What is Urinary Incontinence?
Do you catch yourself saying, “I have to go right now?” Are you struggling to control your bladder?
If you're experiencing the inability to control your bladder, you’re not alone.
Urine leakage or urinary incontinence (UI) is a common condition that many women and some men encounter. While prevalent, it is not normal at any age and should be something you consult with your medical provider about.
With approximately 30-50% of women experiencing urinary incontinence at some point during their lifetime, it’s essential to know what it is and how to treat it.
Problems with bladder control are serious health issues, and they can affect the way you live your life.
Do I have Incontinence?
Are you unsure whether or not you may be experiencing a loss of bladder control? Consider the questions below:
- Are you worried about laughing, coughing, sneezing, or lifting heavy objects because it may result in leakage?
- Do you experience pressure or a bulging feeling in your vagina?
- Has your urine stream become weakened or turned into a spray?
Symptoms and Types of Urinary Incontinence
There are 7 different types of urinary incontinence that produce a range of symptoms.
Types of Urinary Incontinence
- Stress Incontinence: Stress incontinence is urine leakage due to abdominal pressure. It can be caused by laughing, coughing, sneezing, or physical activity.
- Urge Incontinence or Overactive Bladder (OAB): Urge incontinence, or OAB, is characterized by an inability to hold urine long enough. It is described as a sudden urge to urinate, oftentimes followed by urinary leakage.
- Mixed Incontinence: Mixed incontinence is the presence of multiple contributing factors for urinary incontinence. This may include having both stress incontinence and urge incontinence.
- Overflow Incontinence: Overflow incontinence occurs when the bladder’s capacity to hold urine is not there, resulting in small or frequent leakage of urine. It is usually caused by an obstruction or blockage that prevents the bladder from emptying properly.
- Functional Incontinence: Functional incontinence is leakage caused by the inability to reach the restroom in time. While seemingly similar to urge incontinence, functional incontinence is prompted by physical conditions such as arthritis or using a walker or wheelchair.
- Fistula: Fistula occurs when there is an abnormal connection between the vagina and the urinary tract. It is usually caused by surgery, trauma, or radiation.
- Diverticulum: Diverticulum is characterized by the collection of urine within a pouch in the urethra and leads to leakage.
What is the difference between stress incontinence and urge incontinence?
The two most common types of urinary incontinence are stress incontinence and urge incontinence. Let’s discuss each in more detail and what makes them different from one another.
What is stress incontinence?
Stress Urinary Incontinence (SUI) is caused by leakage of urine during physical activities. Once an increase in abdominal pressure occurs within the bladder, it quickly fills with liquid, causing stress on the bladder which leads to leakage.
Some activities that cause SUI include:
- Lifting heavy items
- Physical activities such as walking, jogging, and running
What is urge incontinence?
Urge incontinence or overactive bladder (OAB) is characterized by the quick, sudden urge to urinate.
Having an overactive bladder means that the bladder no longer holds urine normally. This can make it difficult to reach the restroom in time.
OAB occurs when the bladder muscles send information to the brain notifying that it’s full even when it’s not. These signals make the bladder contract which causes leakage.
Symptoms of urge incontinence include:
- Leaking at unwelcome times
- Severe urgency to urinate
- More than 8 voids in 24 hours
- Experiencing a “gotta-go-now” sensation
- Urinating more than twice during the night
Learn more about the difference between these two common incontinence disorders.
Severity of urinary incontinence
The severity of urinary problems varies from person to person, and what is a minor inconvenience to one might be a serious issue to another. In severe cases, the impact on life means that a person may limit their social activities and no longer enjoy spending time outside of their home. If this is the case for you, we urge you to make an appointment with a Metro OBGYN provider ASAP.
Causes and Risks of Urinary Incontinence
Urinary incontinence is not a disease, it’s a symptom. This means it is caused by underlying medical conditions or physical problems.
There may also be certain foods or beverages that are encouraging UI issues such as diuretics which stimulate your bladder and increase the volume of urine produced.
The following can cause temporary urinary incontinence:
- Carbonated beverages
- Spicy, sugary, and acidic foods
- Certain medications for high blood pressure and heart conditions
- Large amounts of vitamin C
What is the risk of having urinary incontinence during your lifetime?
It’s important to discuss the risk of having urinary incontinence. There are some factors that cause some women to experience UI more than others, including genetics, health conditions, and life events.
Genetics sometimes come into play if you are born with a weaker pelvic floor or certain health conditions. Those who have a familial link to urinary incontinence will be at greater risk for developing bladder control issues. According to a University of Gothenburg study, genetics can account for up to half of an individual’s risk of developing incontinence.
Certain health conditions can put you at higher risk for developing urinary incontinence.
