Urinary Incontinence in Women

Millions of women experience involuntary loss of urine called urinary incontinence (UI). Women experience UI twice as often as men. Pregnancy and childbirth, menopause and the structure of the female urinary tract account for this difference, but anyone can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis and physical problems associated with aging.

Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Urine loss can also occur during sexual activity and cause tremendous emotional distress. Many women experience more than one symptom. UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends.

Older women experience UI more often than younger women, but incontinence is not inevitable with age. Urinary incontinence is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.

Types of Urinary Incontinence

Stress: Leakage of small amounts of urine during movement (coughing, sneezing, exercising)

Urge: Leakage of large amounts of urine at unexpected times, including during sleep

Overactive Bladder: Urinary frequency and urgency, with or without urge incontinence

Functional: Untimely urination because of physical disability, external obstacles or problems in thinking or communicating that prevent you from reaching a toilet.

Overflow: Unexpected leakage of small amounts of urine because of a full bladder

Mixed: Usually the occurrence of stress and urge incontinence together

Transient: Leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing)

How Is Incontinence Detected and Evaluated?

The first step toward relief is to see a doctor. Your family physician or your gynecologist can initiate an evaluation, or you may choose to visit a urologist, a specialist in the urinary tract, to learn more about your symptoms and how they can be treated. Tools for diagnosing your problem may include:

• Explaining your symptoms and medical history
• Evaluating your urine specimen for abnormal substances, such as protein or signs of infection
• Keeping a bladder diary to identify your pattern of voiding and urine leakage
• A physical exam for signs of medical conditions causing incontinence
• Urodynamic testing

Urodynamic Testing

Your doctor may recommend urodynamic testing to evaluate the storage of urine in the bladder and the flow of urine from the bladder through the urethra, especially if you are having symptoms that suggest problems with the muscles or nerves of your lower urinary system and pelvis (ureters, bladder, urethra, and sphincter muscles). Urodynamic testing may include:

• Uroflowmetry: The patient voids into a special commode chair that measures the rate, volume and time and gives a pattern for review.
• Cystometrogram (CMG): A dual lumen catheter is placed in the patient’s bladder and a catheter is placed in the vagina or rectum, then sterile water is instilled in the bladder. During this time pressures are obtained, including vesical pressure, detrusor pressure and abdominal pressure. During filling, sensations of the bladder  are noted.
• Voiding Pressure Study: Immediately after filling the patient’s bladder, he or she is given the opportunity to void, and the previous pressures are measured during voiding.
• Leak Point Pressure: This measures the amount of abdominal pressure that causes a patient to leak urine. During the filling phase, the patient is requested to cough to see if leaking occurs. This may be repeated several times.
• Sphincter Electromyogram (EMG): Electrodes are placed around the anus to record the electrical activity of this area. This test is performed simultaneously with CMG.

Scheduling Urodynamic Testing

Urodynamic studies are performed daily at Cabell Huntington Hospital. Common reasons for having the tests include any of the different kinds of incontinence, as well as neurological conditions such as multiple sclerosis or spinal cord injury.

Your physician can order the study by providing a written order that includes a clinical reason for performing the test. Please have your physician's office call 304-526-6089 or 304-526-2125. You must register at the Registration Desk in the hospital lobby prior to having the study performed. The only preparation for you as a patient is to have a comfortably full bladder upon arrival.

Treating Incontinence

A written report of your test results is sent to your physician, who will discuss the results with you. Based on this report and the discussion with your physician, your treatment plan may include:

• Behavioral Remedies: bladder retraining and Kegel exercises
• Medication or Injections
• Biofeedback: using measuring devices to help you become aware of your body's functioning
• Neuromodulation: stimulation of nerves to the bladder
• Catheterization
• Surgery

Don't let life pass you by because you are embarrassed or afraid to mention this problem to your doctor! You may discover that your urinary incontinence can improve with treatment. Please take the first step and share your concerns with your healthcare provider.

• Last updated: 09/05/2012
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