Urinary Incontinence in Women
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Urinary incontinence is an inability
to hold your urine until you get to a toilet. More than 13 million
people in the United States—male and female, young and
old—experience incontinence. It is often temporary, and it always
results from an underlying medical condition.
(In this fact sheet, the term
"incontinence" will be used to mean urinary incontinence.)
Women experience incontinence twice
as often as men. Pregnancy and childbirth, menopause, and the
structure of the female urinary tract account for this difference.
But both women and men can become incontinent from neurologic
injury, birth defects, strokes, multiple sclerosis, and physical
problems associated with aging.
Older women, more often than younger
women, experience incontinence. But incontinence is not inevitable
with age. Incontinence is treatable and often curable at all ages.
If you experience incontinence, you may feel embarrassed. It may
help you to remember that loss of bladder control can be treated.
You will need to overcome your embarrassment and see a doctor to
learn if you need treatment for an underlying medical condition.
Incontinence in women usually occurs
because of problems with muscles that help to hold or release urine.
The body stores urine—water and wastes removed by the kidneys—in the
bladder, a balloon-like organ. The bladder connects to the urethra,
the tube through which urine leaves the body.
During urination, muscles in the wall
of the bladder contract, forcing urine out of the bladder and into
the urethra. At the same time, sphincter muscles surrounding the
urethra relax, letting urine pass out of the body (see figure 1).
Incontinence will occur if your bladder muscles suddenly contract or
muscles surrounding the urethra suddenly relax.
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Figure 1.—Front
view of bladder and sphincter muscles |
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Stress Incontinence
If coughing, laughing, sneezing, or
other movements that put pressure on the bladder cause you to leak
urine, you may have stress incontinence. Physical changes resulting
from pregnancy, childbirth, and menopause often cause stress
incontinence. It is the most common form of incontinence in women
and is treatable.
Pelvic floor muscles support your
bladder (see figure 2). If these muscles weaken, your bladder can
move downward, pushing slightly out of the bottom of the pelvis
toward the vagina. This prevents muscles that ordinarily force the
urethra shut from squeezing as tightly as they should. As a result,
urine can leak into the urethra during moments of physical stress.
Stress incontinence also occurs if the muscles that do the squeezing
weaken.
Stress incontinence can worsen during
the week before your menstrual period. At that time, lowered
estrogen levels might lead to lower muscular pressure around the
urethra, increasing chances of leakage. The incidence of stress
incontinence increases following menopause.
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Figure 2.—Side
view of female pelvic muscles |
Urge Incontinence
If you lose urine for no apparent
reason while suddenly feeling the need or urge to urinate, you may
have urge incontinence. The most common cause of urge incontinence
is inappropriate bladder contractions.
Medical professionals describe such a
bladder as "unstable," "spastic," or "overactive." Your doctor might
call your condition "reflex incontinence" if it results from
overactive nerves controlling the bladder.
Urge incontinence can mean that your
bladder empties during sleep, after drinking a small amount of
water, or when you touch water or hear it running (as when washing
dishes or hearing someone else taking a shower).
Involuntary actions of bladder
muscles can occur because of damage to the nerves of the bladder, to
the nervous system (spinal cord and brain), or to the muscles
themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's
disease, stroke, and injury—including injury that occurs during
surgery—all can harm bladder nerves or muscles.
Functional Incontinence
People with functional incontinence
may have problems thinking, moving, or communicating that prevent
them from reaching a toilet. A person with Alzheimer's disease, for
example, may not think well enough to plan a timely trip to a
restroom. A person in a wheelchair may be blocked from getting to a
toilet in time. Conditions such as these are often associated with
age and account for some of the incontinence of elderly women in
nursing homes.
Overflow Incontinence
If your bladder is always full so
that it frequently leaks urine, you have overflow incontinence. Weak
bladder muscles or a blocked urethra can cause this type of
incontinence. Nerve damage from diabetes or other diseases can lead
to weak bladder muscles; tumors and urinary stones can block the
urethra. Overflow incontinence is rare in women.