Health conditions that may increase your risk of UI include:
- Chronic constipation
- Lung conditions
- Neurological conditions
- Kidney or bladder stones
If you are suffering from any of these health conditions and experiencing incontinence, talk to your provider about ways you can achieve relief.
Various life events can also increase your risk for developing UI.
Certain life events can lead to different forms of incontinence:
- Being pregnant
- Childbirth (vaginal delivery)
- Accidental injury
Various lifestyle choices can also cause an increased risk for urinary incontinence over time
- Drinking excessive amounts of caffeine
- Physical activities such as heavy lifting
Unfortunately, not all bladder control issues can be attributed to a specific cause. However, relief is often possible through treatment.
Non-Surgical and Surgical Treatments for Urinary Incontinence
With a wide range of non-surgical and surgical procedures available, many women find relief from their UI symptoms through one or more of the options below.
Non-surgical treatments for UI include medication, lifestyle changes, behavioral changes, alternative options, and devices. We’ll outline each below:
Medicines can help control how the bladder functions. There are a wide variety of options available on the market.
Medications relieve urinary incontinence by:
- Blocking muscle spasms in the bladder
- Calming nerve signals to the bladder
It’s best to talk with your provider about whether or not certain medications are a good fit for you.
There are a few additional non-surgical treatment options to discuss with your provider if medication does not work.
Changing aspects of your lifestyle may help reduce your symptoms of incontinence.
- Maintain a healthy weight: The more overweight you are, the more likely you are to develop incontinence. As a result, it’s best to maintain a healthy weight to keep symptoms at bay. You can speak with your provider about the best ways to reduce or maintain weight for your body type.
- Limit foods and drinks that irritate your bladder: Foods or beverages that cause bladder irritation can increase your potential for developing urinary incontinence. While it’s important to limit the consumption of things like caffeine, alcohol, and sugary beverages, don’t limit your water intake.
- Avoid smoking: Smoking is not good for your health and can also cause issues with urinary incontinence. Speak with your provider about ways you can quit.
Similar to lifestyle changes, there are also behavioral changes you can make to help with incontinence.
- Pelvic floor muscle exercises: Pelvic floor exercises are a great way to strengthen your pelvic muscles. Strengthening your pelvic floor with kegels, yoga, or pilates can prevent urinary incontinence.
- Scheduled toilet trips: You may consider scheduling your trips to the toilet to help regulate when you go to the bathroom. Work with your provider to come up with a good system to get you back to feeling your best.
- Intermittent catheterization: If you’re unable to empty your bladder properly, using a catheter every once in a while may help. Discuss this method with your provider.
- Absorbent pads: You may find that using absorbent panty liners, disposable underwear, and pads can help get you back to enjoying social activities without worrying about accidents and leakage.
- Bladder retraining: You can retrain your bladder by holding off urinating until a set time. Start in small time increments like 20 to 30 minutes and then work your way up to 2-4 hours between trips to the bathroom.
There are two alternative medicine options that can potentially reduce your incontinence symptoms: biofeedback and acupuncture.
- Biofeedback: Biofeedback uses different devices to identify how the pelvic muscles are contracting. Biofeedback is completed by a physical therapist and involves touching the contracted muscles, connecting small sensors to the vagina, rectum, abdomen, and legs, and using vaginal weight training. These techniques can help strengthen and thus improve control of your pelvic muscles.
- Acupuncture: Inserting tiny needles into the surface of your skin can help to stimulate the nerves around your pelvic floor and alleviate incontinence by helping you regain control of your pelvic muscles.
Various vaginal devices can help achieve greater bladder control and/or prevent leakage.
- Urethral plug
- Vaginal pessary
These devices are inserted into the vagina to lift the bladder by applying compression, thus stopping the cause of leakage. They are a low-risk treatment option that can be administered in the doctor’s office or at home. Furthermore, these devices combat other pelvic issues such as
pelvic organ prolapse, uterine prolapse, and bowel control.
Learn more about non-surgical UI treatment options in our blog post Non-Surgical and Surgical Options for Urinary Leakage.
If non-surgical options do not work, there are a few non-invasive procedures that may reduce incontinence.
Nerve stimulation involves sending small electrical currents to your bladder or pelvic floor. Two types of nerve stimulation help improve nerve sensation and strengthens the pelvic muscles:
- Percutaneous Tibial Nerve Stimulation (PTNS): PTNS delivers small electrical currents near your ankle. This less invasive procedure is completed through multiple treatments which help stimulate the nerves of the pelvic muscles.
- Sacral Nerve Stimulation (SNS): SNS delivers electrical stimulation to your sacral nerves through a device implanted in your buttocks. SNS is similar to a pacemaker and is an effective procedure which improves the symptoms of UI.
