Urinary Incontinence in Women: A Guide To Causes & Treatments


Urinary incontinence is a medical condition that is known by many names, among them…

  • Weak bladder
  • Involuntary urine leakage
  • Stress incontinence
  • Overactive bladder
  • Sensitive bladder

Despite its many names, urinary incontinence, in general, refers to the involuntary leakage of urine. This condition is more commonly seen in an estimated 50 percent of elderly women age 60 years old and above. Although not considered a serious disease, it is known to cause the sufferer undue physical discomfort and mental distress. It is also very expensive, considering that a woman needs to buy special incontinence pads, diapers or pants. Ironically, women need not suffer from urinary incontinence since it is treatable.

 

How Urinary Incontinence Develops

Everyone drinks water and other fluids to keep the body hydrated. Any excess fluids are filtered by the kidneys and stored in the bladder, which is the reservoir of urine. Normally, when not completely filled, the bladder is in a relaxed state with the urethra, where the urine exits the body, contracted so as to prevent urine from leaking. Once the bladder is full, the organ sends signals to the brain, alerting you to the need to head off to the nearest bathroom to pee.

In urinary incontinence, there is a disruption in the control mechanism that enables you to hold urine in your bladder, causing urine to leak. In mild cases, the urine leak may only be a few drops or a trickle. In the more severe cases, there is complete loss of control that the bladder empties its full load automatically.

 

Causes of Urinary Incontinence

The causes of urinary incontinence are classified according to whether the condition is temporary/transient or persistent/progressive. These causes are as follows…

 

Causes of Temporary/Transient Urinary Incontinence

  • Urinary Tract Infection (UTI)
  • Vaginal inflammation or infection
  • Constipation
  • Impaired mobility/prolonged bed rest due to arthritis, Parkinson’s disease, or acute phase of a stroke

Transient urinary incontinence is resolved upon treatment of these conditions.

Causes of Progressive Pathological Urinary Incontinence

  • Disruption of the ligaments supporting the bladder and urethra due to multiple labours and deliveries, and traumatic or assisted vaginal deliveries
  • Connective tissue atrophy resulting from menopause
  • Damage to the pelvic floor muscles due to increased body weight (overweight/obesity), regular, severe abdominal straining as a result of the increased physical weight, persistent constipation, and chronic cough
  • Neurological diseases, such as dementia and/or stroke, affecting the central nervous system
  • Chronic lifestyle diseases that disrupts the normal functioning of the nervous system

Progressive pathological urinary incontinence is more difficult to treat because damage has been inflicted upon the bladder, urethra and/or nervous system.

 

Types of Urinary Incontinence

Aside from classifying urinary incontinence according to their cause, doctors further classify this condition into the following types…

  • Genuine Stress Incontinence = Urine leak occurs with sneezing, coughing, laughing, or lifting heavy weights
  • Urge Urinary Incontinence = When a strong urge to urinate develops, your bladder is unable to hold the urine in before you can run to a bathroom.
  • Mixed Urinary Incontinence = Combination of the above two types of incontinence
  • Overflow Urinary Incontinence = Although you feel that your bladder is full, you are unable to completely empty it or there is intermittent loss of urine
  • Continuous Urinary Incontinence = Continuous leak of urine due to a fistula or false passage formed between your bladder or ureter and your vagina

 

Diagnosis of Urinary Incontinence

A thorough assessment of the patient’s history is done to determine the presence of medical conditions or prior surgical procedures that are causing urinary incontinence. A gynaecologic history is also important to assess the oestrogen status since deficiency of this hormone causes atrophic vaginitis or atrophic urethritis, which cause urinary incontinence. A cough stress test is performed to determine stress incontinence.

Doctors may recommend that the patient keep a voiding diary in order to monitor the frequency and volume of urination. Laboratory tests such as urinalysis, serum creatinine, and PostVoid Residual Urine may also be ordered. In severe urinary incontinence, surgery is the definitive treatment. For example, sling procedures are done in severe stress incontinence. In patients with poor support to the bladder and urethra, bladder neck suspension is performed.

 

Treatment of Urinary Incontinence

The treatment of urinary incontinence depends upon the causative factor. In most cases, the condition can be treated conservatively through bladder retraining and Kegel or pelvic floor exercises.

Lifestyle changes also need to be made, including eating a healthy diet, drinking 6-8 glasses of water daily, regular exercise, and limiting intake of alcoholic beverages. These measures help to restore central control over the continence mechanism of the bladder. In the presence of bladder infection or oestrogen deficiency, the doctor may prescribe antibiotics and hormonal preparations.

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