Ask The Doctor: What is Urinary Incontinence?

By Susan A. Hobson MD, PhD

Q: What is urinary incontinence?

Do you avoid running, lifting, or jumping on a trampoline for fear of getting wet? Or do you find you make sure you know where the bathroom is wherever you go so that you don’t have accidental leakage? If either or both of these situations sound familiar, you have urinary incontinence.

Simply put, urinary incontinence is the involuntary loss of urine, a common but seldom-discussed problem. It is more common as we age, but it is important to know that it is not a normal part of aging. In fact, it is never normal. While some women may have this infrequently and consider it a minor nuisance, for other women it can be very socially, psychologically, and physically distressing.

Q: What causes urinary incontinence?

There are several causes of urinary leakage. Knowing which type of leakage is occurring is an important step toward preventing it.

One of the most common types of leakage is called stress urinary incontinence. This type of leakage occurs with activity—such as running, lifting, and even sneezing—and is caused by a sudden increase in pressure in the abdomen. The urethra—the tube from the bladder through which urine passes—is usually held closed during activity to prevent leakage of urine during times of increased abdominal pressure. In some women, however, the seal becomes weak and opens with these increases in pressure, allowing urine to leak.

Another common type of leakage is called urge urinary incontinence. This is part of a condition referred to as “overactive bladder.” Overactive bladder can cause urinary frequency and the sudden, strong urge to urinate. When leakage actually occurs, we refer to it as urge urinary incontinence; it often happens in response to triggers, such as running water, driving into the driveway, or just spontaneously. Sometimes the leakage occurs on the way to the bathroom or just prior to sitting down on the toilet. Women often wonder Is it in my mind? because it will start just after they have thought about the bathroom. The problem is actually in the bladder; it is as if the bladder is eavesdropping on the brain and then running ahead without permission.

Overactive bladder can be caused by irritations to the lining of the bladder, such as diet, tobacco, or a kidney stone. Rarely, overactive bladder can be a sign of a neurologic disorder or growth in the bladder. Another source of bladder overactivity is postmenopausal vaginal dryness from lack of estrogen. The pelvic floor muscles can also contribute to bladder overactivity if they are inflamed or in spasm. For about half of women with overactive bladder and urinary urge incontinence, no identifiable cause is found.

It is also common for women to have both causes of leakage at the same time, and each has to be addressed appropriately.

There are other, less common causes of urinary leakage. If you have leakage that does not seem to fit into any of the above categories, you should discuss the symptoms with your physician.

Q: Is treatment available?

Yes. The vast majority of women are significantly improved or cured of leakage after seeking appropriate treatment. The treatment will vary depending on the cause of leakage and a woman’s individual preferences.

Stress urinary incontinence. This condition occurs due to a weakening of the support structures under the urethra. It can often be improved or cured with muscle exercises known as Kegels. The American Urogynecologic Society website has written instructions for doing Kegels that women can access (www.voicesforpfd.org/p/cm/ld/fid=12). It often takes three to six weeks of regular exercises before improvement is noted. Some women require additional evaluation and specialized instruction from a pelvic floor physical therapist to get optimal results.

For some women with stress urinary incontinence for whom therapy is not the answer, there are nonsurgical options that rely on mechanical support of the urethra. This can be as simple as wearing a tampon during exercise: the presence of the tampon applies pressure to the urethra through the vaginal wall. Another method of mechanical support is called a pessary—a sturdy, silicone device shaped like a diaphragm that sits comfortably in the vagina to support the urethra. This can be used throughout the day or be placed just prior to exercise.

Surgery may be the best option for some women with stress urinary incontinence. Luckily, current surgical repairs are highly effective, long lasting, and often minimally invasive.

Urge urinary incontinence and overactive bladder. Many women are able to identify items in their diet that irritate the bladder, and simply avoiding those items can greatly improve their continence. Common bladder irritants are citrus, tomatoes, caffeine, carbonation, and alcohol. Tobacco smoking can also cause bladder irritation. If other sources of irritation are identified, such as a urinary tract infection, a lack of estrogen, or overactive pelvic floor muscles, treatment of these conditions will improve symptoms. Some women respond to bladder “retraining” and physical therapy as well.

Women who are unable to determine the cause of urge urinary incontinence and overactive bladder should see their healthcare provider; a bladder control medication will usually improve their symptoms.

Q: Can lifestyle modification (such as exercise and food and beverage choices) help alleviate urinary incontinence?

For stress urinary incontinence, just being generally physically fit (even without doing Kegels) can decrease symptoms of urinary incontinence. Doing Kegels on their own also benefits many women. Although women can avoid the activities that cause leakage, my hope is that they seek help before making these types of lifestyle modifications so that they do not become less active. Being of normal weight for your height can also improve continence; even a proportionately small loss of weight when one is overweight can decrease leakage for some women. Urge urinary incontinence and symptoms of overactive bladder can also be improved through lifestyle modifications for many women. This might include the dietary modifications noted above; it may also include not drinking fluids in excess in general and not drinking large amounts right before bedtime.

We also work with women to retrain the bladder by putting off going to the bathroom for longer periods of time. If lifestyle modification does not improve symptoms or if you have any of the warning signs listed below, you should see a physician.

Q: What else should I know about urinary incontinence?

Infrequently, urinary incontinence can be an indication of a more serious underlying problem. Warning signs of a more serious issue include:

  • Sudden severe leakage
  • Blood in the urine
  • New leakage associated with any other new complaint, such as back pain, numbness, or pelvic pain

If any of these warning signs are present, you should see your healthcare provider for an evaluation to ensure that the leakage is not due to a more serious underlying health problem. Urinary incontinence is very treatable and should not stop a woman from living her life to the fullest. Eighty-five to 90 percent of women with incontinence can be made much better or cured. So if you have urinary leakage, know that you can get help, get dry, and get back to living your life!