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Urinary Incontinence in Women

What is Urinary Incontinence?

Urine is formed in the kidneys and then passes through the ureters (narrow tubes) into the bladder, where it is temporarily stored until you are ready to urinate. Urinary incontinence is the loss of urine when you are not intending to urinate. It comes in several different forms which have different causes.

Types of Urinary Incontinence

Types of urinary incontinence:

  • Stress incontinence: Leakage of small amounts of urine when pressure is exerted on the bladder while coughing, laughing, sneezing, lifting a heavy object or exercising
  • Urge incontinence: Leakage of urine at unexpected situations after having a sudden urge, including during sleep
  • Functional incontinence: Physical or mental disability that prevents you from reaching a toilet in time
  • Overflow incontinence: Unexpected leakage of small amounts of urine because of a full bladder
  • Mixed incontinence: Presence of more than one type of incontinence
  • Continuous Incontinence: Continuous loss of urine, constantly leaking.

Causes of Urinary Incontinence

The causes of urinary incontinence include:

  • Weak muscles in the lower urinary tract
  • Pregnancy, childbirth, menopause, weight gain or other conditions that stretch the pelvic floor muscles or damage the local nerves
  • Urinary tract infection (UTI)
  • Constipation
  • Bladder cancer or stones
  • Blockage within the urinary tract
  • Removal of the uterus (hysterectomy)
  • Surgery of the pelvis or rectum
  • Neurological disorders such as multiple sclerosis or dementia

Symptoms of Urinary Incontinence

The common symptoms include a sudden, urgent and uncontrollable need to urinate, involuntary release of urine and frequent urination.

Diagnosis of Urinary Incontinence

To diagnose urinary incontinence, your doctor will review your medical history and may ask you to maintain a diary on the pattern of your voiding. A thorough physical examination is also performed. Your doctor may perform a bladder stress test to view the loss of urine when you cough. A urine analysis and culture of a sample of your urine may be ordered to examine for signs of infection or urine stones. Pelvic ultrasound and cystoscopy (a flexible camera inserted into the bladder through the urethra) may be ordered to view abnormalities in the urinary tract. Urodynamics testing may be used to measure the function of the bladder and your ability to sense when your bladder is full.

Treatment for Urinary Incontinence

Treatment for urinary incontinence is focused on the type of incontinence. Most patients are treated for either stress urinary incontinence or urge urinary incontinence. If you have leakage with both stress and urgency, you can be treated for both.

Treatments for Stress Urinary Incontinence

  • Weight loss – for overweight women, weight loss is highly effective at reducing leakage of urine due to stress
  • Kegel exercises – pelvic floor training to reinforce your natural bladder control
  • Pessary placement – use of a silicone device inserted into the vagina to help keep the urethral closed
  • Intravaginal estrogen – post-menopausal women may have atrophy of vaginal tissues that weakens the ability of the urethral to prevent urine leakage. Use of intravaginal estrogen can help to restore the normal function.
  • Mid urethral sling placement – surgical placement of a durable mesh to reinforce your bodies natural structures. This is different from transvaginal mesh and is considered safe and effective by the FDA.
  • Urethral bulking injections – injection of material around the urethral to reduce leakage.
  • Autologous fascial sling/bladder neck sling – surgical graft of tissue from your leg or abdomen to support the natural structures of your urethra.

Treatments for Urge Urinary Incontinence

  • Weight loss – for overweight women, weight loss is moderately effective at reducing
  • Bladder training – times voiding exercises can help to re-establish the natural control of your bladder
  • Intravaginal estrogen - post-menopausal women may have atrophy of vaginal tissues that weakens the ability of the urethral to prevent urine leakage. Use of intravaginal estrogen can help to restore the normal function.
  • Oral medications – two major types of oral medications exist that can help reduce loss of urine with urgency.
    • Anticholinergics – medications that work on receptors in the bladder that allow muscle contraction. These medication reduce the bladder’s drive to contract. They have the side effects of dry eyes, dry mouth, and constipation.
    • Beta 3 agonists – newer medications that work on receptors in the bladder to promote relaxation of the muscle. These medications have rare side effects, but may slightly increase the blood pressure in some patients.
  • Intradetrusor botulinum toxin – Use of Botox in the muscle of the bladder can reduce urgency. This treatment is highly effective, but requires a procedure and must be repeated every 4-6 months to remain effective. There is a risk of urinary tract infection, and complete inability to urinate.
  • Sacral neuromodulation – use of an implanted generator in the buttock to stimulate the nerves of the spinal cord. This can greatly reduce urgency and leakage, but requires a surgery and must be replaced every 3-7 years.
  • Percutaneous tibial nerve stimulation – working on the same nerves as sacral nerve stimulation, but through electrical stimulation of the tibial nerve in the leg. Daily placement of an acupuncture type needle and stimulation in the office can achieve similar benefit to sacral nerve stimulation, but takes many visits.

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