Urinary incontinence is the leaking of urine from the bladder. It can be just a few drops, or it can be the complete release of all the contents of the bladder. While urinary incontinence isn’t an uncommon problem for women, the silence around the topic can lead to a lot of unnecessary embarrassment.
What are the types of urinary incontinence?
There are three types of urinary incontinence, according to the American College of Obstetricians and Gynecologists (ACOG):
1. Stress urinary incontinence (SUI): You leak urine when coughing, sneezing, laughing, or even moving, and it’s often associated with exercising.
2. Urge incontinence: You have a sudden need to go to the bathroom and may leak a few drops on the way to bathroom. Women often say it’s hard to control the flow, so they can’t stop it.
3. Mixed incontinence: This is a combination of SUI and urge incontinence.
What are the causes of incontinence?
Some of the things that cause incontinence are temporary, while others are longer-lasting. Certain medications or other physical issues may cause some of the symptoms of incontinence. These might include medications that you are taking for unrelated illnesses, like a diuretic, Over-the-counter products like caffeine and alcohol can also cause incontinence symptoms, according to ACOG. If your body makes more urine, it will make it easier to have leaks. And sometimes, incontinence is age-related.
You may have a temporary bout of incontinence if you are suffering from a urinary tract infection (UTI). This is a temporary infection that can be treated with antibiotics. With this treatment, the incontinence symptoms will usually clear up as the UTI recedes.
Sometimes women will experience incontinence with constipation. While we often don’t want to think about how close the rectum is to the rest of the female body parts, even a slight case of constipation can increase the pressure and make a leak more likely to happen.
Pelvic floor disorders are also reasons for incontinence. These disorders occur when the tissues and muscles of the pelvic floor are weakened. This happens for a variety of reasons, including after being pregnant. Pelvic floor disorders also may come with a variety of other symptoms, including a prolapse of the bladder and/or uterus, and may include leakage of the bowels.
There may also be problems with the anatomy that are not specific to the pelvic floor that are causing your incontinence. For example, you may have a blockage from bladder stones, an anomaly from birth, or other problems. Neuromuscular issues — when there is an electrical signal misfire from the brain to the bladder and urethra — can also cause you to have leaking urine.
How do you diagnose incontinence?
You should talk to your doctor or midwife about any symptoms that you are having with your bladder. Tell your practitioner about the following types of signs and symptoms:
- How often you urinate? Is this normal for you?
- How strong is the urge to urinate?
- How often do you get up at night to urinate?
- Does it hurt when you urinate, called dysuria?
- When do you leak? Stress-related leaks? Random leaking? While you are sleeping?
- Medications you are taking and changes in those medications
- Other medical issues you may be experiencing
Then, your doctor will likely do a physical exam. They will assess your pelvic floor and organs for prolapse and muscle integrity. You may be asked to cough while your bladder is full to see if you have any leaks, according to the American Academy of Family Physicians (AAFP). If your leaks are of large quantities of urine, you may also wear a pad and have it weighed to see how much urine you are leaking.
If all of this isn’t enough to diagnose your problems, there are more tests that can be done. These can include blood tests for infections, imaging exams to test for anomalies or structural issues, and more. There are also specific bladder function tests that can provide additional information.
While most of this can be taken care of with your normal family practitioner or gynecologist, you may also be referred to a urogynecologist. This is a specialist who works with urinary issues in women.
How do you treat urinary incontinence?
The treatment for your urinary incontinence depends on the cause. This means that there are a number of treatments that your doctor may offer you, both non-surgical and surgical, depending on your specific scenario. Sometimes, like in the case of UTI-related incontinence, the treatment is as simple as antibiotics and watchful waiting.
Lifestyle changes can help with some types of incontinence, according to the AAFP. The first thing to try may be to manage your fluids. If you’ve been drinking large amounts of fluid before bed, perhaps try to cut down or cut yourself off several hours before your bedtime. This can be particularly helpful for those struggling with incontinence during sleep. You may also see if decreasing the amount of caffeine or alcohol alters your symptoms and adjust accordingly.
Losing weight can be helpful if you are overweight. Losing as little as 10 percent of your body weight can reduce the amount of urine that you leak.
Bladder training may be helpful for some people. This involves holding your urine for progressively longer amounts of time. This type of intervention works best if you have urge incontinence.
Kegel exercises or other pelvic floor strengthening exercises can be useful for some women with SUI and mixed incontinence. This is a form of specific tightening of the pubococcygeus muscle in order to gain better control over the bladder and urine leakage. This exercise can be recommended for all women who deal with incontinence. If you’ve had a baby more than three months ago, this can also be helpful for you. There is also a form of biofeedback from sensors placed inside the vagina or outside the vagina to help you identify which muscles need work.
A pessary is a device that can be inserted into the vagina to treat pelvic floor problems and SUI. These can be prescribed by your practitioner or some devices are available over the counter and are inserted like tampons for a temporary fix. These are designed for temporary relief or when surgery is not an option. This can be useful for some, but one study showed that behavioral training alone fared better in patient satisfaction after three months than pessary use did, though that didn’t hold out past the year mark. For most people, a pessary is a stop-gap measure rather than a permanent solution.
Sacral neuromodulation can help with urge incontinence. In this procedure, a small wire is placed in the skin near the low back to the nerve that controls the bladder. This sends a signal to help improve bladder functions.
Another option is percutaneous tibial nerve stimulation (PTNS). PTNS is done using needles inserted near the nerve controlling the bladder at the ankle and using a special machine electrical signals are sent into that nerve. It can be done with or without biofeedback. This is done during weekly visits, lasting about 30 minutes. However, it may take many weeks or months to receive the full benefits.
Medications are most effective for urge incontinence and are not recommended for those with stress incontinence. Other methods should be tried prior to resorting to a systemic medication. These drugs typically work by targeting the muscles involved. Some drugs control the spasms that can occur and therefore reduce the urgency and frequency of urination. Other medications help to actually relax the bladder and allow it to hold more urine, thereby decreasing the frequency. Most of these medications or taken orally.
You may have surgery in which slings of synthetic materials or your own tissues are used to provide support for the urethra. The most common type is the midurethral sling. Midurethral slings are more effective at treating SUI than some of the older types of surgeries available. Your doctor may also recommend colposuspension; this is where stitches are placed around the bladder neck to support the urethra and hold it where it belongs.
If these surgeries fail, there is also something called urethral bulking, where injected materials narrow the urethral opening and decrease incontinence. However, surgery is often recommended as the last line of defense in incontinence management.
The bottom line
All in all, there are many options for people with urinary incontinence. Most of the non-surgical and medical therapies are enough for people to see a large change and feel better with their decreasing symptoms, though some women will require medications or even surgery. Be sure to seek the help of a doctor you trust, and hopefully you’ll be back to feeling good about your bladder control soon.