Urinary Incontinence In Women: Causes And Treatment
Urinary incontinence is twice as common in women than in men, and it’s especially common in older women. Among women ages 65 and older, 4 in 10 experience some loss of bladder control.The three main types of urinary incontinence are:
- Stress urinary incontinence, when you experience leakage or loss of urine when you laugh, sneeze, run or make some other sudden movement
- Urge incontinence, when you have a frequent or sudden urge to urinate
- Mixed, in which women experience symptoms of both types
When either form of urinary incontinence affects your quality of life, seek a medical professional’s help. Beaufort Memorial has a team of women’s health specialists trained in the latest treatments for this medical condition.
Request an appointment with an OB-GYN or gynecologist.
Symptoms Of Urge Incontinence
Urge incontinence occurs due to overactivity of the detrusor muscle. The hallmark symptom of this kind of urinary incontinence is a sudden, overwhelming urge to void, accompanied by loss of urine. Frequent urination and nighttime urination often occur with this type of urinary incontinence. The amount lost is variable. Hearing running water or changing position may trigger bladder contractions and lead to urine loss. This type of incontinence can occur in anyone of any age, but it is more typical with advancing age. Just 9% of women between the ages of 40 and 44 suffer from urge incontinence while 31% of women over the age of 75 suffer from the condition.
Sometimes stress incontinence and urge incontinence occur at the same time. This is called mixed incontinence. People who suffer from urge incontinence lose greater amounts of urine than those who suffer from stress incontinence. Those who suffer from stress incontinence notice leaks with activities that increase abdominal pressure. Keeping a voiding diary, noting the time, place, and activities associated with symptoms of urine loss can help the physician determine whether you suffer from stress incontinence, urge incontinence, mixed incontinence, or another issue.
Control Your Urge To Urinate
You may be able to control, or suppress, the strong urge to urinate, which is called urge or urgency suppression. With this type of bladder training, you can worry less about finding a bathroom in a hurry. Some people distract themselves to take their minds off needing to urinate. Other people find that long, relaxing breaths or holding still can help. Doing pelvic floor exercises to strengthen your pelvic floor also can help control the urge to urinate. Quick, strong squeezes of the pelvic floor muscles can help suppress urgency when it occurs, which may help you get to the toilet before you leak.
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Symptoms Of Stress Incontinence
Common in Women
Stress incontinence occurs when pelvic floor muscles weaken. The condition is the most common type of urinary incontinence in young women. Stress incontinence is the second most common type in older women. Activities like exercise, walking, stretching, bending, laughing, coughing, sneezing, or lifting place strain on weakened pelvic floor muscles, and that leads to leaks. Any activity that increases physical strain on pelvic floor muscles may lead to stress incontinence–even sex. The amount that leaks varies. It may be a few drops or up to a tablespoon or more, depending on severity.
Some studies suggest 24% to 45% of women over the age of 30 suffer from stress incontinence. If you suffer from urinary incontinence, you are definitely not alone. Weakness in not just the pelvic floor muscles, but also in the urethral sphincter often plays a role in this type of urinary incontinence.
What Is Urinary Incontinence
Urinary incontinence is the accidental loss of urine. According to the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. UI can occur at any age, but it is more common among women over 50. Urinary incontinence may be a temporary condition that results from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
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Specialized Tests To Diagnose Incontinence
Sometimes routine testing does not reveal the underlying cause, and further evaluation is required. You may be referred to a urologist or a urogynecologist for more specialized testing if your health concern is accompanied by pain, recurrent UTIs, blood or protein in the urine, neurological symptoms or muscle weakness, or pelvic organ prolapse. Women with this issue who have a history of radiation or surgery to the pelvic region may also be referred to a urologist.
Specialized testing can assess how well the bladder, urethra, and sphincters store and dispose of urine. There are many different types of instruments that can be used for urodynamic testing. Cystometry is a test that is used to help diagnose urge incontinence. It measures bladder pressure. The structures in the pelvis can be visualized with ultrasound. Uroflowometry can measure the volume of urine and flow rate. This test is used to determine the strength of related muscles and helps assess whether urine flow is blocked. There are other tests a urologist may perform depending on your symptoms.
