Millions of women experience involuntary loss of urine, called urinary incontinence. The condition affects all ages and women of every social and economic level, though urinary incontinence occurs more often in older women than in young women. There are two basic forms of incontinence in women:
- Stress incontinence: occurs when sneezing, coughing or during other activities that put pressure on your bladder.
- Urge incontinence: a sudden and urgent need to urinate due to involuntary bladder contraction.
Urinary incontinence can be caused from muscle weakness in the bladder or pelvic floor, or problems in the nerves that control urination. In general, it occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull. Smoking, previous pregnancies, obesity, diabetes, bladder disease, certain medications or constipation can contribute to incontinence. Congenital problems or neurologic disease (for example: stroke, Parkinson’s disease, Multiple Sclerosis or a spinal cord injury) can also contribute to incontinence.
The main symptom of incontinence is the accidental release of urine.
- If you have stress incontinence, you may leak urine when you cough, laugh, exercise or move suddenly.
- If you have urge incontinence, you may leak when you get the urge to urinate. You will often urinate frequently.
- If you have mixed incontinence you may have symptoms of both problems.
A urologist will perform a detailed history and physical exam to categorize the incontinence. It is helpful if the patient keeps a diary for a few days before examination to record times of urination, how much urine is passed, leakage and the foods and beverages consumed. The physician may also perform one of several tests:
- Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
- Postvoid residual volume: A test that measures the amount of urine left in the bladder after urination.
- Urinalysis: An examination of the composition of the patient’s urine.
- Bladder scan: An ultrasound of the kidneys, bladder and urethra, to see if the bladder empties completely.
- Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
- Urodynamics: A special technique that measures pressure in the bladder and urine flow.
Both stress and urge incontinence may be managed by lifestyle changes, including modifications to the diet and Kegel exercises. The physician may also recommend the following treatments:
- Medications: Anticholinergics, tricyclic antidepressants or alpha-adrenergic drugs are usually taken to treat urge or mixed incontinence.
- Injection therapy: The physician injects collagen, body fat or synthetic compounds around the urethra to bulk up or improve the function of the urethral sphincter and also compress the urethra near the bladder outlet.
- Posterior Tibial Nerve Stimulation (PTNS): The physician performs periodic stimulation of the posterior tibial nerve (near the ankle) as a weekly, outpatient therapy.
- Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.
- Tension-free vaginal tape (TVT): Mesh tape is placed under the urethra like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed when you cough or move vigorously or suddenly. This is usually used to treat stress or mixed incontinence.
- Sacral nerve stimulation: A pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone to stimulate the sacral nerves. This treatment is usually used for urge incontinence.
For more information on Female Incontinence visit WebMD's Incontinence & Overactive Bladder Health Center.
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