Diagnosis Of Urinary Incontinence In Women
Urinary incontinence in women can be diagnosed during a physical exam with your primary care doctor, gynecologist or female urologist. During the exam, your doctor will evaluate your symptoms to determine which type of urinary incontinence you are suffering from.
To do this, he or she will take a full medical history and may order tests such as:
A urinalysis is a diagnostic test that checks for signs of infection, blood or other abnormalities in your urine.
Bladder or urination diary
A bladder diary is a record of your urinary habits over the course of a few days. Your doctor will ask you to record:
- How much you drink
- Amount of urine you expel
- Number of sudden urges you have had to urinate
- How many accidents or incontinence episodes you have had
Post-void residual measurement
A post-void residual measurement is a diagnostic test that examines urine output and the amount of urine leftover in your bladder after you urinate. If you have leftover urine in the bladder after you urinate, you could have a urinary tract blockage or another functional issue.
Cystoscopy is a diagnostic test that allows your doctor to see inside the urethra and bladder to diagnose a urinary condition such as female incontinence. During the test, your doctor will insert a thin tube with a camera into the urethra.
Diagnosis Screening And Prevention
The presenting symptom of urinary incontinence is, by itself, not necessarily diagnostic of the subtype of urinary incontinence or its underlying cause. A comprehensive assessment is needed to determine the exacerbating factors, the effect on the womans quality of life and her desire for treatment55. The typical diagnostic work-up involves medical history, physical examination, urinalysis , assessment of post-void residual volume and exclusion of conditions that require specialist referral . After these assessments, a provisional diagnosis of stress, urgency or mixed urinary incontinence can be made in the majority of patients56. Most women present with a degree of mixed urinary incontinence, and establishing the predominant symptom can assist in directing the appropriate treatment. Depending on the severity of the individual components of their overall incontinence, patients often benefit from initial treatment that is focused on urgency urinary incontinence.
Diagnostic work-up of women with 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.
How Is The Cause Of Urinary Incontinence In Women Diagnosed
If incontinence makes you sad and affects your daily life, you should see your doctor. Your doctor will first ask questions about your symptoms and medical history. These questions will help your doctor find out what type of urinary incontinence you are suffering from and rule out any underlying causes. Your doctor may also ask about any medication you use.
Your doctor will then physically examine you. Your doctor may press on certain points on your abdomen or perform an internal examination. During the internal examination, he or she will ask you to tighten your pelvic floor muscles. So, your doctor can see how well your pelvic muscles are working.
Your doctor may ask you to keep a bladder diary for a while. For today, this means that when you go to the toilet, you write down how much urine you get and whether you have incontinence. To get a complete diagnosis, its best to fill out your diary on both work and non-workdays.
Depending on your symptoms, your doctor may test your urine to see if there is an infection. There may also be a need for more detailed types of examination, such as ultrasound.
Talking To Your Doctor About Stress Urinary Incontinence
You may feel hesitant to speak with your doctor about urinary incontinence, but you can rest assured that your doctor has likely treated many people with this condition youre not the first and you certainly wont be the last to ask about SUI. Talking about your condition is the first step toward treatment, and its an important one, so its good to be prepared. Here are some things you can do to help make your visit more productive:
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What Are Urge Incontinence Treatments
If pelvic floor exercises and other techniques dont help, your healthcare provider may recommend one of these treatments:
- Medications or bladder botulin toxin injections to relax your bladder muscle so it can hold more urine.
- Nerve stimulation using a device that sends electrical pulses to your nerves. These impulses act as a bladder pacemaker to relax and regulate overactive bladder squeezes. Your healthcare provider may recommend a surgical procedure to place a sacral nerve stimulation device. Or you may have an in-office procedure for percutaneous tibial nerve stimulation .
- to enlarge your bladder using tissue taken from your intestine.
- Urinary diversion surgery to redirect your ureters to a urine drainage bag outside of your body instead of into your bladder.
