What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine, which becomes a social and hygienic problem. A few common types of incontinence we see include:

• Stress incontinence: Involuntary loss of urine due to physical increases in intra-abdominal pressure, such as coughing, sneezing, laughing or lifting heavy things.
• Urge incontinence: When the bladder suddenly contracts involuntarily and expels urine.
• Mixed incontinence: The woman has both forms of incontinence at the same time.

What causes urinary incontinence?

Stress incontinence can be caused by:

• Pregnancy and vaginal delivery
• Chronic constipation
• Frequent coughing from asthma or smoking
• Urethral sphincter deficiency

Urge urinary incontinence can be caused by:

• Advancing age
• Spinal injury

Pelvic prolapse may or may not be associated with incontinence.

What are the symptoms of urinary incontinence?

Stress incontinence occurs when pressure is placed on the bladder. Urge incontinence is associated with a sudden urge to go to the bathroom, followed by involuntary leakage. Women can have both stress and urge incontinence, called mixed incontinence. Frequent urination is common in both forms of incontinence.

How is urinary incontinence diagnosed?

There are several steps involved in diagnosing urinary incontinence. These include:

• History: What activities are associated with the incontinence?
• Physical examination: Is there prolapse or not?
• Stress test: Coughing, valsalva maneuver (forcible pushing).
• Urodynamics: Catheters are placed in the bladder to measure spontaneous contractions of the bladder.

How many women have urinary incontinence?

Despite the social stigma associated with bladder control, urinary incontinence is an extremely common problem, especially in women. Urinary incontinence affects:

• 20-30% of young women
• 30-40% of middle aged women
• 30-50% of older women

When women have incontinence, about 40-50% have stress incontinence, 10-20% have urge incontinence and 30-40% have mixed incontinence.

What is the best treatment option for urinary incontinence?

Nonsurgical management options for incontinence include:

• Behavior modification: Bladder training, timed voiding, pelvic muscle exercises (Kegel's), biofeedback
• Devices: Vaginal cones and pessaries
• Medicines: Oxybutynin and other anticholinergic medications can help urge incontinence.  Estrogen replacement can be given and may be helpful.

Surgical management options may be best for those with vaginal prolapse. These options include:

• Slings: These are helpful for stress incontinence. When mixed incontinence is present many women report less problems with urge incontinence after a sling is used to fix the stress incontinence.
• Neuromodulation: An electrical signal can inhibit unexpected bladder contractions. This therapy can be intermittent and done in individual sessions. A permanent implant is sometimes required.