommended for some women with stress incontinence and can be performed as an office procedure with local anesthesia.

Another office procedure that is recommended for some women with urgency incontinence involves injections of Botox into the bladder muscle.

Medications

There are prescription medications available to help block the abnormal bladder contractions associated with overactive bladder and urgency incontinence.

Neuromodulation

Neuromodulation uses electrical stimulation to treat urgency incontinence by sending a mild electric current to nerves in the lower back or the pelvic muscles. This may be performed through an office procedure or outpatient surgery.

Surgery

Surgery may also be recommended for stress urinary incontinence.

Prevention

While there are some causes of incontinence that you can’t prevent, there are ways to decrease your chances of developing urinary leakage. These include:

• Avoid food and beverage irritants, such as:
  • Caffeine
  • Carbonated drinks
  • Artificial sweeteners
• Avoid dehydration and over-drinking
• Reduce fluids at bedtime
• Avoid repetitive heavy lifting
• Don’t smoke or quit smoking to prevent unnecessary coughing