Urinary incontinence is the involuntary loss of urine. Millions of women experience it each year. Some women may lose a few drops of urine while coughing, sneezing, laughing, during exercise, even during sexual activity. Others may feel a strong, sudden urge to urinate but may leak a large amount of urine before reaching the bathroom. Some women experience a combination of both of these. In addition, there are other types of incontinence which are detailed below.
Due to the risk of public embarrassment, many women alter their lifestyles, choosing not to participate in the things they normally enjoy. Many women also choose to ignore their symptoms and refuse to discuss incontinence with their providers. Regardless of your type of incontinence, UT Urogynecology can quickly investigate, diagnose and treat it with care and compassion.
Does Everyone Need Surgery for Incontinence?
No, absolutely not. No single treatment is available to treat all types of incontinence. While surgery is warranted in some patients, many patients never require a surgical repair. More conservative therapies, including pelvic floor physical therapy (Kegel exercise), control of medical conditions, weight loss, medications and pessaries can be used to control leakage.
Stress Urinary Incontinence (SUI)
In women, stress incontinence is nearly always due to one or both of the following:
- Urethral hypermobility
- Intrinsic sphincter deficiency
In general terms, SUI is caused by a combination of increasing pressure inside the bladder (from coughing, sneezing, laughing, lifting), and weakness, or a lack of support, beneath the bladder neck and urethra. This weakness, usually resulting from pregnancy, childbirth and menopause, manifests itself when an increase in bladder pressure pushes urine through the urethra resulting in leakage.
Urge Incontinence (UUI) / Overactive Bladder (OAB)
Is caused by abnormal and involuntary contractions of the bladder (detrusor) muscle. Overactive bladder (OAB) symptoms occur when abnormal nerve signals to the bladder fire at the wrong time, causing the detrusor muscle to squeeze without warning. Women with overactive bladder may find symptoms such as the following:
- urinary frequency—bothersome urination eight or more times during the day
- urinary urgency—the sudden, strong need to urinate immediately
- nocturia—awaking more than two times at night to urinate
- feeling of incomplete bladder emptying – the feeling of having to return to the bathroom to finish urinating, many times within a few minutes of voiding
Urge Urinary Incontinence occurs if you lose urine for no apparent reason after suddenly feeling the need or urge to urinate. This is a frequent finding in individuals with the symptoms of overactive bladder. Many women will experience “triggers” (include hearing or seeing running water) that cause them to have an intense urge to void and may cause them to leak urine. Some medications–and even some food items (caffeine, chocolate)–may increase bladder contractions and urinary leakage.
Mixed Urinary Incontinence
Many women experience symptoms of both Stress Urinary Incontinence (SUI) and Urge Urinary Incontinence (UUI). This, according to many, is the most commonly seen incontinence pattern in women.
Functional Incontinence is incontinence due to mental or physical disabilities that impair a person’s ability to use or get to the toilet, despite a healthy urinary system. For instance, individuals with Alzheimer’s disease may simply forget to urinate. Individuals with injuries, or those that are wheelchair bound, may not be able to make it to the bathroom on time, leading to urinary leakage.
Overflow Incontinence occurs when the bladder cannot empty completely. As the bladder continues to fill, it reaches the point where it can hold no more urine, leading to an eventual leakage of the bladder content. Bladder obstruction, an inactive or weak bladder muscle, or neurologic (spinal injuries) and metabolic (diabetes) disorders can cause overflow incontinence.
The causes of the conditions leading to overflow incontinence in women include:
- Certain medications (anticholinergics, antidepressants, antipsychotics, sedatives, narcotics and alpha-adrenergic blockers)
- Scar tissue
- Nerve damage and/or detrusor dysfunction. In such cases, nerves in the bladder are damaged so that the body cannot feel when the bladder is full, and/or the bladder lacks the ability to contract. Such damage can be caused by spinal cord injuries, previous surgery around the bladder, colon or rectum, and pelvic fractures. Diabetes, multiple sclerosis, and shingles also can cause this problem.
Sensory Irritative Incontinence
Sensory Irritative Incontinence occurs due to chronic or acute bladder irritation. This can be cause by Urinary Tract Infections or Vaginal Atrophy as seen in post-menopausal females.
Bypass Incontinence occurs in individuals with urinary tract fistulae. Urine can freely flow from the bladder through a hole leading directly into the bladder. The result is chronic, continuous urinary leakage. Please see the section on fistulae for details.