Urinary incontinence is the loss of bladder control, causing the leakage of urine. There are two main types of urinary incontinence that affect women:
- Stress incontinence (SI) occurs when an activity such as coughing, sneezing, laughing or exercising causes a small amount of urine to leak from the urethra (the tube that carries urine from the bladder to outside the body). SI is the most common type of incontinence women experience.
- Urge incontinence, also called overactive bladder (OA), is when the urge to urinate comes on quickly and you’re unable to get to the toilet in time
Some women can have a combination of both types of urinary incontinence.
Incontinence affects twice as many women as men. This is likely because pregnancy, childbirth, and menopause are all risk factors for developing urinary incontinence.
While the chances of having UI increase as you age, this condition should not be accepted as normal part of aging – and it can be treated. In fact, there are many treatment options available which can be tailored to your unique situation. These include simple lifestyle changes, special exercises to strengthen the pelvic muscles, medications to control OA, and surgery.
The symptoms of UI may mimic other health conditions, so it’s important to see a doctor for an accurate diagnosis.
One of the biggest barriers to women seeking treatment for UI is their embarrassment about having this condition. Unfortunately, some women will isolate themselves because fear of wetting themselves keeps them from taking part in activities with family and friends, including intimacy with their partner.
A medical and surgical subspecialty called urogynecology—also referred to as pelvic reconstructive surgery—was established in the 1990s to address conditions like UI in women. These highly trained doctors are skilled and compassionate in talking to women about these types of problems, and they offer an array of effective treatment options tailored to a woman’s individual situation.
Why Choose Cooper to Diagnose and Treat Urinary Incontinence
Cooper University Health Care has a comprehensive urogynecology program that is on the forefront of care for urinary incontinence in women. Our team of fellowship-trained urogynecologists offers a full range of today’s most advanced diagnostic and treatment services, delivered in a caring, sensitive manner:
- We have the region’s only pelvic floor physical therapy (PT) program, a specialized form of rehabilitation that focuses on strengthening the pelvic floor, which helps control UI
- If surgery is necessary, we have the region’s only robotic surgery program for treating pelvic floor disorders and urinary incontinence—a minimally invasive approach that results in faster recovery, reduced pain and minimal scarring
- We teach the next generation of urogynecologists through a respected fellowship program—testament to the high level of clinical expertise available here
- Our urogynecologists are involved in leading-edge research, giving you access to the latest knowledge and advances in treating urinary incontinence in women
Causes and Risk Factors for Urinary Incontinence in Women
Urinary incontinence is most frequently caused by problems with the muscles and nerves that help the bladder hold or pass urine. Certain situations unique to women, such as pregnancy, childbirth and menopause, can affect these muscles and nerves.
Other causes of or risk factors for urinary incontinence include:
- Being overweight: Excess weight puts pressure on the bladder; this can weaken the supporting muscles over time
- Constipation: Chronic (long-term) constipation can put stress or pressure on the bladder and pelvic floor muscles, weakening them over time and causing problems with bladder control
- Nerve damage: Childbirth, spinal cord injury, and conditions such as diabetes, multiple sclerosis or Parkinson’s disease can damage nerves in the bladder, urethra or pelvic floor muscles. These damaged nerves may send signals to the bladder at the wrong time or not at all.
- Surgery: Any surgery involving a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed. As a result, a woman’s bladder muscles may not work like they should, causing urinary incontinence.
- Heavy lifting: A job, hobby or lifestyle that involves repeated heavy lifting can put strain on the pelvic floor muscles, weakening them over time and contributing to UI
Sometimes urinary incontinence is temporary, occurring for other reasons, including:
- Medication: Urinary incontinence may be a side effect of medicines such as diuretics (“water pills”) used to treat heart failure, liver cirrhosis, high blood pressure, and certain kidney diseases. The incontinence often stops when you stop taking the medicine.
- Caffeine: Caffeinated drinks can cause the bladder to fill quickly, which can cause urine leakage
- Infection: Urinary tract infections may cause incontinence for a short time; bladder control often returns when the infection goes away
Symptoms of Urinary Incontinence in Women
Urinary incontinence—the leakage of urine—is not a disease on its own. It is a symptom of another health problem, usually weak pelvic floor muscles. In addition to urinary incontinence, some women have other urinary symptoms:
- Pressure or spasms in the pelvic area that causes a strong urge to urinate
- Going to the bathroom more than usual (more than 8 times a day or more than twice at night)
- Urinating while sleeping (bedwetting)
- Needing to rush to the bathroom because of an overwhelming, sudden urge to urinate
- Pain related to filling the bladder or urinating
- Frequent bladder infections
- Feeling as if you haven’t completely emptied your bladder after urinating
Treating Urinary Incontinence in Women
Treatment for UI depends on what’s causing it and how severe the condition is. Fortunately, today there are many treatment options, including:
- Behavioral therapies that help you regain bladder control, including:
- Bladder training that teaches you to resist the urge to urinate and expand the time between “going”
- Scheduled toileting so you go to the bathroom at set times to prevent leaking
- Pelvic muscle rehabilitation to strengthen and control pelvic muscles and prevent leakage; this can include:
- Kegel exercises that involve relaxing and clenching targeted pelvic muscles
- Biofeedback, used together with Kegel exercises, helps you identify the specific muscles to exercise
- Vaginal weight training in which small weights are held within the vagina by clenching the vaginal muscles
- Electrical stimulation of pelvic floor muscles to strengthen them by simulating muscle contractions
- Lifestyle changes including losing weight to alleviate pressure on the bladder and nearby muscles, avoiding caffeinated drinks or alcohol, and quitting smoking
- Treating constipation, as it can worsen UI; this may involve dietary changes including eating more fiber
- Medications, which may include:
- Medications specifically for overactive bladder that have recently become available
- Topical estrogen therapy for women after menopause; vaginal creams, rings or patches can help strengthen the muscles and tissues in the urethra and vaginal area, helping with bladder control
- Vaginal pessary, a small plastic or silicone ring-shaped device that you insert into the vagina; it supports the pelvic floor muscles and helps reduce stress UI
- Bulking agents, such as collagen, may be injected into the tissues around the bladder and urethra, causing them to thicken, and reducing the amount of urine leakage
- Surgery may be an option if incontinence is due to structural problems such as an abnormally positioned bladder or a blockage. Surgery also may be considered if other treatments don’t work, or if the incontinence is severe. The two most common types of surgery for UI are:
- Sling procedures in which synthetic mesh or tissue from your own body is placed under your urethra; it acts like a hammock to support the urethra and hold the bladder in place
- Colposuspension, a procedure that also helps hold the bladder in place with stitches on either side of the urethra
Surgery for urinary incontinence is not recommended if you plan to get pregnant in the future, as pregnancy and childbirth can cause leakage to occur again.