Urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder. Incontinence is a common problem, and there are many treatment options available.
It is common for other symptoms to occur along with urinary incontinence:
- Urgency—Having a strong urge to urinate
- Frequency—Urinating (also called voiding) more often than what is usual for you
- Nocturia—Waking from sleep to urinate
- Dysuria—Painful urination
- Nocturnal enuresis—Leaking urine while sleeping
Urinary incontinence in women can be divided into three main types:\
Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks can also happen when you walk, run, or exercise.
Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. You may leak urine on the way to the bathroom. If you have an "overactive bladder," it means that you have symptoms of urgency and frequency that may or may not include incontinence.
Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.
There are many causes of urinary incontinence. Often, there is more than one cause. Some causes of urinary incontinence are easily diagnosed. Others are more complex. Some of the causes of urinary incontinence include the following:
- Urinary tract infection (UTI)—UTIs sometimes cause leakage and are treated with antibiotics.
- Diuretic medications, caffeine, or alcohol—Incontinence may be a side effect of substances that cause your body to make more urine.
- Pelvic floor disorders—These disorders are caused by weakening of the muscles and tissues of the pelvic floor and include urinary incontinence, accidental bowel leakage, and pelvic organ prolapse.
- Constipation—Long-term constipation is often present in women with urinary incontinence, especially in older women. Treating constipation may help with urinary symptoms.
- Neuromuscular problems—When nerve signals from the brain to the bladder and urethra are disrupted, the muscles that control those organs can malfunction, allowing urine to leak. Muscle control problems can occur in conditions such as diabetes mellitus, stroke, or multiple sclerosis.
- Anatomical problems—The outlet of the bladder into the urethra can become blocked by bladder stones or other growths. The urethra may develop an abnormal pouch called a diverticulum that causes urine leakage or dribbling. A fistula is an abnormal connection from the urinary tract into another part of the body, such as the vagina, which allows urine to leak out. Pelvic surgery, radiation treatment, pelvic cancer, or childbirth may cause a fistula.
The first steps in assessing urinary incontinence are usually a medical history and physical exam:
- Medical history—Your obstetrician–gynecologist (ob-gyn) should ask you to explain your signs and symptoms in detail. You may be asked to fill out a bladder diary for a few days. In a bladder diary, you record the time and amount of leakage as well as the times you urinated. You also note how much liquid you drank and what you were doing when a leak happened.
- Physical exam—A pelvic exam may be done to see if you have pelvic organ prolapse and to look for other anatomical problems. A "cough test" may be done during the exam. During a cough test, you are asked to cough and bear down with a full bladder to see if urine leaks. A pad test may be done, in which you wear a pad that absorbs leaked urine. The pad is weighed for the amount of leakage. A test to measure the support of the urethra may be done.
Treatment depends on the type of incontinence you have and your goals for treatment. How much your symptoms bother you is an important factor in deciding on a treatment plan.
Your ob-gyn may first recommend nonsurgical treatment. This may include lifestyle changes, bladder training, physical therapy, and using certain bladder support devices. For urgency urinary incontinence, the treatment may involve medication. Surgery may help certain types of incontinence. Often, several treatments are used together for the best effect.
Losing weight. In overweight women, losing even a small amount of weight (less than 10 percent of total body weight) may decrease urine leakage.
Managing your fluid intake. If you have leakage in the early morning or at night, you may want to limit your intake of fluids several hours before bedtime. Limiting how much you drink may also be useful (no more than 2 liters of fluids total a day). If your urine is pale or has no color, you may be drinking too much. Limiting alcohol and caffeine may be helpful as well
Training your bladder. The goal of bladder training is to learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every 3 to 4 hours during the day and every 4 to 8 hours at night). After a few weeks of training, you may leak urine less often.
Kegel exercises can help strengthen the pelvic muscles. These exercises are helpful for all types of incontinence. You may also be referred to a physical therapist who specializes in pelvic health. Biofeedback is a training technique that may help you locate the correct muscles.
In one type of biofeedback, sensors are placed inside or outside the vagina that measure the force of pelvic muscle contraction. When you contract the right muscles, you will see the measurement on a monitor. This feedback lets you know that you are doing Kegel exercises in the right way. There are in-home biofeedback devices that you can use as well.
A pessary is a device that is inserted into the vagina to treat pelvic support problems and SUI. Pessaries support the walls of your vagina to lift the bladder and urethra. They come in many shapes and sizes.
Your ob-gyn can fit you for a pessary to find the right one to help your symptoms. Pessaries often provide relief of symptoms without surgery.
There is also an over-the-counter tampon-like device that is designed specifically to help prevent bladder leaks.
Many medications are available to help reduce the symptoms of urgency urinary incontinence and overactive bladder:
Medications that control muscle spasms or unwanted bladder contractions can help prevent leakage from urgency urinary incontinence and relieve the symptoms of urgency and frequency. They are available in pill form or as a skin gel or skin patch. A medication called oxybutynin is available over-the-counter as a patch. Possible side effects include dry mouth, dry eyes, and constipation.
Mirabegron is a medication that relaxes the bladder muscle and allows the bladder to store more urine. This medication is used to treat urgency urinary incontinence and relieve the symptoms of urgency and frequency.
Injection of a drug called onabotulinumtoxinA into the muscle of the bladder helps stop unwanted bladder muscle contractions. The effects last for about 3 to 9 months. Possible side effects include UTI and, in about 5 in 100 women, an inability to empty the bladder. If this happens, you may need to use a catheter to drain the bladder for a few days to a few weeks
Estrogen medication inserted into the vagina may help with urinary incontinence.