Urinary Incontinence

Urinary incontinence (involuntary loss of urine) affects a large and uncertain percentage of the female population. The percent is difficult to quantify since most women with incontinence do not seek medical help. This is unfortunate, since many women with urinary incontinence can be helped.

Types of Urinary Incontinence

Most urinary incontinence can fall along a spectrum from stress incontinence to spasm (urge) incontinence.

Stress incontinence - Incontinence which occurs after a mechanical stress such as coughing, sneezing or jumping. This is the most common form of incontinence.

Spasm incontinence, a.k.a. "overactive bladder", urge incontinence or detrusor instability The detrusor muscle is the muscle of the bladder wall.) - This is incontinence which occurs out of the blue, or with anxiety about voiding, or from other events like hearing running water. This type of incontinence becomes more prevalent as women age.

Mixed incontinence - This is a combination of both stress and spasm type incontinence.

Causes of urinary incontinence

1. Infection - Infection can cause incontinence to begin, and even after the infection is treated, the incontinence may take a while to go away. Any type of incontinence can be worsened by the presence of a urinary tract infection.

2. Pelvic relaxation - This is a situation wherein the muscles of the pelvis are weakened by age, deliveries, or chronic cough such as from smoking, or even constipation and obesity. See our page on Pelvic Relaxation and Prolapse.

3. Various neurologic conditions - The bladder muscles maintain their tone through the nerves which innervate them. If there is neurologic disease in this region of the body, this can interfere with continence.

Evaluation of urinary incontinence

History - Ideally including at least a 3 day voiding diary to identify the frequency, amount and circumstances of urine lost. A full medical, surgical, medication, obstetric and gynecologic history is taken, since all of this can play into the incontinence situation.

Physica l- Including a full pelvic exam with attention to the degree of pelvic muscle relaxation. Sometimes it is useful to perform the exam standing or while bearing down or coughing. Sometimes a Q tip can be placed in the urethra to determine the angle of the neck of the bladder, to see if it is overly lax (The Q-tip test).

Lab studies - Urinalysis, either by clean catch, or ideally by sterile catheter, is essential. This is used to rule out infection and look for other findings such as blood.

Urodynamic studies - These are often done in the offices of a Urologist, and involve instruments to measure the volumes, pressures, and behavior of the bladder. This can be useful to sort out the type of incontinence that is present.

Treatments of Urinary Incontinence

Treatments of incontinence depend on the causes. Here is a list of methods which have proven effective if used appropriately.

Behavioral methods

Scheduled or prompted voiding, bladder training (for those with urge and mixed incontinence)
Pelvic muscle rehabilitation (for those with stress and mixed incontinence)
Weight loss
Caffeine reduction and fluid management
Smoking cessation
Correction of constipation

Medical

Antibiotics for urinary tract infection
Anti-spasm medications ( anticholinergics ) for bladder spasm

Surgical

Procedures to restore normal anatomy and support of the bladder and bladder neck:

Burch retropubic urethropexy, either open or laparoscopic
Sling procedures such as Monarc suburethral sling
Tension free vaginal tape (TVT)
Bulking agents for those who cannot have surgery

For more general information on surgery, see our Surgery FAQ section.