Urinary Incontinence in Women National Kidney and Urologic Diseases Information Clearinghouse Millions of women experience involuntary stroke, multiple sclerosis, and physical loss of urine called urinary incontinence problems associated with aging. (UI). Some women may lose a few drops of urine while running or coughing. Others Older women experience UI more often National than younger women. But incontinence Institute of may feel a strong, sudden urge to urinate Diabetes and just before losing a large amount of urine. is not inevitable with age. UI is a medical Digestive problem. Your doctor or nurse can help and Kidney Many women experience both symptoms. Diseases UI can be slightly bothersome or totally you find a solution. No single treatment debilitating. For some women, the risk of works for everyone, but many women can NATIONAL find improvement without surgery. INSTITUTES public embarrassment keeps them from OF HEALTH enjoying many activities with their family Incontinence occurs because of problems and friends. Urine loss can also occur dur­ with muscles and nerves that help to hold ing sexual activity and cause tremendous or release urine. The body stores urine— emotional distress. water and wastes removed by the kidneys— Women experience UI twice as often as in the bladder, a balloon-like organ. The men. Pregnancy and childbirth, meno­ bladder connects to the urethra, the tube pause, and the structure of the female uri­ through which urine leaves the body. nary tract account for this difference. But During urination, muscles in the wall of both women and men can become inconti­ the bladder contract, forcing urine out of nent from neurologic injury, birth defects, the bladder and into the urethra. At the Kidneys Muscular bladder wall Ureters Pelvic Sphincter bones muscles Urethra Bladder Bladder and sphincter muscles U.S. Department of Health and Human Services Figure 1. Front view of female urinary tract. same time, sphincter muscles surrounding the urethra relax, letting urine pass out of Enlargement of pelvic floor muscles the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder. Obesity, which is associated Uterus with increased abdominal pressure, can worsen incontinence. Fortunately, weight Bladder loss can reduce its severity. What are the types of incontinence? Stress Incontinence Vagina If coughing, laughing, sneezing, or other Pelvic floor movements that put pressure on the blad­ muscle der cause you to leak urine, you may have Urethra stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. Figure 2. Side view of female pelvic muscles. This type of incontinence is common in women and, in many cases, can be treated. a result, urine can leak into the urethra during moments of physical stress. Stress Childbirth and other events can injure the incontinence also occurs if the squeezing scaffolding that helps support the blad­ muscles weaken. der in women. Pelvic floor muscles, the vagina, and ligaments support your bladder Stress incontinence can worsen during the (see figure 2). If these structures weaken, week before your menstrual period. At your bladder can move downward, push­ that time, lowered estrogen levels might ing slightly out of the bottom of the pelvis lead to lower muscular pressure around toward the vagina. This prevents muscles the urethra, increasing chances of leak­ that ordinarily force the urethra shut from age. The incidence of stress incontinence squeezing as tightly as they should. As increases following menopause. 2 Urinary Incontinence in Women Urge Incontinence Specifically, the symptoms of overactive If you lose urine for no apparent reason bladder include after suddenly feeling the need or urge to • urinary frequency—bothersome urina­ urinate, you may have urge incontinence. tion eight or more times a day or two A common cause of urge incontinence or more times at night is inappropriate bladder contractions. Abnormal nerve signals might be the cause • urinary urgency—the sudden, strong of these bladder spasms. need to urinate immediately Urge incontinence can mean that your blad­ • urge incontinence—leakage or gushing der empties during sleep, after drinking a of urine that follows a sudden, strong small amount of water, or when you touch urge water or hear it running (as when wash­ ing dishes or hearing someone else taking • nocturia—awaking at night to urinate a shower). Certain fluids and medications such as diuretics or emotional states such Functional Incontinence as anxiety can worsen this condition. Some People with medical problems that inter­ medical conditions, such as hyperthyroidism fere with thinking, moving, or communicat­ and uncontrolled diabetes, can also lead to ing may have trouble reaching a toilet. A or worsen urge incontinence. person with Alzheimer’s disease, for exam­ ple, may not think well enough to plan a Involuntary actions of bladder muscles can timely trip