How Is Urinary Incontinence Treated
You and your doctor or nurse will work together to create a treatment plan. You may start with steps you can take at home. If these steps do not improve your symptoms, your doctor or nurse may recommend other treatments depending on whether you have stress incontinence or urge incontinence or both.
Be patient as you work with your doctor or nurse on a treatment plan. It may take a month or longer for different treatments to begin working.
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Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
Stress Urinary Incontinence And Kegel Muscles
BF is mainly used in SUI, because this method increases the muscle strength of pelvic floor muscles, which in this type of incontinence are weakened. The pelvic floor muscles are a specific basket supporting the internal organs within abdominal cavity. They are supported in this task by the fascia within pelvis. The following muscles play an essential role in maintaining urine and feces: levator ani, muscles of this group , as well as urethral sphincters and transverse perineal muscles.6,48 Weakening of the previously mentioned muscles is a result of degradation of collagen structures in the tissue, and injuries during childbirth. During pregnancy, as well as after delivery, an increased synthesis of estrogen, a hormone that weakens collagen in pelvic floor muscle tissues, is observed in a woman. This results in tissue limpness and weakness of their contractility. This causes problems with maintaining urine and often even feces. Collagen damage in tissues is also observed very intensively during and after menopause.4,49,50
Pelvic floor muscle training has a significant influence on UI prevention in women. Unfortunately, the knowledge on appropriate contraction and training of these muscles is limited, as shown by research conducted by Piernicka et al.51 on 98 students, where about 20% of them were unable to perform adequate Kegel muscle contraction, and most of them pointed to the need to improve access to knowledge about both the muscles and their training methods.
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How Do I Do Kegel Exercises
Kegel exercises are a simple way to build strength in your pelvic floor muscles. These exercises are done by lifting, holding and then relaxing your pelvic floor muscles. You can find these muscles by stopping the flow of urine mid-stream while youre urinating. Only do this until you learn how to find the muscles stopping the flow of urine mid-stream isnt healthy over a long period of time.
When youre doing Kegel exercises, start small. Only hold it for a few second. Over time you can slowly work your way up to longer and longer stretches of holding the muscles tight.
Unlike other types of workouts, no one can tell when youre doing Kegel exercises. Aim to do several sets of Kegel exercises twice a day.
What Causes Urinary Incontinence
Urinary incontinence is not an inevitable result of aging, but it is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after the hormonal changes of menopause.
What Steps Can I Take At Home To Treat Urinary Incontinence
Your doctor or nurse may suggest some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:
You can also buy pads or protective underwear while you take other steps to treat urinary incontinence. These are sold in many stores that also sell feminine hygiene products like tampons and pads.
Why Does Pregnancy Cause Incontinence
During pregnancy, your body goes through a lot of physical changes. As your uterus stretches to hold the growing baby, a few things happen. Your bladder can be squished by the expanding baby, making your bladder hold less than before. You might experience an increased urgency to pee during pregnancy because your bladder cannot hold as much as before. This might become even more challenging towards the end of pregnancy when the baby is at its largest.
Another reason for incontinence during pregnancy is the weakening of your pelvic floor muscles. These muscles are the support structures for all of the organs in your pelvis. During pregnancy, they can be stretched and weakened as your uterus expands.
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Clinical Studies On Urinary Incontinence And Biofeedback Therapy
The knowledge on the use of BF in UI treatment is still relatively low. Koziol et al.11 conducted research on 40 women aged 20 to over 50years, including women without symptoms and those with UI symptoms. Women completed detailed questionnaires, which provided important information related to disease. It turned out that only five women had heard of BF, while four of them used this method. All women treated with BF saw improvement and were satisfied with the course of treatment.