Symptoms Of Stress Urinary Incontinence
Women with stress urinary incontinence feel a sudden and intense need to urinate, often triggered by activities that place added pressure or stress on their bladder and pelvic floor muscles. Some of the more common activities that can lead to leakage include:
Getting in or out of a car
Leakage may include just a small drop or two of urine or even a whole stream. Any amount is unwanted, so dont dismiss your concerns simply because your leakage doesnt seem as bad as it might otherwise be. If you find yourself wet, you can find yourself a treatment option.
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What Causes Urge Incontinence
An overactive bladder causes your muscles in your bladder to squeeze more often than they should. This makes you feel like you have to pee before your bladder is actually full.
The squeezed bladder also causes your sphincter muscle inside your urethra to relax. When this muscle opens, it lets urine leak out.
Common Types Of Urinary Incontinence In Women
There are five main types of urinary incontinence that occur in both men and women: stress incontinence, urge incontinence, overflow incontinence, functional incontinence, or mixed incontinencea combination of multiple types of incontinence. Among these five, three types of urinary incontinence affect women more disproportionately than any others: stress incontinence, urge incontinence, or a combination/mixture of the two.
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Bladder Leakage 3 Things Women Should Know About Urinary Incontinence
To dispel misconceptions, a urogynecologist discusses the surprisingly common, lingering issue many women experience.
Bladder leakage. For some women, the condition runs their life from the inside, preventing them from playing outside with their kids, going to a workout class or staying the night with family or friends.
And theyre not alone. Living with some degree of urinary incontinence, defined as an uncontrolled leakage of urine, is actually common, according to Pamela Fairchild, M.D., a urogynecologist at Von Voigtlander Womans Hospital at Michigan Medicine.
She says that approximately half of all women over the age of 20 experience some degree of incontinence. This means urinary incontinence isnt just an issue that affects elderly or postpartum women, although aging and childbirth are risk factors.
But if so many women experience it, then why does the topic still seem embarrassing?
Women get the sense that this is inevitable, that its a natural part of aging and they have to live with it, says Fairchild. This false perception leaves women feeling powerless, even though there are ways to greatly improve their quality of life.
To help overcome the stigma, Fairchild shared three facts about urinary incontinence that all women should know.
What Causes Urge Urinary Incontinence
Urge urinary incontinence is the involuntary loss of urine associated with urgency , or being unable to delay passing urine until a convenient time.
The uncontrollable need to pass urine occurs due to overactivity of the muscle of the bladder wall. It is associated with increased urinary frequency, urgency and needing to wake up multiple times during the night in order to pass urine. Typically, the feeling of urgency can be associated with daily activities, such as when you put the key in the front door, or when water is running. This is also known as overactive bladder syndrome. Some people with overactive bladder syndrome can feel urgency, but not actually leak any urine.
Mixed urinary incontinence is the involuntary loss of urine associated with both urgency and any physical exertion, or when sneezing or coughing.
Stress Urinary Incontinence Treatment
There are three main treatments for stress urinary incontinence in women.
- Pelvic floor muscle training :Your pelvic floor muscles help control your bladder and bowel. Strengthening these muscles through exercise can sometimes help with stress incontinence. How to do these exercises will be explained to you by your doctor. But to see the benefits of exercise, you will need to stick to the plan given to you. You may need to do the exercises three times a day for three months.
- Medicines:There are some medications that can help treat female urinary incontinence. However, since these will usually cause side effects, they are not given to the patient in the first stage of treatment. If you do not want to have surgery, your doctor may suggest that you take a medication. Your doctor will prescribe the best medicine for your situation and will talk to you about the medicine after a certain period to see if the medicine is working.
- Surgical:There are several operations to treat stress urinary incontinence, depending on the cause. If youve tried nonsurgical treatments with your doctor and those methods havent helped, surgery may be done.
