Female Incontinence

Muscle weakness in the bladder or pelvic floor, or problems in the nerves that control urination cause urinary incontinence. 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 such as 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.

• Stress incontinence: Urine leaks when coughing, laughing, exercising or sudden movements.
• Urge incontinence: An immediate need to urinate, even small amounts. Patients urinate frequently and have trouble reaching the toilet in time.
• Overflow incontinence: A constant urge to urinate, but urine just dribbles continuously.

A urologist will perform a detailed history and physical exam, so it is helpful if the patient keeps a diary for a few days beforehand to record times of urination, the amount of urine, leakage and foods and beverages consumed. The physician may also perform one or more tests:

• Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
• Postvoid residual volume: A measure of 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 technique that measures the pressure in the bladder and urine flow.

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Lifestyle changes, including modifications to the diet and Kegel exercises, can help manage both stress and urge incontinence. Your physician may also recommend one of these treatments:

• Medications: Anticholinergics (which block neurotransmitters) can help suppress involuntary contractions by the muscle surrounding the bladder. Other medications include estrogens, antidepressants or alpha-adrenergic (nerve-stimulating) drugs.
• Pessary ring: It is a removable device that goes inside your vagina to provide support to your pelvic organs if you have pelvic organ prolapse or stress incontinence. The ring is usually made of soft silicone.

Minimally-invasive treatments for female urinary incontinence

• Injection therapy: Injecting collagen, body fat or synthetic compounds around the urethra to bulk up or improve the function of the urethral sphincter and compress the urethra near the bladder outlet.
• Posterior Tibial Nerve Stimulation (PTNS): A periodic stimulation of the posterior tibial nerve (near the ankle) as regular, 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

Surgical treatments for female urinary incontinence

• Urethral bulking agents: A medication is injected under the lining of the urethra to ‘bulk up’ the channel. Bulkamid^® is a common type.
• Sacral nerve stimulation: A pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone to calm the nerves that control bladder function. This usually treats urge incontinence. Read Christopher’s Story.
• Midurethral Mesh Sling: A small piece of mesh is placed around the urethra to support the urethra and improve closure.
• Autologous fascial sling: A piece of the patient’s tissue (fascia) is harvested and placed around the urethra.
• Tension-free vaginal tape (TVT): Mesh tape placed under the urethra acts like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed during a cough or vigorous or sudden movement. This usually treats stress or mixed incontinence.
• Burch Procedure: Abdominal surgery using sutures to support the bladder neck.