With a low complication rate, many women find injections to be a more desirable option than surgery.
- Urethral bulking agents: During this procedure, a long-acting gel or paste-like substance is injected into the muscular walls of the urethra. Once inserted, the bulking agents narrow the urethra to reduce urine leakage.
- Botulinum toxin (Botox®): Botox A, commonly used in cosmetic care, can also be an effective incontinence treatment. During this treatment, a series of Botox injections are made into the bladder or pelvic floor region. The use of Botox paralyzes the bladder muscles which then decreases the feeling and sensitivity of needing to urinate.
Benefits of injections include:
- Less invasive than surgery
- Does not require incisions
- Low complication rate
- Performed in a doctor’s office on an outpatient basis
Injection risks include:
However, as with any medical procedure, there are risks.
- Post-procedure urinary retention
- Urinary tract infection
- Hematuria (blood in urine)
- Temporary body weakness
Discuss the risks and benefits of injections with your provider to find out if bulking agents or Botox are good options for you.
In severe cases, or when non-surgical options have been unsuccessful, surgery for urinary incontinence may be needed.
There are three different types of surgical treatments provided by Metro OBGYN to treat urinary incontinence:
- Vaginal repairs
- Vaginal mesh repairs
- Robotic sacrocolpopexy
Your provider will evaluate your condition and symptoms to determine which treatment option is best for you and your lifestyle.
Learn more about surgical options for incontinence in our blog Treatment Options for Overactive Bladder.
Stay Proactive with Your Pelvic Floor Health
It’s important to be proactive when it comes to the health of your pelvic floor. While urinary incontinence may not be entirely preventable, there are several ways to alleviate the issue:
Identifying Your Pelvic Muscles
Being aware of where your pelvic muscles are located is the first step to strengthening your pelvic floor. But, how do you locate your pelvic muscles? There are three different ways to find your muscles:
3 ways to locate your pelvic muscles:
- Locate the muscles surrounding your bladder opening by starting and stopping a stream of urine. If you can stop the flow of urine mid-stream, you’ve used your pelvic floor muscles.
- Locate the muscles around your back passage (rectum). If you can tighten these muscles by holding wind (gas) or at the end of a bowel movement, you’ve used your pelvic floor muscles.
- Locate your muscles when you properly squeeze your pelvic floor by engaging muscles in an upward motion. If you can feel the upward movement of your muscles, you’re using your pelvic floor muscles.
Pelvic Floor Exercises
Exercising your pelvic floor will help strengthen muscles, allowing you to control your bladder and bowel better, and can also alleviate discomfort. Pelvic floor exercises may include:
- Kegels: Often referred to as “pelvic floor exercises”, Kegels are ideal for women of all ages. Kegels involve tightening your muscles as if you were sitting on a marble and then lifting that marble up to strengthen your pelvic floor muscles from the inside. You can incorporate Kegels into your daily routine by completing three sets of 10-15 repetitions.
- Pilates: Pilates utilizes both slow and fast movements. Many of these exercises reinforce the muscles surrounding the pelvis which can help strengthen the pelvic floor and reduce symptoms of incontinence.
- Yoga: Yoga helps to strengthen pelvic floor muscles, improve balance, and is a great way to meditate.
Want to learn even more about pelvic health and how to keep your pelvic muscles strong? Check out our blog How to Strengthen Your Pelvic Muscles.
Female pelvic health and reconstruction
Incontinence can often seem embarrassing. If you’re hesitant to disclose your incontinence issues to your provider, remember that you’re not alone and it’s nothing to hide.
The first step to taking back your life is speaking with a pelvic floor specialist about your pelvic health. Here are several steps you can take to prepare for your visit with a specialist.
Metro OBGYN providers are experts in treating conditions such as urinary incontinence. Should you and your provider determine that surgery is your best option, rest assured that our specialists are leaders in pelvic floor reconstructive surgery, including laparoscopic and robotic approaches.
Specialized training and expertise in pelvic health
Metro OBGYN's care team includes two leading experts in female pelvic medicine and reconstructive surgery, Dr. Kevin A. Hallman and Dr. Ron Mjanger.
Dr. Hallman and Dr. Mjanger are experienced providers specializing in women’s health. They are:
- Board-certified Fellows in the American College of Obstetricians and Gynecologists (FACOG)
- Board-certified inaugural Fellows in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery (FPMRS)
Our specialists have extensive experience treating all conditions related to the female urinary and reproductive tract. Learn more about female pelvic health in our blog 15 FAQs about Urogynecology.
Nearly one in four women will experience pelvic floor symptoms at some point in their lifetime. Consult with one of our specialists to explore treatment options or to learn more about pelvic floor disorders.