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Urinary Incontinence

Urinary Incontinence–Female

Urinary incontinence is often the result of pelvic floor damage. Many women experience it when they go for a walk or a run, and they often find it embarrassing and debilitating.

Women with urinary incontinence problems may have one or more of the following:

  • Stress incontinence: This happens when something you do, such as coughing, laughing, sneezing jumping, lifting or exercise. The external force pushes on your bladder and causes urine past the urethra.
  • Urge incontinence or latch key incontinence (over-active bladder): Women with this are not able to wait until it's convenient to empty their bladder because of their weakened ability to tell the bladder to wait. Women may experience getting up frequently during the night to urinate, bed-wetting or going to the bathroom every two hours.
  • Overflow: This is a rare condition where women leak small amounts of urine frequently because their bladder is constantly full. With this condition the bladder does not empty completely, and as a result the bladder becomes progressively swollen. The bladder is unable to do its job properly, and urine leaks due to overflow.
  • Mixed incontinence: Women with urinary incontinence generally have stress, urge, and often times mixed incontinence, which is a combination of both stress and urge. Sometimes women experience problems with urination due to other conditions such as frequent bathroom trips or excessive fluid intake.

The Causes of Urinary Incontinence

Different causes contribute to the various forms of incontinence.

  • Stress incontinence is a result of damage to the urethra or the bladder neck. A condition called intrinsic sphincter deficiency (ISD) can result from damage to the urethra and the urethral sphincters. This condition usually results in severe stress incontinence. If these structures fail, then the urethra moves too much, leading to incontinence.
  • Urge incontinence is usually the result of problems with the bladder muscle. The bladder muscle tightens or contracts involuntarily when it should be relaxed.
  • Mixed incontinence is a combination of stress and urge incontinence.

Recent childbirth

This is one of the most common causes of urinary incontinence among women. Most women recover, but if you still have urinary incontinence six months after delivery, make an appointment with your doctor.

Aging/Menopause

As women age they're more likely to develop urinary incontinence. Some women have worsening symptoms around the time of menopause.

Urinary tract infections (UTIs), medications and lifestyle behaviors may also contribute to your incontinence. 

Lifestyle behaviors include:

  • Bladder irritants: The most common are caffeine, decaffeinated coffee, carbonated beverages and spicy foods.
  • Excessive fluid intake: A recommended amount of fluid for bladder health can be anywhere from 30-60 ounces per day depending on the individual.

Diagnosing Urinary Incontinence

Your doctor will ask for your health history and perform a pelvic exam. During the exam, your doctor may ask you to push down or cough to see how much urine you leak. Your doctor may also perform a rectal exam to check the strength of these muscles, which can weaken with age or childbirth.

Post-void Residual (PVR)

A post-void residual (PVR) determines how much urine is left behind after you urinate. It's normal for the bladder to not completely empty itself. During this test, you'll first empty your bladder. Then, 15 minutes later, your doctor places a catheter into your bladder to determine the amount of urine left behind. 

Urinalysis

This test determines if you have an infection or if other substances are present in your urine. After you provide a urine sample, your doctor dips a test strip into the urine to see if you have a high white blood cells count, which could indicate a bladder infection. For follow-up, you doctor may send your urine out to be cultured, which is a more sensitive test.

Bladder Testing (Urodynamics)

Urodynamic testing is a series of bladder tests that see how your bladder reacts under certain conditions and to help figure out what type of incontinence you may have.

Cystometry

During this test, your doctor places a small, soft catheter in your bladder and uses a tube, which is hooked up to a bag of sterile water, to fill your bladder. Your doctor then inserts a second catheter, which is connected to a computer, to measure the pressures within your bladder.

Voiding (Bladder) Diary

An important tool in treating urine loss is to keep records of your bladder function over a 3-day period. You'll be given a special container to put on the toilet to help measure your urine volumes. You should record when you go to the bathroom, when you experience incontinence and what type of urine loss (urge versus stress incontinence). You should also keep track of your fluid intake. At your follow-up visit, your doctor reviews your diary and makes treatment recommendations.

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