• Urinary Incontinence—Female

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

    Definition

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

    Causes

    Temporary incontinence can be caused by:
    Permanent urinary incontinence may be one of four types. Some people have a mixture of these types.

    Stress Incontinence

    This is the most common type of incontinence. It may be caused by:
    • Weakening of muscles that suspend the bladder
    • Weakening of muscles that control urine flow
    • Obesity
    Muscles Involved in Incontinence in Women
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Urge Incontinence

    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 the bladder overflows. This leads to 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 (such as 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 you have normal bladder control, but you can't reach the toilet in time. It may be caused by medical conditions like severe arthritis. Drugs that cause confusion or sedation can also cause functional incontinence.
    Some incontinence may be caused by a fistula. A fistula is an abnormal opening between the bladder and outside.
    Incontinence has several different causes. The cause could also be unclear.

    Risk Factors

    Risk factors include:

    Symptoms

    Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
    Stress incontinence is when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise.
    Urge incontinence is a loss of bladder control following a strong urge to urinate. The bladder is unable to hold urine long enough to make it to a restroom.

    When Should I Call My Doctor?

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

    Diagnosis

    Your doctor will ask about your symptoms and medical history. You will be asked how often you empty your bladder, and about patterns of urine leakage. Your doctor will do a physical exam to look for any physical causes. These include blockages and nerve problems.
    Your doctor may ask you to keep a diary of your urination habits. You may be referred to an urologist or an urogynecologist.
    Tests to help determine a cause 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 into the urethra to view the urethra and bladder
    • Urodynamic tests—tests that measure the flow of urine and pressure in the bladder

    Treatment

    Treatments may include:

    Behavioral Therapy

    Behavioral therapy includes:
      Making muscles stronger by:
      • Kegel exercises—These strengthen the muscles that hold the bladder in place and those that control urine flow.
      • Painless electrical stimulation—This may strengthen the muscles more quickly and is helpful for stress incontinence.
      • Pelvic floor exercises using cone-shaped weights that are placed in the vagina.
    • Bladder training—Setting a regular, timed schedule for emptying your bladder. You may also be asked to drink fewer liquids.
    • Biofeedback—When doing pelvic floor muscle exercises, a device signals how strong you are at contracting your muscles.

    Weight Loss

    If you are a woman who is overweight or obese, losing weight may help 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 called anticholinergics may be prescribed to relax the bladder muscles. They are often used in treating urge incontinence.

    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. One type of surgery is called a urethral suspension. 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.
    A supportive device called a pessary may also be used in women. Pessaries are devices that raise the uterus or the prolapsed bladder. It can decrease 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 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 many other conditions. There are several ways to prevent incontinence:
    • If advised by your doctor, do exercises to strengthen your pelvic floor muscles, such as Kegel exercises. This is especially important if you are pregnant.
    • Reduce your intake of substances that lead to incontinence (such as caffeine, alcohol, and certain drugs).
    • Lose weight, if needed.
    • Eat a healthy diet to avoid constipation.

    RESOURCES

    Urology Care Foundation http://www.urologyhealth.org

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

    CANADIAN RESOURCES

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

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    American Urological Association Foundation. Overactive bladder. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=112. Updated January 2011. Accessed September 14, 2012.

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

    Incontinence. American Urologic Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=143. Updated January 2011. Accessed September 14, 2012.

    National Association for Continence. Overactive bladder treatment. National Association for Continence website. Available at: http://www.nafc.org/bladder-bowel-health. Updated September 2011. Accessed September 14, 2012.

    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. American Academy of Family Physicians. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/urinary-incontinence.html. Updated July 2012. Accessed September 16, 2012.

    Urinary incontinence in women. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 29, 2012. Accessed September 14, 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 September 2010. Accessed September 14, 2012.

    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 https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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.

    3/5/2013 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012 Oct 17;10:CD007471.

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