Leakage of urine is called urinary incontinence. Some women leak small amounts of urine. At other times, leakage of urine is frequent or severe.
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 or exercises. It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra.
• Urge incontinence – Leakage of 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.
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
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 diuretics.
• Abnormal growths – Polyps, bladder stones, or less commonly, 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 unsure about the source of any bleeding, it is important to alert your health care provider right away.
Long – term causes include the following:
• Pelvic support problems – The pelvic organs are held in place by 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.
• Neuromuscular problems – These disorders can interfere with the transmission of signals from the brain and spinal cord to the bladder and urethra.
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 also 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 tests – The bladder is filled through a catheter. These tests check the function of the urethra and bladder.
Post void residual volume test – the amount of urine that is left in the bladder after urinating 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. Any loss of urine is recorded.
• Cystoscopy – A thin, lighted tube with a lens at the end 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.
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 minimally invasive surgery.
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 fluids and limit intake of caffeine, which is a diuretic.
• Seek treatment for chronic coughing.
• Stop smoking.
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.
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.
Kegel exercises tone your pelvic muscles. Here is how they are done:
• Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating).
• Hold for up to 10 seconds, then release.
• Do this 10-20 times in a row at least 3 times a day.
Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. It may take 4-6 weeks to notice an improvement in urinary incontinence symptoms.
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.
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.
These agents may be used when the muscle surrounding the urethra is very weak and surgery may not be ideal 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.
Several very successful surgical procedures have been developed to treat stress urinary incontinence. We will discuss many factors that should be considered, including you age, lifestyle, and general health before choosing to have surgery.