Urinary Incontinence - Female
Leaking When You Laugh Is No Laughing Matter
Stress incontinence is the accidental leakage of urine that occurs when the abdomen contracts from sudden movements, such as sneezing, coughing, laughing, or exercise. It is the most common form of incontinence among women.
What is Female Stress Urinary Incontinence?
Urinary incontinence is the involuntary leakage of urine. The two basic forms of incontinence include urge incontinence and stress incontinence. This page covers stress incontinence, which is the most common. It occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine. Stress incontinence happens due to physical activity or increases in abdominal pressure (i.e. coughing, laughing, lifting).
What are the symptoms of Female Stress Urinary Incontinence?
Women with stress urinary incontinence may experience the following symptoms:
- Leakage with cough, sneeze, laugh, physical activity, intercourse
- A sudden and intense need to urinate
What causes Female Stress Urinary Incontinence?
Stress urinary incontinence (SUI) is the most common occurring form of incontinence in women under the age of 60 and accounts for more than half the cases. One in every two to three women in the U.S. experience SUI at some time in her life. While pregnancy and childbirth are the leading causes of SUI, there are other health factors that may put you at risk, too. They include:
- Anatomical predisposition
- Chronic coughing due to smoking and lung disease
- Hysterectomy (or any other surgery that affects your pelvic floor)
- Loss of pelvic muscle tone: this most often occurs with aging or childbirth
- Nerve and muscle damage from childbirth or surgical trauma
- Repeated heavy lifting or high impact sports
How is Female Stress Urinary Incontinence diagnosed?
What to know before your visit to MidLantic Urology in Philadelphia and surrounding counties:
- During your visit, your doctor will ask you questions regarding your medical history and will perform an exam. It is helpful to keep a bladder diary for at least three (3) days before seeing your physician. This will help inform your doctor of things like the severity of your bladder leaks and when you’re experiencing urine leaks, all of which may help to uncover any patterns happening with leakage. It is also helpful to bring a list of any medications, vitamins or other supplements you are taking to discuss with your doctor.
Other tests that may be performed during or after your visit:
- Urinalysis: this evaluates for any blood in the urine or infection
- Post-void residual: The physician will often ask you to void and then check to make sure you are emptying your bladder.
- Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the bladder
- Urodynamics: This is a test where a small tube is inserted into the urethra/bladder and another into the rectum to help measure the pressures in the bladder during urination.
How is Female Stress Urinary Incontinence treated?
There are many treatment options as well as simple management techniques that can help you get your life back the way you want it.
- Loss of Excess Weight: Obesity is a risk factor in developing stress urinary incontinence due to the extra pressure placed on the pelvic floor and the bladder. Following a healthy diet and losing weight can help ease symptoms.
- Smoking Cessation: Smoking can cause or contribute to many diseases, it’s also a real factor in the development of SUI. All that coughing can put stress on your pelvic floor and that can lead to muscle weakness and leakage.
- Pelvic Floor Muscle Exercises: Kegel exercises help to strengthen the pelvic floor muscles so you’re able to better hold in urine. It’s a good idea to see a physical therapist to get a proper evaluation and to learn how to do these exercises correctly.
- Biofeedback: Biofeedback is often done in conjunction with Kegels. A physical therapist may use a biofeedback instrument to measure your pelvic floor strength and monitor your improvement.
- Bladder Retraining: This involves timing your trips to the toilet and slowly increasing the length of time between each visit.
- Pelvic Floor Stimulation or E-Stim: This therapy delivers a small amount of electrical stimulation to the nerves and muscles of the pelvic floor and bladder to help them tighten or contract, thereby strengthening them.
- Injection Therapy: This technique uses a bulking agent that’s injected into the tissues around the urethra to help close the sphincter muscle without interfering with urination.
- Pessary: This is a ring-like device that your doctor will fit for you inside the urethra. The device helps to support the base of the bladder to prevent at most 50% of urine leaks. This is especially helpful for those who may have experienced a pelvic organ prolapse as it is not commonly used for stress incontinence alone.
- Topical Estrogen: Rarely prescribed to treat stress urinary incontinence due to low success rates, low dosage estrogen is administered vaginally to gently lubricate the tissues of the vagina. Many clinicians observe improvement in symptoms of SUI in many women. This should not be confused with Hormone Replacement Therapy (HRT), which has not proven to relieve incontinence in postmenopausal women.
- Mid-urethral synthetic sling (“sling procedure”): The most common procedure for stress urinary incontinence is a surgical mesh in the form of a “sling” permanently implanted beneath the urethra.
- Autologous fascial sling: The autologous fascial sling uses the patient’s own tissue, taken either from the abdominal region or the thigh, to create the sling that supports the urethra.
- Urethral bulking agents: A medication is injected inside the urethra to make the space around it thicker, thus helping to control urine leakage. The effects may not be permanent.