What are the other Names for this Condition? (Also known as/Synonyms)

• Bladder Incontinence in Women
• Unable to hold Urine - Women
• Weak Bladder in Women

What is Urinary Incontinence in Women? (Definition/Background Information)

• Urination is a voluntary reflex that is under the control of an individual. Incontinence occurs, when certain problems are encountered by the muscles that help in holding and releasing urine
• Urine is stored in the bladder, which is connected to the urethra - the tube through which it is released out of the body
• When an individual urinates, the muscles in the walls of the urinary bladder contracts. This allows the urine to be discharged out of the bladder, into the urethra. The sphincter muscles around the urethra relax, allowing the urine to pass out of the body
• An individual with urinary incontinence is unable to control this reflex mechanism

On the basis of the underlying mechanism of loss of control of urination, the different types of Urinary Incontinence in Women are:

• Urge incontinence
• Stress incontinence
• Overactive bladder
• Functional incontinence
• Overflow incontinence
• Mixed incontinence
• Transient incontinence

Who gets Urinary Incontinence in Women? (Age and Sex Distribution)

• Women of all ages, race, and from any geographical area, may be affected by urinary incontinence
• Elderly women are at increased risk of developing this condition

What are the Risk Factors for Urinary Incontinence in Women? (Predisposing Factors)

The risk factors associated with Urinary Incontinence in Women are:

• Multiple childbirth
• Menopause
• Anatomical structure of the female urinary tract
• Obesity
• Use of substances that irritates the bladder, like caffeine
• Constipation

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Urinary Incontinence in Women? (Etiology)

Urinary Incontinence in Women causal factors may include:

• The muscles of the pelvic floor surrounding the bladder become weak, due to:
  • Pregnancy
  • Childbirth
  • Menopause
• Irritation of urinary bladder may lead to incontinence, due to the following causes:
  • Urinary infection
  • Overactive bladder
• Other diseases affecting the nerves that supply the bladder tissues, can also lead to urinary incontinence. These include:
  • Dementia
  • Stroke
  • Multiple sclerosis
  • Spinal cord injury
• A short urethra can predispose an individual to urinary incontinence
• Side-effects of certain drugs and medications, taken for treating other diseases and conditions

What are the Signs and Symptoms of Urinary Incontinence in Women?

The various signs and symptoms associated with Urinary Incontinence in Women are:

• Urinating spontaneously without control while engaged in any activity, like laughing, sneezing, lifting heavy objects, playing, etc.
• A very strong and powerful desire to urinate constantly
• Unable to hold back urine, till one reaches the restroom
• Difficulty to activate the process of urination
• Experiencing a lot of pain and strain, attempting to empty the bladder
• Weak urinary stream and trickling of urine may occur

How is Urinary Incontinence in Women Diagnosed?

The diagnosis of Urinary Incontinence in Women is made on the basis of a physical examination, medical history evaluation, and certain diagnostic tests.

• To determine the cause of the disease, the physical examination may include:
  • Examination of the urinary system
  • Examination of the nervous system
• Evaluation of medical history may include the risk factors associated with the disease. A previous history of similar episodes may be present or confirmed
• Patients are also asked to maintain a diary, which consists of information on their bladder habits

Other diagnostic testing tools for Urinary Incontinence in Women may include:

• Urinalysis to check for infections and kidney function
• Stress test, which is conducted with a full bladder: The physician shall check the amount of bladder support present, while urinating
• Ultrasound of kidney and urinary bladder: To check the amount of urine left in the bladder after urinating, and to look for any structural defects
• Cystoscopy test, to examine the urinary bladder: A thin tube with light source and a camera at its end is passed into the bladder through the urethra, to detect any structural abnormalities or abnormal growth
• Urodynamic tests - various measurements may be made using this test, like:
  • Capacity and volume of the bladder
  • Pressure which the bladder will exert
  • Maximum pressure, which the sphincter muscles can bear
  • Speed with which the bladder is emptied
  • Co-ordination between the sphincter and bladder muscles

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Urinary Incontinence in Women?

Various complications of long-standing Urinary Incontinence in Women may include:

• Skin complications, due to constant wetting of the skin as a result of urine leakage. It may lead to skin rashes, sores, or skin infections
• Infections of the urinary tract: Untreated urinary incontinence may lead to repetitive urinary tract infections
• Difficulty living, performing, normal/regular/daily activities: Urinary incontinence may become a cause of social embarrassment, leading to anxiety and depression. It may hamper the individual’s capacity to work, play, exercise, and perform routine activities. It may also cause distress, while having sex

How is Urinary Incontinence in Women Treated?

Various treatment options for Urinary Incontinence in Women may include:

• Behavioral remedies:
  • Timed voiding: Based on the facts and observations recorded in the bladder diary, the physician shall fix a pattern to toilet usage, at certain set/regular intervals. This will help in training the patient gain control over the bladder
  • Kegal exercises to strengthen the muscles that help in holding urine
• Medications (such as anticholinergics) to control overactive bladder may be prescribed; and discontinuation of those medications that cause urinary incontinence
• Biofeedback: Electronic devices are used to measure functioning of the body and to keep track of the time, when the bladder and urethra contacts. This will help in gaining control over these organs
• Neuromodulation: Used when urge incontinence cannot be controlled by drugs or behavioral treatment. In this technique, activating the nerves from the spine to the bladder, using neuromodulation therapy may be helpful
• Vaginal devices to control stress incontinence: A pessary (a medical device for the vagina) or a stiff ring is inserted into the vagina in such a way, as to press the walls of the vagina and the adjoining urethra. This helps in repositioning the urethra, which reduces the leakage
• Some women use menstrual pads to absorb slight leakages that take place, during various physical activities
• The intermittent use of urinary catheter may be a treatment option, depending on the mechanism of urinary incontinence

Surgery for stress incontinence - 3 types of surgery are in practice, and these are:

• Retropubic suspension: Surgical threads called sutures are used to hold the bladder neck and control the flow of urine
• Traditional sling procedures:
  • Uses  one’s own tissue called fascia, to support the bladder neck
• Midurethral sling procedures:
  • Synthetic mesh materials are placed in the midway, along the urethra
  • The two types of midurethral slings generally used are - transvaginal tape slings and transobturator slings (called TVT and TOT slings respectively)

When a post-menopausal woman suffers from a pelvic prolapse, surgery with pelvic repair along with a hysterectomy is usually recommended.

How can Urinary Incontinence in Women be Prevented?

The risk of Urinary Incontinence in Women can be reduced by following certain preventative and precautionary measures, such as:

• Undertaking regular pelvic floor exercises or kegal exercises to strengthen the pelvic muscles, following childbirth
• Maintaining an appropriate body weight
• Smoking cessation: Smoking leads to persistent coughing, which will in turn put pressure on the bladder muscles, leading to urinary incontinence
• Avoiding drinks and food that contain substances that irritate the bladder, like caffeine, may help in preventing Urinary Incontinence in Women
• A fiber-rich diet is helpful in eliminating constipation, which is considered as a major cause of urinary incontinence
• Minimizing alcohol intake

What is the Prognosis of Urinary Incontinence in Women? (Outcomes/Resolutions)

• The prognosis depends on the cause of Urinary Incontinence in Women
• The condition can be appropriately managed with medications and lifestyle changes. Surgery is curative in some cases

Additional and Relevant Useful Information for Urinary Incontinence in Women:

Urinary incontinence may affect males of all ages too; however, the causal factors may vary.