Other Types of Incontinence
Stress and urge incontinence often
occur together in women. Combinations of incontinence—and this
combination in particular—are sometimes referred to as "mixed
incontinence."
"Transient incontinence" is a
temporary version of incontinence. It can be triggered by
medications, urinary tract infections, mental impairment, restricted
mobility, and stool impaction (severe constipation), which can push
against the urinary tract and obstruct outflow.
The Types of Urinary
Incontinence
| Stress |
|
Leakage of small amounts of
urine during physical movement (coughing, sneezing,
exercising). |
| Urge |
|
Leakage of large amounts of
urine at unexpected times, including during sleep. |
| Functional |
|
Untimely urination because
of physical disability, external obstacles, or problems in
thinking or communicating that prevent a person from
reaching a toilet. |
| Overflow |
|
Unexpected leakage of small
amounts of urine because of a full bladder. |
| Mixed |
|
Usually the occurrence of
stress and urge incontinence together. |
| Transient |
|
Leakage that occurs
temporarily because of a condition that will pass
(infection, medication). |
|
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The first step toward relief is to
see a doctor who is well acquainted with incontinence to learn what
type you have. A urologist specializes in the urinary tract, and
some urologists further specialize in the female urinary tract.
Gynecologists and obstetricians specialize in the female
reproductive tract and childbirth. A urogynecologist focuses on
urological problems in women. Family practitioners and internists
see patients for all kinds of complaints. Any of these doctors may
be able to help you.
To diagnose the problem, your doctor
will first ask about symptoms and medical history. Your pattern of
voiding and urine leakage may suggest the type of incontinence.
Other obvious factors that can help define the problem include
straining and discomfort, use of drugs, recent surgery, and illness.
If your medical history does not define the problem, it will at
least suggest which tests are needed.
Your doctor will physically examine
you for signs of medical conditions causing incontinence, such as
tumors that block the urinary tract, stool impaction, and poor
reflexes or sensations, which may be evidence of a nerve-related
cause.
Your doctor will measure your bladder
capacity and residual urine for evidence of poorly functioning
bladder muscles. To do this, you will drink plenty of fluids and
urinate into a measuring pan, after which the doctor will measure
any urine remaining in the bladder. Your doctor may also recommend
- Stress test—You relax, then cough
vigorously as the doctor watches for loss of urine.
- Urinalysis—Urine is tested for
evidence of infection, urinary stones, or other contributing
causes.
- Blood tests—Blood is taken, sent
to a laboratory, and examined for substances related to causes of
incontinence.
- Ultrasound—Sound waves are used to
"see" the kidneys, ureters, bladder, and urethra.
- Cystoscopy—A thin tube with a tiny
camera is inserted in the urethra and used to see the inside of
the urethra and bladder.
Urodynamics—Various techniques
measure pressure in the bladder and the flow of urine.
Your doctor may ask you to keep a
diary for a day or more, up to a week, to record when you void. This
diary should note the times you urinate and the amounts of urine you
produce. To measure your urine, you can use a special pan that fits
over the toilet rim.
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Exercises
Kegel exercises to strengthen or
retrain pelvic floor muscles and sphincter muscles can reduce or
cure stress leakage. Women of all ages can learn and practice these
exercises, which are taught by a health care professional.
Most Kegel exercises do not require
equipment. However, one technique involves the use of weighted
cones. For this exercise, you stand and hold a cone-shaped object
within your vagina. You then substitute cones of increasing weight
to strengthen the muscles that help keep the urethra closed.
Electrical Stimulation
Brief doses of electrical stimulation
can strengthen muscles in the lower pelvis in a way similar to
exercising the muscles. Electrodes are temporarily placed in the
vagina or rectum to stimulate nearby muscles. This will stabilize
overactive muscles and stimulate contraction of urethral muscles.
Electrical stimulation can be used to reduce both stress
incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to
help you become aware of your body's functioning. By using
electronic devices or diaries to track when your bladder and
urethral muscles contract, you can gain control over these muscles.
Biofeedback can be used with pelvic muscle exercises and electrical
stimulation to relieve stress and urge incontinence.
Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder
training are techniques that use biofeedback. In timed voiding, you
fill in a chart of voiding and leaking. From the patterns that
appear in your chart, you can plan to empty your bladder before you
would otherwise leak. Biofeedback and muscle conditioning—known as
bladder training—can alter the bladder's schedule for storing and
emptying urine. These techniques are effective for urge and overflow
incontinence.
Medications
Medications can reduce many types of
leakage. Some drugs inhibit contractions of an overactive bladder.
Others relax muscles, leading to more complete bladder emptying
during urination. Some drugs tighten muscles at the bladder neck and
urethra, preventing leakage. And some, especially hormones such as
estrogen, are believed to cause muscles involved in urination to
function normally.
Some of these medications can produce
harmful side effects if used for long periods. In particular,
estrogen therapy has been associated with an increased risk for
cancers of the breast and endometrium (lining of the uterus). Talk
to your doctor about the risks and benefits of long-term use of
medications.
Pessaries
A pessary is a stiff ring that is
inserted by a doctor or nurse into the vagina, where it presses
against the wall of the vagina and the nearby urethra. The pressure
helps reposition the urethra, leading to less stress leakage. If you
use a pessary, you should watch for possible vaginal and urinary
tract infections and see your doctor regularly.
Implants
Implants are substances injected into
tissues around the urethra. The implant adds bulk and helps to close
the urethra to reduce stress incontinence. Collagen (a fibrous
natural tissue from cows) and fat from the patient's body have been
used. Implants can be injected by a doctor in about half an hour
using local anesthesia.
Implants have a partial success rate.
Injections must be repeated after a time because the body slowly
eliminates the substances. Before you receive collagen, a doctor
must perform a skin test to determine whether you would have an
allergic reaction to the material.
Surgery
Doctors usually suggest surgery to alleviate incontinence only
after other treatments have been tried. Many surgical options have
high rates of success.
Most stress incontinence results from the bladder dropping down
toward the vagina. Therefore, common surgery for stress incontinence
involves pulling the bladder up to a more normal position. Working
through an incision in the vagina or abdomen, the surgeon raises the
bladder and secures it with a string attached to muscle, ligament,
or bone.
For severe cases of stress incontinence, the surgeon may secure
the bladder with a wide sling. This not only holds up the bladder
but also compresses the bottom of the bladder and the top of the
urethra, further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a
doughnut-shaped sac that circles the urethra. A fluid fills and
expands the sac, which squeezes the urethra closed. By pressing a
valve implanted under the skin, you can cause the artificial
sphincter to deflate. This removes pressure from the urethra,
allowing urine from the bladder to pass.
Catheterization
If you are incontinent because your bladder never empties
completely (overflow incontinence) or your bladder cannot empty
because of poor muscle tone, past surgery, or spinal cord injury,
you might use a catheter to empty your bladder. A catheter is a tube
that you can learn to insert through the urethra into the bladder to
drain urine. Catheters may be used once in a while or on a constant
basis, in which case the tube connects to a bag that you can attach
to your leg. If you use a long-term (or indwelling) catheter, you
should watch for possible urinary tract infections.
Other Procedures
Many women manage urinary incontinence with pads that catch
slight leakage during activities such as exercising. Also, you often
can reduce incontinence by restricting certain liquids, such as
coffee, tea, and alcohol.
Finally, many women who could be treated resort instead to
wearing absorbent undergarments, or diapers—especially elderly women
in nursing homes. This is unfortunate, because diapering can lead to
diminished self-esteem, as well as skin irritation and sores. If you
are an elderly woman, you and your family should discuss with your
doctor the possible effectiveness of treatments such as timed
voiding, pelvic muscle exercises, and electrical stimulation before
resorting to absorbent pads or undergarments.
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Urinary incontinence is common in women.
All types of urinary incontinence can be treated.
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Incontinence can be treated at all ages.
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You need not be embarrassed by incontinence.
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This information on this site
is not medical advice
and is not intended as a substitution
for the evaluation of your individual health
condition by your personal healthcare provider.
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