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Urinary Incontinence—Female

Urinary Incontinence—Female

(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)

by Julie Riley, MS, RD

En Español (Spanish Version)  More InDepth Information on This Condition 
Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or chronic (lasting for a long time). Incontinence is a symptom not a condition.

Causes

Temporary incontinence can be caused by:

More permanent urinary incontinence may be one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. The cause may also be unclear.

Stress Incontinence

This results when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise. This is the most common type of incontinence. It may be caused by:

  • Weakening of the muscles that suspend the bladder
  • Weakening of muscles that control urine flow
  • Obesity

Muscles Involved in Incontinence in Women

Nucleus factsheet image
© 2011 Nucleus Medical Media, Inc.

Urge Incontinence

Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is not able to hold urine long enough to make it to a restroom. This is also known as overactive bladder. It may be caused or worsened by:

Overflow Incontinence

This occurs when the bladder will not empty. Urine builds up, and this causes an overflow and leaking of urine. It may be caused by:

  • A bladder that is blocked, such as by a scar in the urethra (stricture)
  • Fecal impaction
  • Drugs (eg, antidepressants, hypnotics, antipsychotics, antihistamines, calcium channel blockers)
  • Vitamin B12 deficiency 
  • Weak bladder muscles
  • Nerve damage due to:
    • Surgery
    • Diabetes
    • Spinal cord injuries
    • Other factors

Functional Incontinence

This occurs when there is normal bladder control, but an inability to reach the toilet in time. An example would be severe arthritis  . Drugs that cause confusion or sedation can also cause functional incontinence.

Risk Factors

Risk factors include:

Symptoms

Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

When Should I Call My Doctor?

Call your doctor if you experience a loss of urine control. Your doctor can help you determine the underlying cause.

Diagnosis

The doctor will ask about your symptoms and medical history. You will be asked how often you empty your bladder and patterns of urine leakage. Your doctor will perform a physical exam to look for any physical causes, such as blockages or nerve problems. You will keep a diary of your bladder habits. You may be referred to an urologist or an urogynecologist.

Tests may include:

  • Stress test—you relax then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.
  • Urine tests
  • Blood tests to detect diabetes
  • Ultrasound  —a test that uses sound waves to examine structures inside the body to determine the residual urine volume after voiding
  • Cystoscopy  —a thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder
  • Urodynamic tests—tests used to measure the flow of urine and pressure in the bladder

Treatment

Treatments may include:

Behavioral Therapy

Behavioral therapy includes:

  • Making muscles stronger by doing Kegel exercises  —This strengthens the muscles that hold the bladder in place and those that control urine flow.
  • Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence.
  • Pelvic floor exercises may also be done using cone-shaped weights that are placed in the vagina.
  • Bladder training—This can be done by setting a regular, timed schedule for emptying your bladder and by drinking fewer liquids.
  • Biofeedback—This involves being attached to a device with sensors. When doing pelvic floor muscle exercises, the device shows a signal on the screen, indicating how strong you are contracting your muscles.

Weight Loss

If you are a woman who is overweight or obese, losing weight may help to reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program  that is right for you.

Medication

Medicines may be prescribed to relax the bladder muscles. These types of medicines, called anticholinergics, are often used in treating urge incontinence. Examples include:

Nerve Stimulation

Nerve stimulation is effective for urge urinary incontinence. It can be done by stimulating a nerve in your ankle. Or, it can be done by implanting a device that stimulates the bladder nerves.

Surgery

In women, surgery can support weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra.

Devices

Absorbent diapers are often used with incontinence.

Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases. Alternatively, pessaries may be used in women. Pessaries are devices that raise the uterus or the prolapsed bladder. This decreases pressure on the bladder.

Home Care

  • Take care of your skin by gently cleaning yourself after an episode of incontinence. Let the skin air dry.
  • Make it easier for you to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night lights in the hallway and in the bathroom.
  • If needed, keep a bedpan handy in your bedroom.

Prevention

Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:

  • If advised by your doctor, do Kegel exercises.
  • Reduce your intake of substances that lead to incontinence (eg, caffeine, alcohol, and certain drugs).
  • Lose weight.
  • Eat a healthy diet to avoid constipation.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases

http://www.niddk.nih.gov/

Urology Health

http://www.urologyhealth.org/

CANADIAN RESOURCES:

Health Canada

http://www.hc-sc.gc.ca/

Women's Health Matters

http://www.womenshealthmatters.ca/

References:

American Foundation for Urologic Disease. Causes and natural history of incontinence. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=06topic=172. Accessed August 7, 2010.

American Foundation for Urologic Disease. Minimally invasive management of urinary incontinence. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=06topic=106. Accessed August 7, 2010.

American Foundation for Urologic Disease. Surgical management of urinary incontinence. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/adult/index.cfm?;cat=06&topic=133. Accessed August 7, 2010.

American Urological Association Foundation. Overactive bladder. American Urological Association Foundation website. Available at: http://www.urologyhealth.org. Updated July 2009. Accessed August 7, 2010.

Controlling urinary incontinence. FDA Consumer Magazine, United States Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/505_incontinence.html. Published September-October 2005. Accessed July 19, 2008.

Corcos J, Gajewski J, Heritz D, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol. 2006;13:3127-3138.

National Association for Continence. Overactive bladder treatment. National Association for Continence website. Available at: http://www.nafc.org. Updated July 2009. Accessed November 2, 2009.

Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57-67.

Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence, and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dys Function. 2008;19(3):367-373.

Urinary incontinence: lifestyle and home remedies. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/urinary-incontinence/DS00404/DSECTION=lifestyle-and-home-remedies. Updated June 25, 2011. Accessed January 10, 2012.

Urinary incontinence in women. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/. Published October 2007. Accessed August 7, 2010.

Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175:S5-10.

2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.

1/11/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: AHRQ evidence report on treatment for overactive bladder in women 2009. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/clinic/tp/bladdertp.htm. Published August 2009. Accessed January 11, 2010.

3/5/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Vardy MD, Mitcheson HD, Samuels TA, et al. Effects of solifenacin on overactive bladder symptoms, symptom bother and other patient-reported outcomes: results from VIBRANT—a double-blind, placebo-controlled trial. Int J Clin Pract. 2009;63(12):1702-1714.

12/3/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK. Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.

12/13/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. Recommendations for the management of urge urinary incontinence in women. Agency for Healthcare Research and Quality website. Available at: http://www.guideline.gov/content.aspx?id=16322. Published May 2010. Accessed December 13, 2010.

Last reviewed September 2011 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © EBSCO Publishing. All rights reserved.

 
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