Incontinence in Women
While incontinence is often an embarrassing concern for both men and women, this issue is fairly common and should not be a source of shame. Urinary incontinence happens more often in women than men due to both their unique anatomy and life events. Read more below on the causes of this issue, what to look for in terms of symptoms, and how it can be treated.
What Is Female Urinary Incontinence?
Simply put, urinary incontinence is the inability to control bladder function. This issue results in urine leakages. Under the incontinence umbrella, there are some further distinctions between types.
Stress incontinence is caused by damage to or weakness of the muscles that prevent urination, or allow us to “hold” our urine, such as the urethral sphincter. This type of incontinence can also be caused by weakness of the pelvic floor muscles. With stress incontinence, patients often report urine “accidentally” leaking out when coughing, sneezing, or laughing. The condition is called stress incontinence because of the pressure, or stress, placed on the bladder.
Urge incontinence happens when the muscles that control the bladder — the detrusor muscles — engage in overactivity, causing frequent spasms in the bladder. Patients with urge incontinence feel sudden, uncontrollable urges to urinate accompanied by leakage. These urges are very intense and can happen even immediately after the bladder has been emptied.
Patients can have either of these types of incontinence, or may have a combination of both — which we call “mixed” incontinence.
Why Does Incontinence Happen in Women?
Because the urethra — the small duct connected to the bladder that is responsible for transporting urine — is shorter in women than in men, women often struggle with urinary incontinence more frequently. With less muscle due to the urethra’s smaller mass, any weakening or damage can cause symptoms pretty quickly.
In addition to the anatomical basis, women also have more life events, such as pregnancy, childbirth, and menopause, that can contribute to the damaging or weakening of muscles in the pelvic floor and urinary tract.
What Causes Incontinence?
Pregnant women are especially affected by incontinence, with almost half experiencing this issue. As the baby grows and increases pressure on the bladder, the pelvic floor muscles can start to weaken. Typically, this type of incontinence clears up several weeks after childbirth, but sometimes it can linger.
Occasionally, nerve damage in the pelvic floor region can happen during labor, especially with a vaginal birth. Often, healing and regeneration happens naturally over time, but sometimes childbirth can cause a more lasting issue.
Older women, especially those who have gone through menopause, also frequently experience urinary incontinence. The combination of decreased estrogen and aging internal muscles can contribute to a weakened urethra and loss of bladder control.
Other contributing factors include obesity, surgery, some medications, chronic constipation, infection in the urinary tract, or nerve damage due to multiple sclerosis (MS) or diabetes.
Symptoms of Incontinence
Urinary incontinence can present a number of symptoms, with the most obvious being an intense or frequent urge to urinate. Other symptoms include:
- Leaking urine when sneezing, laughing, or exercising
- Pressure in the pelvic region
- Spasming or squeezing in the bladder
- Bedwetting during the night
When to See a Doctor
If you are encountering any of these symptoms on an ongoing basis, it is time to see your doctor. As urological specialists, our patients are often referred to us by primary care providers or OB/GYNs.
We do a thorough examination including a medical history intake and current symptom questionnaire, followed by a physical examination. From there we can determine whether any other tests are needed, which could include a simple urine test, or further imaging through an ultrasound or cystoscopy, which provide us with an actual view of your organs and any damaged tissue surrounding them. Other common tests for incontinence may include a bladder stress test or a series of tests called urodynamics, which can show us how effectively your bladder is filling and emptying.
How Is Incontinence Treated?
Once we are able to diagnose the issue, we will build a treatment plan tailored to your specific needs and accounting for your lifestyle. While treatment takes some time and effort, often we are able to prescribe simple exercises you can do at home to effectively solve the problem.
Other times we may need to go the route of additional medical treatment, which could involve the use of a vaginal pessary — a small device inserted into the vagina to help support the muscles around the urethra and pelvic floor. We can also treat the weakened tissue by inserting collagen, or prescribing medications with estrogen. Occasionally, surgery is required to help with the position and proper functioning of the bladder.
If you are struggling with urinary incontinence, do not withhold this information from your doctor, even if you find it embarrassing to talk about. We see this issue quite often and it can typically be treated with some simple steps. Book an appointment with us if you suspect any incontinence issues, and we can help create a treatment plan that works for you.