Female Incontinence Overview
Millions of people experience involuntary loss of urine or a sudden urge to urinate before losing a large amount of urine. Urinary incontinence and bladder control are issues that more than 13 million people in the United States share. Although both men and women can share these often embarrassing situations, incontinence and bladder control are twice as likely to occur in women, especially moms and older women. Pregnancy and childbirth, menopause, and the structure of the female urinary tract all account for this difference between the sexes.
However, female incontinence is not inevitable with age. It is a medical problem and your doctor or nurse can help you find a solution. If you sometimes have trouble reaching the bathroom in time or experience leaking when you laugh, sneeze or lift something heavy, then there may be a bladder control treatment for you, and Dr. Mark Allen, Plano, Frisco and Dallas, Texas urology specialist, might have the answer.
Anatomy and Physiology
Female incontinence usually occurs because of weak muscles that help to hold or release urine. When the muscles of the bladder contract, urine is forced out of the bladder and this causes urination. Simultaneously, sphincter muscles surrounding the urethra (the tube through which urine leaves the body) relax and allows urine to pass out of the body. Female incontinence usually happens if the bladder muscles suddenly contract, forcing urine out of the bladder, or the muscles surrounding the urethra unexpectedly relax, letting urine flow freely.
Signs and Symptoms of Female Incontinence
Ask yourself the following questions to determine if you have female urinary incontinence:
1. Do you leak urine unexpectedly?
2. Is the urine leakage:
- Mild (a few drops)
- Moderate (wet underwear)
- Severe (wet outerwear)
3. Does the urine loss occur during coughing, sneezing, laughing, bending or lifting?
4. Does the urine loss occur when you change from a sitting or lying position to a standing position?
5. Do you leak urine continuously?
6. Is urine loss a problem to you?
7. Has this urine loss caused you to change your lifestyle?
8. If you have changed your lifestyle, how?
- I limit the fluids I drink
- I stay at home
- I limit my choice of clothing to dark colors
If you answered “Yes” to any of these questions, or if your answers are of concern to you, you are not alone. Over 51 million women worldwide experience urinary incontinence.
These incontinence questions were designed to show the different symptoms that indicate the various types of female incontinence. Talk with a doctor to discuss your responses from this self-test.
Causes of Female Incontinence
Various biological life stages or natural anatomy such as pregnancy and childbirth, menopause, and/or the structure of the female urinary tract account for the fact that women experience incontinence twice as often as men. However, both women and men can experience urinary incontinence due to birth defects, infections, medications, strokes, injury to the nervous system, hyperthyroidism, uncontrolled diabetes, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, obesity, and various physical problems that are brought on by aging or genetic factors.
Urinary incontinence in women usually occurs because of problems or weakening of the muscles that help to hold or release urine. If these muscles do not function properly, then leaking of urine or an uncontrollable urge to urinate may become a constant irritation in everyday life. But you are not alone. Millions of women experience the same issues and many have found successful treatments.
Types of Female 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, after drinking a small amount of water, or when you touch water or hear it running.
- 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. This happens when the bladder doesn’t empty properly, causing it to spill over. Weak bladder muscles, blocked urethra, some tumors, and urinary stones have all been known to cause this type of incontinence even though it’s very rare in women.
- Mixed– Usually the occurrence of stress and urge incontinence together. Many studies show that mixed incontinence is the most common type of urine loss in women.
- Transient– Leakage that occurs temporarily because of a condition that will pass. Urinary tract infections, medications, mental impairment, and restricted mobility can all be triggers of transient incontinence.
- Overactive bladder– Having to urinate more frequently than seven times a day. This occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Symptoms might include: bothersome urination eight or more times a day/two or more times at night (urinary frequency); the sudden, strong need to urinate immediately (urinary urgency); urge incontinence; and/or awaking at night to urinate (nocturia).
Tests/Evaluation for Female Incontinence
In order to diagnose the problem, Dr. Allen will first gather a patient medical history that will include the symptoms you are experiencing, your pattern of urinating, and urine leakage. Therefore he might suggest you start a bladder diary that includes any straining and discomfort, fluid intake, use of drugs, recent surgery, recent illness, and the times and estimated amount of urination.
Dr. Allen will also physically examine you for signs of medical conditions that might cause female incontinence, such as treatable blockages from bowel or pelvic growths, weakness of the pelvic floor, or prolapse (where the vagina or bladder begins to protrude out of your body). He might also suggest other tests:
- Bladder stress test- You cough vigorously as the doctor watches for loss of urine from the urinary opening
- Pad test– Measures the amount of urine released by weighing the increased weight of an absorbent pad after urine leakage occurs
- Post Void Residual (PVR)– Assesses the adequacy of the bladder’s ability to empty
- Urinalysis and urine culture– Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes
- Ultrasound– This tests uses sound waves to create an image of the kidneys, ureters, bladder, and urethra
- Cystoscopy– The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder
- Cystometry– A series of tests that study pressure and volume of fluid in the bladder during filling, storing, and voiding
- Urodynamics- Various techniques measure pressure in the bladder and the flow of urine
- Uroflowmetry– Measures urine volume voided over a period of time and can be used to determine the severity of any blockage or obstruction.
Bladder Control Treatment Options
If you are found to have female urinary incontinence, your doctor might suggest a variety of bladder control treatment options. Here is a brief list of some of the treatments available, both surgical and non-surgical.
The information provided on this website is not intended to be a substitute for a thorough discussion with Dr. Allen about which treatment option for female incontinence, should you need one, is best for you, including surgical treatment. There are risks associated with any surgical procedure and individual results may vary. Surgery may not be appropriate for every individual. If you believe you are in need of any advice or treatment for urinary incontinence, consult with a qualified physician, like Dr. Allen, about treatment options that may be appropriate for your medical condition.
Non-Surgical Bladder Control Treatments
1. Behavioral modifications
- Timed noiding- Making it a point to use the bathroom at regular timed intervals to gain control of the time between scheduled trips
- Decrease intake of diuretics like coffee, tea, and alcohol
- Pelvic muscle exercises
- Kegel exercises- strengthens muscles that help hold in urine
2. Protective undergarments
- Pads/adult incontinence products
- Your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency
- Anticholinergics- help relax bladder muscles and prevent bladder spasms
4. Vaginal/external devices
- Pessary- a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and nearby urethra. The pressure helps to reposition the urethra, leading to less stress leakage.
5. Bulking injections
- Collagen and carbon spheres are available for injection near the urinary sphincter. These bulking agents are injected into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence
- A catheter is a tube you can insert through the urethra into the bladder to drain urine. This is used with overflow incontinence because the bladder never empties completely because of poor muscle tone, past surgery, or spinal cord injury.
Surgical Bladder Control Treatments
- For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients.
- A stimulator device, InterStim, is surgically implanted.
2. Retropubic suspension
- Uses surgical threads to support the bladder neck by securing the threads to strong ligaments within the pelvis to support the urethral sphincter.
3. Sling procedure
- Uses a strip of our own tissue to cradle the bladder neck. Sling serves as support for the urethra during increased abdominal pressure.
4. Midurethral sling
- Uses synthetic mesh materials that a surgeon places midway along the urethra to provide the right amount of support for urethra.
For more resources on female incontinence, or to discuss the appropriate bladder control treatment for you, please contact Dr. Mark Allen, urology specialist serving the communities of Plano, Frisco and Dallas, Texas.