What is urinary incontinence?
Leakage of urine is called incontinence. Some women leak small amounts of urine. In other cases, however, the leakage 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. Leakage can also happen when she walks, runs or exercises. This type of incontinence is caused by weakening of the tissues that support the bladder or of the muscles of the urethra.
- Urge incontinence — leakage of urine caused by overactive bladder muscles that contract too often, or by problems with the nerves that send signals to the bladder.
- Mixed incontinence — a combination of the symptoms of stress incontinence and urge incontinence
- Overflow incontinence — constant loss of small amounts of urine when the bladder does not empty completely. It can be caused by underactive bladder muscles or by 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
- Frequenc y — Voiding more often than she considers usual
- Nocturia — T he need to void during hours of sleep
- Dysuria — P ainful voiding
- Enuresis — B ed-wetting or leaking while sleeping
What causes urinary incontinence?
Urinary incontinence can have short-term and long-term causes. The short-term causes are easier to treat and include the following:
- Urinary tract infection — loss of bladder control can be caused by a urinary tract infection. Bladder infections (cystitis) are common in women. These infections are treated with antibiotics.
- Medication — reduced bladder control can be a side effect of medicines such as diuretics.
- Abnormal growths — polyps, bladder stones or, less often, bladder cancer can cause urinary incontinence. Abnormal growths often cause urge incontinence and may be associated with blood in the urine. If you see blood in your urine, or if you are not sure where any bleeding is coming from, it is important to tell your doctor straight away.
The long-term causes include the following:
- Pelvic support problems — the pelvic organs are held in place by supporting tissues and muscles. These tissues can tear or stretch, or they can weaken with age. If the tissues supporting the urethra, bladder, uterus or rectum become weak, these organs can drop downwards, causing urine leakage or difficulty passing 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 through the vagina. Neuromuscular problems — these disorders can interfere with the signals sent from the brain and spinal cord to the bladder and urethra.
How is urinary incontinence diagnosed?
Several steps may be needed to find the cause of urinary incontinence, and in some cases there is more than one cause. You may be asked to keep a bladder diary for a few days, recording the time and amount of each leak. You should also note how much fluid you drank and what you were doing when the leakage occurred. A pelvic examination will be done to look for physical conditions that may be related to the problem. Laboratory tests may also be done to detect a urinary tract infection. Other tests that assess how your bladder works include the following:
- Urodynamic testing — the bladder is filled through a catheter. These tests assess the function of the urethra and the bladder. Post-void residual volume — the amount of urine left in the bladder after passing urine is measured with an ultrasound device or by placing a catheter in the bladder. Stress test — you are asked to cough a few times with a full bladder, and any leakage of urine is recorded. Cystoscopy — a thin tube with a lens at the end is used to examine the inside of the bladder and urethra. Dye test — a non-toxic dye is placed in the bladder and a pad is worn. If the pad is stained with the dye, this shows that urine is leaking.
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, medications, bulking agents, and surgery.
What are some of the lifestyle changes that are used to manage urinary incontinence?
Making the following changes to your lifestyle, where they apply to you, may help with the problem:
- Weight loss — in overweight women, losing weight has been shown to reduce how often urine leaks. Avoiding constipation — repeated straining can damage the pelvic floor. Drinking less fluid and limiting caffeine, which is a diuretic. Seeking treatment for a chronic cough. Stopping smoking.
What is bladder training?
The goal of bladder training is to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3 – 4 hours during the day and every 4 – 8 hours at night). After a few weeks of this training, leakage may occur less often.
What types of physical therapy are used to treat urinary incontinence?
There are many types of physical therapy that can be done to treat urinary incontinence. One type, Kegel exercises, can help strengthen the pelvic muscles. Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in treating stress incontinence and urge incontinence. If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in women’s pelvic health. Biofeedback is a training technique that may be useful if you have problems locating the correct muscles.
How are Kegel exercises done?
Kegel exercises strengthen your pelvic muscles. The steps for doing them are described below:
- Squeeze the muscles you would use to stop the flow of urine (but do not do these exercises while passing urine). Hold for up to 10 seconds, then release. Repeat this 10–20 times in a row, at least 3 times a day.
- Take care not to tighten the muscles of your legs, buttocks or abdomen. Do these exercises regularly. It can take 4–6 weeks before you notice an improvement in your incontinence symptoms.
What devices are used to treat urinary incontinence?
A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence. Pessaries support the pelvic structures, and some compress the urethra. They come in all shapes and sizes. They are useful for women who do not want or cannot have surgery to correct their incontinence.
What medications are used for treatment?
Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge incontinence. These medications also can help reduce the frequency of urination. Your health care provider will help you decide which drug is most likely to work best for you.
What are bulking agents?
These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option or has not worked. A substance is injected into the tissues around the urethra to add bulk. The urethra becomes narrowed, decreasing leakage. This procedure can be done in a doctor’s office or clinic.
What types of surgery treat urinary incontinence?
A number of operations have been developed to treat stress urinary incontinence. You and your doctor should discuss many factors, including your age, your lifestyle and your general health, before deciding to have surgery.