to a restroom. A person in a occur because of damage to the nerves of wheelchair may have a hard time getting to the bladder, to the nervous system (spinal a toilet in time. Functional incontinence cord and brain), or to the muscles them­ is the result of these physical and medical selves. Multiple sclerosis, Parkinson’s conditions. Conditions such as arthritis disease, Alzheimer’s disease, stroke, and often develop with age and account for injury—including injury that occurs during some of the incontinence of elderly women surgery—all can harm bladder nerves or in nursing homes. muscles. Overflow Incontinence Overactive Bladder Overflow incontinence happens when the Overactive bladder occurs when abnormal bladder doesn’t empty properly, causing nerves send signals to the bladder at the it to spill over. Your doctor can check for wrong time, causing its muscles to squeeze this problem. Weak bladder muscles or without warning. Voiding up to seven a blocked urethra can cause this type of times a day is normal for many women, incontinence. Nerve damage from diabetes but women with overactive bladder may or other diseases can lead to weak bladder find that they must urinate even more muscles; tumors and urinary stones can frequently. block the urethra. Overflow incontinence is rare in women. 3 Urinary Incontinence in Women Other Types of Incontinence The Types of Urinary Stress and urge incontinence often occur together in women. Combinations of Incontinence incontinence—and this combination in Stress Leakage of small amounts particular—are sometimes referred to as of urine during physi­ mixed incontinence. Most women don’t cal movement (coughing, have pure stress or urge incontinence, and sneezing, exercising). many studies show that mixed incontinence is the most common type of urine loss in Urge Leakage of large amounts women. of urine at unexpected times, including during Transient incontinence is a temporary ver­ sleep. sion of incontinence. Medications, urinary tract infections, mental impairment, and Overactive Urinary frequency and restricted mobility can all trigger transient Bladder urgency, with or without incontinence. Severe constipation can urge incontinence. cause transient incontinence when the Functional Untimely urination because impacted stool pushes against the urinary of physical disability, exter­ tract and obstructs outflow. A cold can nal obstacles, or problems trigger incontinence, which resolves once in thinking or communicat­ the coughing spells cease. ing that prevent a person from reaching a toilet. How is incontinence Overflow Unexpected leakage of evaluated? small amounts of urine The first step toward relief is to see a doc­ because of a full bladder. tor who has experience treating incon­ Mixed Usually the occurrence of tinence to learn what type you have. A stress and urge incontinence urologist specializes in the urinary tract, together. and some urologists further specialize in the female urinary tract. Gynecologists Transient Leakage that occurs tempo­ and obstetricians specialize in the female rarily because of a situation reproductive tract and childbirth. A uro­ that will pass (infection, tak­ gynecologist focuses on urinary and associ­ ing a new medication, colds ated pelvic problems in women. Family with coughing). practitioners and internists see patients for all kinds of health conditions. Any of these doctors may be able to help you. In addition, some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening. 4 Urinary Incontinence in Women To diagnose the problem, your doctor will functioning bladder muscles. To do this, first ask about symptoms and medical his­ you will urinate into a measuring pan, after tory. Your pattern of voiding and urine which the nurse or doctor will measure leakage may suggest the type of inconti­ any urine remaining in the bladder. Your nence you have. Thus, many specialists doctor may also recommend other tests: begin with having you fill out a bladder diary over several days. These diaries can • Bladder stress test—You cough vigor­ reveal obvious factors that can help define ously as the doctor watches for loss of the problem—including straining and dis­ urine from the urinary opening. comfort, fluid intake, use of drugs, recent • Urinalysis and urine culture—Labo­ surgery, and illness. Often you can begin ratory technicians test your urine for treatment at the first medical visit. evidence of infection, urinary stones, Your doctor may instruct you to keep a or other contributing causes. diary for a day or more—sometimes up to a • Ultrasound—This test uses sound week—to record when you void. This diary waves to create an image of the kid­ should note the times you urinate and the neys, ureters, bladder, and urethra. amounts of urine you produce. To mea­ sure your urine, you can use a special pan • Cystoscopy—The doctor inserts a thin that fits over the toilet rim.