Guest Author - Denise Howard, M.D., M.P.H.

Urinary incontinence is a condition in which there is an involuntary loss of urine. This may occur with a stressful event such as coughing or laughing or it may occur when one develops the urge to urinate and leaks urine prior to making it to the bathroom. In some cases a woman may appreciate that she is wetting herself but is not able to identify the inciting factor. There are different types of urinary incontinence. This article will focus on the 3 types that are more prevalent in otherwise healthy community dwelling women.

Stress urinary incontinence occurs when there is leakage of urine as a result of a sudden increase in abdominal pressure. This sudden increase can be caused by coughing, laughing, sneezing, jumping, exercising, walking and sudden movements. Urge incontinence occurs when there is leakage of urine associated with a sudden strong urge to urinate. When this occurs, the urge to urinate can not be suppressed and urine is forced out before the toilet can be reached. In many cases a woman may experience both types of incontinence. The term “mixed incontinence” is used to describe this problem.

Urinary incontinence occurs in 35-60% of women. The prevalence is higher in older women and in women who have delivered their children vaginally. The many shelves of protective pads and undergarments seen in the grocery stores and pharmacies are a testimony to the extent of this problem.

Major risk factors for this condition are childbirth, pelvic trauma, and obesity. This problem can be exacerbated by muscle disuse, certain medical conditions, aging, and weight gain. The muscles, nerves and connective tissue of the pelvis are damaged at the time of childbirth or surgery resulting in inadequate support of the pelvic floor and poor control over bladder function.

The decision to seek care is usually dependent on the severity of the problem as well as its impact on one’s quality of life. A sedentary woman may have infrequent episodes of stress urinary incontinence but a woman who exercises may have many more occurrences. This woman can either elect to stop exercising or seek care. A woman who stays at home most of the time can empty her bladder frequently, thereby avoiding episodes of urinary urgency. On the other hand, a woman who is socially active and always on the go may not have the opportunity to urinate more frequently thus she is more likely to experience episodes of urge incontinence. She can elect to stay at home more or seek care.

A comprehensive evaluation is required to identify the problem and to make recommendations for treatment. Urogynecologists are specialists trained to care for women with pelvic floor disorders such as urinary incontinence. The specialty is now referred to as Female Pelvic Medicine and Reconstructive Surgery. Certain Gynecologist and Urologist also have an interest in caring for women with urinary incontinence. It is important to identify a specialist who cares for a large volume of women with these problems so that you can be provided with a thorough evaluation and offered a full range of treatment options.
Treatment options may include medication, dietary changes, pelvic floor muscle rehabilitation, in-office procedures or minimally invasive surgical procedures. The success rates for some procedures can be as high as 92% and the recovery period as short as a few days to 2 weeks. The complication rates are quite low and the hospitalization period as short as a few hours to 1 day.

If you are experiencing these problems, I encourage you to consult with a specialist. The evaluation will entail a thorough history and physical examination. Comprehensive pelvic floor testing may be required. These tests are usually painless. The physician can then discuss a proposed treatment plan and you can decide which therapy is right for you.