BF also supports other physiotherapeutic methods to treat UI. Terlikowski et al.53 in a study of 102 women divided them into two groups: 68 women were treated and 34 belonged to the placebo group. The complete treatment process lasted 2weeks and women were electro-stimulated with superficial EMG BF. Subsequently, differences between the two groups were observed by means of a lapse test, supplementation of the quality of life questionnaire, muscle strength and a diary of urination. Significant improvement and decrease in the frequency of uncontrolled urinary leaks in the group treated by electrostimulation combined with EMG BF compared with the placebo group was observed. The authors concluded that feedback significantly influences the treatment process, and the use of this method with ES increases its effect.53,54
What Are Kegel Exercises
Kegel exercises, also called Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles to help prevent or reduce stress urinary incontinence. Your pelvic floor muscles support your uterus, bladder, small intestine, and rectum.
Four in 10 women improved their symptoms after trying Kegels.9 Kegels can be done daily and may be especially helpful during pregnancy. They can help prevent the weakening of pelvic floor muscles, which often happens during pregnancy and childbirth. Your pelvic floor muscles may also weaken with age and less physical activity.
Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
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Lack Of Continuity Or Deformity
The most common cause of incontinence in this category is a fistula. In developed countries, vesicovaginal or ureterovaginal fistulas typically arise as complications of hysterectomy or other pelvic surgery.6 Patients with other abnormalities such as ectopic ureters and diverticulae can also present with incontinence.
What Are The Treatments For Urinary Incontinence
Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:
- Lifestyle changes to reduce leaks:
- Drinking the right amount of liquid at the right time
- Being physically active
- Staying at a healthy weigh
- Avoiding constipation
- Not smoking
If these treatments do not work, your provider may suggest other options such as:
- Medicines, which can be used to
- Relax the bladder muscles, to help prevent bladder spasms
- Block nerve signals that cause urinary frequency and urgency
- In men, shrink the prostate and improve urine flow
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What Is Female Incontinence
Female incontinence is the loss of bladder control in women. It is not uncommon to lose urine during pregnancy or with urinary tract infections temporarily. There are many reasons you might develop urinary incontinence as a chronic problem. The most common causes are pelvic floor trauma with childbirth, menopause, hysterectomy, obesity, cognitive impairment, chronic cough and constipation.
There are three types of female incontinence:
- Urge incontinence: Women with urge incontinence feel the need to urinate frequently. They experience leakage of urine during times associated with this urge.
- Stress incontinence: Women with stress incontinence, also known as physical or exertion incontinence, may experience urine leakage, especially when coughing, laughing, exercising or sneezing.
- Mixed incontinence: Many women experience a combination of stress incontinence and urge incontinence.
Types Of Urinary Incontinence
There are two main types of urinary incontinence in women.
- Urge incontinence. This is when you feel a sudden need to pee without warning which is difficult to put off. You have to go to the toilet then and there.
- Stress incontinence. This is when urine leaks when you sneeze, cough or exert yourself.
You can also have mixed incontinence. This means you have both stress incontinence and urge incontinence.
An overactive bladder is when you get a strong urge to pee often, including at night. It sometimes, but not always, leads to urge incontinence.
Symptoms Of Urinary Incontinence
The main symptom of urinary incontinence is leaking urine. But this can vary quite a bit, from leaking a few drops to partly or totally emptying your bladder.
If you have urge incontinence, youll feel a sudden urge to pee which you cant put off. You may not be able to make it to the toilet in time. You may also need to go to the toilet at night and sometimes leak at night too.
If you have stress incontinence the main symptom is leaking urine when you do things like cough, sneeze, lift something heavy or exercise.
If you have mixed incontinence, you may have all of these symptoms.
You may have other symptoms such as:
- needing to pee often
- dribbling urine after youve been to the toilet
- it hurts or stings when you pee
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Pelvic Floor Muscle Training
Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
A GP may refer you to a specialist to start a programme of pelvic floor muscle training.
The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.
If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.
Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.
Find out more about pelvic floor exercises.