Other Approaches To Treating Stress Incontinence
Using stool bulking agents or softeners will help avoid constipation and having to strain when opening your bowels. When emptying the bowels and bladder, it may also help to use a low stool to elevate the knees slightly higher than hips, relaxing the pelvic floor and the abdomen. Additionally, avoiding heavy lifting can help avoid raised intra-abdominal pressure leading to SUI.
Another non-surgical option is duloxetine, an antidepressant medication known as a serotonin and noradrenaline reuptake inhibitor . It may help some women but its use is not approved for this purpose in Australia or New Zealand.
Your doctor may recommend surgery if other treatments have not helped. You may be referred to a specialist urogynaecologist to discuss the benefits and risks of surgery for SUI. The types of surgery available for SUI include urethral bulking agents, midurethral slings, colposuspension, or an autologous fascial sling.
None of the types of surgery currently available have a 100% cure rate, however for 80-90% of women, their surgery will provide significant improvement at 12 months post-surgery.
For incontinence caused by neurological disorders, such as multiple sclerosis or spinal cord injury, management should be tailored to the individual woman’s needs.
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What Are The Symptoms
The main symptom is the accidental release of urine.
- If you have stress incontinence, you may leak a small to medium amount of urine when you cough, sneeze, laugh, exercise, or do similar things.
- If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. With this type of bladder control problem, you may leak a larger amount of urine that can soak your clothes or run down your legs.
- If you have mixed incontinence, you may have symptoms of both problems.
Types Of Urinary Incontinence
There are different types of incontinence:
- Stress incontinence occurs when urine leaks as pressure is put on the bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy objects. Its the most common type of bladder control problem in younger and middle-aged women. It also may begin later, around the time of menopause.
- Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimers disease, Parkinsons disease, multiple sclerosis, or stroke.
- Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
- Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.
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Our Approach To Urge Incontinence In Women
Incontinence is not an inevitable part of growing older, and there are a variety of treatments available. A leader in this field, UCSF offers innovative, compassionate care to women with urge incontinence. Our team includes gynecologists, urologists, colorectal surgeons and physical therapists who specialize in pelvic floor rehabilitation. Treatment options include bladder training, medications and Botox injections, as well as targeted exercises, biofeedback and electrical stimulation to strengthen the pelvic floor muscles. For problems with the nerves regulating the bladder, we also offer several types of nerve stimulation therapy.
We believe that empowering women with knowledge is an important part of the healing process, and encourage each patient to participate in choosing the best treatment option for her.
Causes Of Urinary Incontinence
Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.
Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder.
Overflow incontinence is often caused by an obstruction or blockage in your bladder, which prevents it from emptying fully.
Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a small, tunnel like hole that can form between the bladder and a nearby area .
Certain things can increase the chances of urinary incontinence, including:
- pregnancy and vaginal birth
Find out more about the causes of urinary incontinence.
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What Are The Risk Factors For Urge Incontinence
Women are twice as likely as men to develop urinary incontinence. Although the problem becomes more common with age, healthcare providers dont consider incontinence a normal part of aging. That means you may be able to find ways to treat it.
Risk factors for urge incontinence include:
What Is Considered Normal Bladder Function
- Passing urine 4-6 times per day
- Passing urine no more than once per night
- Passing 1-2 cups of urine each time
- Passing urine in a steady stream until the bladder is empty
- Being able to delay passing urine until convenient, and
- Having no leakage of urine between visits to the toilet
In a woman with normal bladder function, the muscles of the pelvic floor contract when she is doing any physical activities. These activities may include sneezing, coughing, sports or any other physical effort which can cause the pressure in the abdomen to rise.
When the pressure in the abdomen rises, the muscles of the pelvic floor contract, compressing the urethra and triggering contraction of the sphincter . This prevents any leakage of urine.
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How Is Incontinence Treated
There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.
Medications to treat incontinence
There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.
In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.
Common medications that can be used to treat incontinence include:
Lifestyle changes to manage 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
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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