Female Urinary Incontinence

Urinary incontinence, the involuntary loss of urine, is more common in women, especially during and after pregnancy, although it can affect people of all ages. While not usually a serious medical condition, incontinence can be embarrassing and can adversely affect quality of life. A symptom, rather than a condition, female urinary incontinence can range from mild stress incontinence to complete loss of bladder control.

Types of Urinary Incontinence

There are three main types of urinary incontinence: urge, stress and overflow. Urge incontinence is most common and involves urine leakage that occurs after a sudden urge to urinate because the muscle wall of the bladder is overactive. Stress incontinence is urine leakage that occurs after an activity that puts pressure on the bladder, such as coughing, laughing or sneezing. Overflow incontinence, the least common type, occurs as the result of an inactive bladder muscle that does not completely empty the bladder during urination.

Causes of Female Urinary Incontinence

There are a great many causes of urinary incontinence. Weak muscles in the urinary tract, resulting from childbirth or aging, may cause the problem. Certain medications may weaken the bladder muscles. In some cases, weak muscles surrounding the urethra may cause urine to leak.

Gynecological and Obstetrical Causes

Women are particularly susceptible to urinary incontinence due to:

  • Hormonal changes during menstruation, pregnancy, and menopause
  • Stress of extra weight during pregnancy
  • Weakening of supportive tissues during childbirth
  • Hysterectomy, which may damage supporting pelvic floor muscles

When supportive tissues weaken during childbirth, pelvic organ prolapse, a condition in which the uterus, rectum, or colon sag or fall, creating pressure against the bladder, may result.

Other Causes

There are a number of other causes of female urinary incontinence. The condition may result from illness or from anatomical obstruction of the urinary tract. Possible causes include:

  • Urinary tract infection (UTI)
  • Interstitial cystitis, an inflammation of the bladder
  • Malignant or benign tumor in the urinary tract
  • Stones in the kidney, bladder or ureter

Certain neurological disorders, such as Parkinson's disease of multiple sclerosis, may also result in urinary incontinence.

Symptoms of Urinary Incontinence

In addition to leaking urine, people with urinary incontinence may also experience the following symptoms:

  • Strong urge to urinate
  • Pelvic pressure
  • Frequent urination
  • Painful urination

Nocturia (excessive urination at night) or bedwetting may also be symptoms of urinary incontinence.

Diagnosis of Urinary Incontinence

Urinary incontinence is diagnosed through a physical examination, an evaluation of the patient's medical history, and several diagnostic tests. Patients may also be asked to keep a urination diary to record frequency and circumstances of their urination. Testing begins with a pelvic examination to detect any physical abnormalities, and usually includes blood tests, urinalysis, and a cystogram. A pad or dye test, which helps to determine urine leakage during stressful situations, may also be administered.

Treatment of Urinary Incontinence

There are many different treatment options available for patients with urinary incontinence, depending on the severity of the condition. Conservative treatments are often effective, and may include the following:

  • Bladder training
  • Avoidance of alcohol and caffeine
  • Medication to control pelvic muscle spasms
  • Electrical stimulation
  • Botox injections
  • Nerve stimulation implant
  • Kegel exercises to strengthen the pelvic floor muscles and prevent urine leakage
  • Limitation of fluid intake, especially before sleep

For more severe cases of incontinence, a medical device may be used to relieve symptoms, or surgery may be necessary. The insertion of a device known as a pessary or urethral insert is designed to prevent urine leakage by providing organ support of the pelvic region. A pessary is inserted through the vagina. When surgery is necessary, it is performed to provide support to the bladder neck and relieve pelvic prolapse.

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