Female Incontinence

Factors that contribute to an increased risk of developing urinary incontinence include:

• Advanced age
• Obesity
• Cigarette smoking
• Kidney disease
• Diabetes

Incontinence can be caused by multiple factors including lifestyle habits, physical problems and medical conditions. Causes of temporary and persistent urinary incontinence include:

• Bladder irritation caused by infection, dietary irritants or kidney stones
• Urinary tract or vaginal infections
• Medications
• Diseases and disorders of the nervous system
• Pelvic surgery
• Diabetes
• Delirium
• Pregnancy and childbirth
• Menopause
• Overactive bladder
• Weakness of certain muscles in the pelvis
• Weakness of the tissues holding the bladder in place
• Weakness of the sphincter muscles surrounding the urethra
• Birth defects
• Spinal cord injuries

Symptoms associated with incontinence in women include:

• Pain related to urination without a proven bladder infection
• Increased rate of urination without a proven bladder infection
• Frequent bladder infections
• Progressive weakness of the urinary stream
• Needing to rush to the restroom and/or losing urine
• Abnormal urination or changes in urination related to a nervous system problem
• Leakage of urine that prevents activities
• Leakage of urine that began or continued after surgery
• Leakage of urine that causes embarrassment

Some women with urinary incontinence experience minor leaks of urine while others frequently wet their clothes. The following are types of incontinence:

• Stress incontinence is leakage that occurs with activities that increase abdominal pressure such as coughing, sneezing, laughing, lifting and running.
• Urgency incontinence or overactive bladder is a sudden, strong urge to urinate that you cannot control. Some women leak urine with no warning.
• Mixed incontinence is a combination of urge and stress incontinence.
• Overflow incontinence happens when the bladder does not empty and the urine amount exceeds the bladder’s capacity. Frequent urination and leaking results.

Tests and procedures to determine incontinence in women include:

• Medical history
• Physical exam
• Urinalysis
• Cough stress test
• Cystoscopy enables an urologist to view the inside of the bladder and urethra via a thin tube.
• Urodynamics tests help your doctor or nurse see how well your bladder and sphincter muscles work.
• Voiding diary

Your urologist may recommend the following treatments for stress incontinence:

• Non-Surgical
  • Behavioral modification
  • Weight loss
  • Quitting smoking
  • Pelvic floor rehabilitation
  • Biofeedback/electrical stimulation
  • Medications
• Surgical
  • Urethral injection, a minimally invasive procedure done under local anesthesia that uses a cystoscope and small needle to close the urethral mucosa.
  • Sub-urethral or TVT (tension-free vaginal tape) sling, a minimally invasive surgical procedure that applies a narrow strip of material under the urethra to provide support.
  • Other procedures to improve urethral support

Less common procedures:

• Retropubic urethropexy (Burch)
• Pubovaginal slings
• Artificial urethral slings

Treatment for urgency incontinence may involve:

• Botox injection
• Behavior modification
• Pelvic floor rehabilitation
• Fluid intake management
• Medications
• Neuromodulation