Urinary incontinence is a very common symptom in women, particularly as one ages or after having children. However, just because it is common does not mean it is normal and one has to live with it. High blood pressure and diabetes are common in the American population and health care professionals do not recommend just dealing with it. There are two most common types of urinary incontinence are stress incontinence and urge incontinence. The classic symptoms of stress incontinence include leaking urine when laughing, coughing, sneezing, exercising, bending over, ect. Essentially, any activity that increases the abdominal pressure in the abdomen can cause leaking of urine. The classic symptoms of urge incontinece include leaking of urine after feeling a sudden and strong urge to urinate and not being able to make it to the bathroom in time. Women often have certain triggers that cause these urges such as putting the key in the door, running water, brushing their teeth, ect. A woman can also have symptoms of both types of incontinence which is call mixed incontinence. There are treatment options for both types of incontinence.
For a woman with stress incontinence, it is important to identify how often it is happening, how much she leaks when it happens, what activities cause it to happen, and how much it is bothering her when it happens. For some women, they leak only a small amount when they have a cold and have coughing. This small amount of leaking may not be bothersome for her. Other women may leak every time they run, laugh, sneeze, cough or do heavy lifting. This frequency of leaking could be very bothersome to her. For a woman presenting for evaluation of her symptoms, I would recommend a careful history and physical examination, focusing on the above questions. During the exam, it is important to determine whether the urethra has support or if ligaments that normally support the urethra have been damaged. It is also important to recreate a scenario in which the woman leaks. This is done by filling her bladder with sterile saline and then having her cough or laugh. This examination helps to determine which treatment would be beneficial.
Treatment options for stress incontinence include expectant management (meaning monitoring symptoms over time until the symptoms become bothersome enough that one would like to proceed with therapy). Other options include pelvic physical therapy. There are physical therapists who specialize in strengthening the pelvic muscles which help women to have better support for their urethra and bladder and decrease the amount of leaking that occurs. This therapy does involve a physical therapist performing a pelvic exam. This treatment option is ideal for women with mild symptoms who are motivated to perform physical therapy. Another treatment option includes a pessary. A pessary is a device that is placed into the vagina. The pessary creates support for the bladder and urethra. It is placed in the vagina and normally removed once per week by the woman for cleaning. The physician will fit the patient for a pessary that is comfortable and does not fall out. The pessary works well for women with mild to moderate stress incontinence who do not or are not able to perform physical therapy or surgery. The disadvantage of the pessary include needing to remove it for cleaning and intercourse and also the slight possibility of the pessary causing an erosion into the vagina. Another treatment option for stress incontinence is surgical management. Surgery involves placing a small mesh sling underneath the urethra which then recreates the supportive ligaments that have been damaged. The surgery is an outpatient procedure and a woman is able to resume her normal activities quickly but is recommended to refrain from intercourse and heavy lifting for 4 weeks. Surgery is very effective with approximately 90% of women having no leaking of urine or markedly less urine loss. The risks include damage to nearby organs, risk of bleeding, risk of infection, and the risk of continued symptoms. Surgery is a good option for women with moderate to severe symptoms who have failed other treatment options or who desire surgical management.
Urge incontinence is usually treated with behavior modifications and medication. Urge incontinence occurs because the bladder contracts to urinate even though a woman may not be ready for urination. The bladder may contract because it is too full with urine, or because of certain foods or liquids that cause irritation. The bladder may also contract due to certain medications such as diurectics which a woman may be on due to medical problems such as high blood pressure and heart failure. When a woman presents for evaluation of urge incontinence, it is again important to perform a thorough history and physical exam. It is important to determine how often a woman has urge symptoms, what triggers her urge symptoms, to evaluate her medications, fluid intake, and food intake. It also important to determine how often a woman is going to the bathroom and whether they feel they have emptied their bladder.
Treatment options include behavioral therapy, restriction of fluids, avoidance of certain bladder irritants or medications, and treatment with medications. Behavioral therapy includes retraining one's bladder to not send a message to one's brain every 30 minutes that it is time to urinate or to not send that message during certain situations such as hearing running water or brushing one's teeth. Many women may leak because they are consuming too many liquids. If one is drinking more than 64 ounces of fluid per day, their bladder may sense that it is full often and contract in response. A treatment option includes restriction of fluid. Avoidance of caffeinated beverages and bladder irritants such as acidic foods can also help decrease urinary urge symptoms. Medication therapy includes medicine that decreases the frequency of bladder contractions. If the bladder is contracting less, then one has less urge symptoms and less leaking. The side effects of medication include dry mouth and constipation.
I recommend for any women experiencing bothersome urinary incontinence symptoms to be evaluated by either her gynecologist or urologist that is trained in treating urinary incontinence in women. There are many noninvasive and minimally invasive treatment options that can signficantly improve their quality of life.
Additional resources include:
The American Urogynecology Society
