Urinary Incontinence in Women

Urinary incontinence is the involuntary and unintentional loss of urine, commonly occurring in pregnancy, childbirth and menopause. Weak bladder muscles, overactive bladder muscles and nerve damage may also cause urinary incontinence. It is not a disease but a symptom.

Some women pass a few drops of urine while coughing or running. Others may feel a sudden, strong urge to urinate. Incontinence can occur following neurologic injury, birth defects, stroke, multiple sclerosis and aging

Incontinence occurs due to problems of nerves and muscles that help hold or release urine. The kidneys remove wastes from the blood and send it to the bladder for storage till it can be periodically expelled from the body through the urethra. The bladder muscles contract and the urine enters the urethra, where the sphincter muscles around the urethral opening relaxes and urine is released.

Types of Urinary Incontinence

  • Stress incontinence: coughing, laughing or sneezing causes urine to leak. Physical changes resulting from pregnancy, childbirth, menopause or birth defects can also cause incontinence. Childbirth, especially can injure the pelvic muscles, ligaments and the vaginal wall, supporting the bladder and cause the bladder to move downwards, which can loosen the urethral sphincter. 
  • Urge incontinence is when there is a sudden need or urge to urinate for no apparent reason. It occurs due to inappropriate bladder contractions caused by abnormal nerve signals. It causes the bladder to empty during sleep or after drinking small amounts of water, or when one touches water or hears it running. Medication such as diuretics, anxiety, uncontrolled diabetes or hyperthyroidism can worsen this condition. Involuntary contractions of the bladder muscles can occur due to damage to the nerves supplying the bladder, damage to the brain or spinal cord, damage to bladder muscles, parkinsonism, Alzheimer’s disease, strokes etc.
  • Overactive bladder: occurs when abnormal nerve signals are sent to the bladder at the wrong time, leading to contraction of the bladder muscles. Some symptoms include:
    • Increased frequency of urination
    • Urgency to urinate
    • Incontinence
    • Nocturia
  • Functional incontinence: occurs in those with medical problems that interfere with thinking, communicating and moving. These people have difficulty in reaching a toilet in time.
  • Overflow incontinence: occurs when the bladder doesn’t empty completely. This may happen due to weak bladder muscles as in diabetes or a blocked urethra due to tumors or stones
  • Mixed incontinence: Varying combinations of the above types of incontinence can occur
  • Transient incontinence may happen for a short duration due to infections or restricted mobility

Diagnosis

  • History is taken to assess the type of incontinence
  • Physical examination to assess pelvic floor muscle strength, anatomical defects etc
  • Ultrasound
  • Urodynamic testing
  • Cystoscopy
  • Urinalysis and culture
  • Bladder stress test

Treatment

  • Weight loss and quit smoking
  • Behavioral treatment like bladder re-training, Kegel exercises
  • Medication
  • Surgery
  • Combination of the above

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