Female Incontinence

Female Incontinence

 


Loss of bladder control is an important health problem known to affect a large number of women. Since many women do not seek help, it is impossible to know exactly how many suffer with unintended urine loss. There is no one cause for female urinary incontinence, but several risk factors do exist.

 

Some Risk Factors for Female Urinary Incontinence

  • Childbirth
  • Urinary tract infections
  • Menopause
  • Prior pelvic surgeries - hysterectomy
  • Increased weight
  • Neurologic illnesses - multiple sclerosis, diabetes, or stroke
  • Advanced age


Whether you leak only occasional small amounts or you experience larger urine losses, the first step in improving your control is to see your primary care physician or urologist. He or she can diagnose your type of incontinence so that an appropriate treatment plan can be initiated.

 

Types of Incontinence

There are several different types of incontinence, but they all have similar outcomes – urine leakage. The vignettes below describe some common symptoms seen with each type of incontinence. Remember, it often takes a visit to your doctor’s office to receive the testing necessary to confirm your diagnosis and form the best treatment plan for your urinary leakage.

 

  • Urge Incontinence – “I have to go to the bathroom all the time. Sometimes the urge to urinate comes on so suddenly that I cannot make it to the toilet in time.”
  • Stress Incontinence – “Whenever I cough, sneeze, or even stand up I leak urine.”
  • Mixed Incontinence – “I seem to leak all the time … sometimes I lose urine when I’m rushing to the restroom and other times when I cough or sneeze.”
  • Overflow Incontinence– “I feel like my bladder never empties even though I am going to the restroom all the time. Sometimes urine even leaks out at unexpected times.”
  • Functional Incontinence – “I can hold my urine reasonably well, but I don’t get around as well as I used to, and reaching the bathroom in time can be so difficult.”


Urge Incontinence

  • A common type of incontinence in both women and men
  • Caused by bladder overactivity
  • Leakage occurs because of a sudden and unstoppable urge to void.
  • Common symptoms include:
        Frequent voiding during the day and night
        Rushing to the bathroom
        Inability to hold back your urine flow
        Loss of urine while sleeping

Urge incontinence can be caused by an infection, a bladder or urethral growth, incomplete emptying of your bladder, or a number of other treatable medical conditions. For women with urge incontinence, a pelvic organ prolapse may be contributing to the bothersome urinary symptoms.

 

For all of these reasons, it is important to see a physician whenever you notice a change in your urinary habits so that you can be thoroughly evaluated and treated.

 

Stress Incontinence

  • Most common in women, but it may also occur in men
  • Women with stress incontinence may also have a pelvic organ prolapse , which contributes to the bothersome urinary symptoms.

 

Stress Incontinence
 WomenMen
Who Common in women who have undergone prior childbirth, pelvic surgery, or menopause. May occur in men who have undergone a radical prostatectomy or other urogenital surgery.
When Occurs when PC muscles weaken or pelvic floor tissues become strained. Occurs when the urinary sphincter mechanism is disrupted.
How

A strong PC muscle helps holds the urethra, bladder, vagina, and rectum in place. When this muscle weakens, the continence mechanism in the urethra does not work as well, and small increases in abdominal pressure can cause urine to leak.

After removal of the prostate, some men may experience some loss of urinary control for a number of reasons. Because of the sensitive location of the prostate, its surgical removal may cause disruption of either the anatomic continence mechanism or the nerves that influence urinary control.
What Urine loss occurs with activities that increase intra-abdominal pressure - sneezing, coughing, laughing, standing, lifting, etc. Urine loss occurs with activities that increase intra-abdominal pressure - sneezing, coughing, laughing, standing, lifting, etc.


Mixed Incontinence

  • A common type of incontinence in women, but it can occur in men also.
  • Caused when symptoms of both urge and stress incontinence exist at the same time.
  • For women with mixed incontinence, a pelvic organ prolapse may be contributing to the urinary symptoms.
Mixed Incontinence - Symptoms of both urge and stress incontinence

At least one of these symptoms:

 

AND

Inability to hold back your urine flow
Rushing to the bathroom
Frequent voiding during the day and night
Loss of urine while sleeping
At least one of these symptoms Urine loss with sneezing, coughing, laughing, standing, or lifting

 

 

 

 

 

 

 

 

 

Overflow Incontinence

  • A common type of incontinence in men, but it also may occur in women.
  • Caused when the bladder does not empty properly.
  • The bladder then becomes stretched with large volumes of urine that have no choice but to “overflow,” or leak out of the bladder.
Causes for Overflow Incontinence
Either an obstruction blocks the outflow of urine from the bladder

 

OR

Some causes for obstruction:

  • Benign Prostatic Hypertrophy
  • Strictures that cause narrowing of the urethra
  • Diseases that affect the nerves associated with urinary sphincter function - Multiple sclerosis is a common example
The bladder loses its contractile power, and can no longer efficiently squeeze out urine

Some causes for loss of contractility:

  • Pelvic surgeries such as a hysterectomy or major bowel surgery
  • Lower back surgeries
  • Diseases that affect the nerves associated with bladder function - Multiple sclerosis and diabetes are two common examples
** For a complete description of how the bladder works, see Urology Anatomy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When the bladder does not empty property, common symptoms include:

  • Frequent passage of small volumes of urine – day or night
  • Difficulty beginning to urinate
  • A weak urine stream
  • Straining, or use of abdominal muscles, when urinating
  • The feeling that your bladder is not completely empty when you are finished urinating
  • Discomfort when urinating
  • Sensation of pressure in the lower abdomen
     

Urology Anatomy -- How Does Overflow Incontinence Occur?

Your two kidneys filter the circulating blood and make urine. The urine made by each kidney then flows downward through a ureter. Both the left and right ureters drain into the bladder, which acts as a urine storage bag. The bladder stores urine until it is full. Then the brain gives it the message that it is time to urinate. When the bladder receives this neurochemical message from the brain, its muscle contracts and urine is pushed out of the body through the urethra.

 

When the bladder does not empty properly, it becomes overfilled with urine. As the urine volumes inside the bladder increase, the pressure inside the bladder also increases. It is because of this pressure that urine is forced out of the body at unexpected times and leakage occurs. This phenomenon is called overflow incontinence.

 

Overflow incontinence may be an indication that the kidneys are becoming damaged. The kidneys perform the important job of making urine 24 hours a day. When the bladder becomes filled to capacity, urine from the kidneys cannot easily drain into it. Urine may then become backed-up in the kidneys causing a damaging swelling called hydronephrosis. In order to prevent hydronephrosis and other negative consequences caused by retaining too much urine, you should seek assistance from your primary care physician or urologist if you believe that you may have overflow incontinence. He or she can diagnose the problem and help you find the treatment plan that is right for you.

 

Pubococcygeus (PC) Muscle

This important muscular sheet helps anchor the urethra, vagina, anus, and rectum in their proper anatomic locations. When the PC muscle weakens, these structures are more likely to shift out of place and prolapse or urinary incontinence may occur.