Incontinence in Women
Incontinence is the accidental leakage of urine. It is often caused by coughing, sneezing or other physically-straining activity although it can also result from neurologic disorders and anatomic abnormalities. It’s not a disease but it is bothersome and can represent a symptom of a serious problem within the urinary system.
Urine is stored in the urinary bladder. The urinary bladder is an elastic organ located just behind the pubic bone. The bladder is made of layers of muscles, which allow it to stretch. Urine produced by the kidneys is stored in the bladder allowing urination to be infrequent and voluntary. A tube called the urethra leads from the bladder to the outside of the body. The urethra in women is a muscular tube that carries urine from the bladder to exit the body in the vaginal area. The urethra passes through a ring of muscles called the urinary sphincter. As the bladder fills, nerve signals tell the sphincter to stay squeezed shut while the bladder stays relaxed. When you urinate, nerve signals tell the muscles in the walls of the bladder to squeeze, forcing urine out of the bladder and into the urethra. At the same time, the bladder squeezes, the urethra relaxes, allowing urine to pass through the urethra and out of the body. The urethra works with the bladder to store urine properly.
Different types of neurological disorders, metabolic diseases (such as diabetes), medications, and prior pelvic surgeries can cause incontinence due to underlying problems with the bladder, urethra, and/or the surrounding muscles.
There are several types of incontinence in women:
- Stress incontinence, linked with exertion or some physical action such as coughing, sneezing or changing position
- Urge incontinence (aka an “overactive bladder”) — a sudden, uncontrollable urge to urinate, often frequently and even during sleep
- Mixed incontinence is a mixture of both stress and urge incontinence; most patients incontinence actually suffer from mixed incontinence.
- Unaware incontinence is linked to the brain, spinal cord, nerves and/or ganglia; patients are unaware of leakage because of impaired sensation or awareness
- Overflow incontinence is leakage resulting from a bladder that doesn't contract properly, causing it to expand to maximum capacity, at which point urine leaks out
Treatment Options
Treatment for incontinence in women depends on the type of condition.
For stress incontinence, exercising the pelvic muscles used to hold in urine and stool can help. Surgery may also be an option: either to place a small "sling" to help support the urethra (minimally invasive, performed through the vagina) or to inject material under the urethral lining to restore its bulk, allowing it to close properly.
For urge incontinence, pelvic muscle exercises can be helpful, as can lifestyle changes such as moderating fluid intake and urinating on a set schedule. Medications in conjunction with these efforts can also be very helpful.
If medicine, exercise and behavioral changes don't work, a minimally invasive procedure called sacral neuromodulation may help. Surgeons place A small implantable device that influences the bladder nerves to reduce symptoms.
Patients with severe urge incontinence who fail less invasive therapies may also benefit from surgery to enlarge the bladder using a section of the bowel.
Treatment for mixed incontinence involves combinations of the approaches for stress and urge incontinence. Treatment for unaware or overflow incontinence varies depending on diagnostic evaluation and the specific causes.
UMass urologists have received advanced urological training for treating male urinary incontinence. We offer the latest minimally invasive surgical as well as non-surgical techniques and our urologists have expertise in robot-assisted surgery. For an appointment with one of our experts please call 1-508-334-8765.