Urinary incontinence in women

(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)

Urinary incontinence in women – Definition

Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or last for a long time. Incontinence is a symptom not a condition.

Urinary incontinence in women – Causes

Temporary incontinence can be caused by:

• Medicines
• Constipation
• Infection
• Muscle weakness
• Restricted mobility
• Obesity
• Endocrinological disorders (eg, diabetes)

More permanent urinary incontinence may be one of four types. Some people have a mixture of these types.

Stress Incontinence

This is the most common type of incontinence. It may be caused by:

• Weakening of the muscles that suspend the bladder
• Weakening of muscles that control urine flow
• Obesity

Urge Incontinence

This is also known as overactive bladder. It may be caused or worsened by:

• Urinary tract infection
• Diabetes type 1 and 2
• Bladder irritation (stone, tumor)
• Drugs (eg, hypnotics, diuretics)
• Caffeine
• Alcohol
• Nerve damage due to:
  • Spinal cord injury
  • Stroke
  • Multiple sclerosis
  • Parkinson’s disease
• Constipation
• Excessive urine intake

Overflow Incontinence

This occurs when the bladder will not empty. Urine builds up, and this causes an overflow and leaking of urine. It may be caused by:

• A bladder that is blocked, such as by a scar in the urethra (stricture)
• Fecal impaction
• Drugs (eg, antidepressants, hypnotics, antipsychotics, antihistamines, calcium channel blockers)
• Vitamin B12 deficiency
• Weak bladder muscles
• Nerve damage due to:
  • Surgery
  • Diabetes
  • Spinal cord injuries
  • Other factors

Functional Incontinence

This occurs when there is normal bladder control, but an inability to reach the toilet in time. It may be caused by medical conditions like severe arthritis. Drugs that cause confusion or sedation can also cause functional incontinence.

Some incontinence may ba caused by a fistula. This is an abnormal opening between the bladder and outside.

In some cases, incontinence may have several different causes. The cause may also be unclear.

Urinary incontinence in women – Risk Factors

Risk factors include:

• Age: older than 65
• Having been pregnant multiple times or having a complicated delivery
• Urinary tract infection
• Obesity
• Chronic lung disease
• Urethritis
• Previous hysterectomy or urethral surgery
• Pelvic organ prolapse
• Depression
• Dementia, including Alzheimer’s disease
• Menopause
• Diabetes
• Stroke
• Multiple sclerosis
• Spinal cord injury or disease
• Use of certain substances or medicines:
  • Caffeine
  • Alcohol
  • Alpha-agonists
  • Cholinergic agents
  • Cyclophosphamide

Urinary incontinence in women – Symptoms

Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

Stress incontinence will occur when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise.

Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is not able to hold urine long enough to make it to a restroom.

When Should I Call My Doctor?

Call your doctor if you have a loss of urine control. Your doctor can help you determine the underlying cause.

Urinary incontinence in women – Diagnosis

The doctor will ask about your symptoms and medical history. You will be asked how often you empty your bladder and patterns of urine leakage. Your doctor will perform a physical exam to look for any physical causes, such as blockages or nerve problems.

Your doctor may ask you to keep a diary of your bladder habits. You may be referred to an urologist or an urogynecologist.

Tests to help determine a cause may include:

• Stress test — you relax then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.
• Urine tests
• Blood tests to detect diabetes
• Ultrasound — a test that uses sound waves to examine structures inside the body to determine the residual urine volume after voiding
• Cystoscopy — a thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder
• Urodynamic tests — tests used to measure the flow of urine and pressure in the bladder

Urinary incontinence in women – Treatment

Treatments may include:

Behavioral Therapy

Behavioral therapy includes:

• Making muscles stronger by:
  • Kegel exercises — This strengthens the muscles that hold the bladder in place and those that control urine flow.
  • Painless electrical stimulation — may strengthen the muscles more quickly and is helpful for stress incontinence.
  • Pelvic floor exercises using cone-shaped weights that are placed in the vagina.
• Bladder training — Setting a regular, timed schedule for emptying your bladder. You may also be asked to drink fewer liquids.
• Biofeedback — When doing pelvic floor muscle exercises, a device signal how strong you are contracting your muscles.

Weight Loss

If you are a woman who is overweight or obese, losing weight may help to reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.

Medication

Medicines may be prescribed to relax the bladder muscles. These types of medicines, called anticholinergics, are often used in treating urge incontinence. Examples include:

• Oxybutynin (Ditropan)
• Tolterodine (Detrol)
• Darifenacin (Enablex)
• Solifenacin (Vesicare)
• Fesoterodine (Toviaz)

Nerve Stimulation

Nerve stimulation is effective for urge urinary incontinence. It can be done by stimulating a nerve in your ankle. Or, it can be done by implanting a device that stimulates the bladder nerves.

Surgery

In women, surgery can support weakened muscles related to bladder function. One type of surgery is called a urethral suspension. Other procedures involve collagen injections into the urethra.

Devices

Absorbent diapers are often used with incontinence.

Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases.

A supportive device called a pessary may also be used in women. Pessaries are devices that raise the uterus or the prolapsed bladder. It can decrease pressure on the bladder.

Home Care

• Take care of your skin by gently cleaning yourself after an episode of incontinence. Let the skin air dry.
• Make it easier for you to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night lights in the hallway and in the bathroom.
• If needed, keep a bedpan handy in your bedroom.

Urinary incontinence in women – Prevention

Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:

• If advised by your doctor, do Kegel exercises.
• Reduce your intake of substances that lead to incontinence (eg, caffeine, alcohol, and certain drugs).
• Lose weight, if needed.
• Eat a healthy diet to avoid constipation.