Urinary Incontinence -- Female
(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)
- Stress incontinence—most common type. Leakage occurs when there is extra pressure on the bladder. Triggers may include laughing, sneezing, lifting heavy objects, or exercise.
- Urge incontinence—known as overactive bladder, a loss of bladder control following a strong urge to urinate. The bladder is unable to hold urine long enough to make it to a restroom.
- Overflow incontinence—the bladder will not empty, so urine builds up and the bladder overflows.
- Functional incontinence—there is normal bladder control, but the toilet can't be reached in time.
- Muscle weakness
- Restricted mobility
- Endocrinological disorders such as diabetes
|Muscles Involved in Incontinence in Women|
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Stress incontinence is an accidental loss of urine during physical activity or coughing, sneezing, and laughing. It may be caused by:
- Weakening of muscles that suspend the bladder
- Weakening of muscles that control urine flow
- Urge incontinence is the accidental loss of urine when the bladder spasms for no reason. It may be caused or worsened by:
Overflow incontinence is leaking of urine due to overfilling up and overflowing from bladder. It may be caused or worsened by:
- A bladder that is blocked, such as by a scar in the urethra
- Fecal impaction
- Drugs such as antidepressants, hypnotics, antipsychotics, antihistamines, or calcium channel blockers
- Vitamin B12 deficiency
- Weak bladder muscles
Nerve damage due to:
- Spinal cord injuries
- Other factors
Functional incontinence may be caused by:
- Medical conditions that make it difficult to move like severe arthritis
- Drugs that cause confusion or sedation
- Childbirth—History of multiple pregnancies or vaginal deliveries
- Urinary tract infection
- Chronic lung disease
- Previous hysterectomy or urethral surgery
- Pelvic organ prolapse
- Dementia, including Alzheimer’s disease
- Multiple sclerosis
- Spinal cord injury or disease
- Use of certain substances such as caffeine, alcohol
- Use of certain medications, such as cholinergic agents or alpha-agonists
When Should I Call My Doctor?
- Blood tests
- Urine tests
- Stress test
- Urodynamic tests
- Limiting the amount of fluids consumed throughout the day.
- Decreasing caffeine—caffeine has been linked to worsening of urinary incontinence.
- Planning frequent bathroom trips throughout the day to prevent accidents.
- Kegel exercises —focuses on muscles that hold the bladder in place and those that control urine flow.
- Painless electrical stimulation—may strengthen the muscles more quickly; helpful for stress incontinence.
- Pelvic floor exercises using cone-shaped weights that are placed in the vagina.
- Biofeedback—a device signals how strong you are at contracting your muscles during exercise.
- Placement of strips of material or sutures to support structures in the area and relieve pressure on the urethra. There are several different types of surgery but a common option, called a urethral suspension uses mesh to help support the urethra.
- Collagen injection into the wall of the urethra. This substance bulks up the wall of the urethra to help stop leaks.
- Drinking less fluid throughout the day
- Avoiding caffeine and alcohol
- Avoiding drinking at bedtime
- Keeping a log of urination schedule and accidents.
Other Management Steps
- If advised by your doctor, do exercises to strengthen your pelvic floor muscles, such as Kegel exercises. This is especially important if you are pregnant.
- Reduce your intake of substances that lead to incontinence such as caffeine, alcohol, and certain drugs.
- Lose weight, if needed.
- Eat a healthy diet to avoid constipation.
Urology Care Foundation http://www.urologyhealth.org
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov
Health Canada http://www.hc-sc.gc.ca
Women's Health Matters http://www.womenshealthmatters.ca
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2/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.
1/11/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: AHRQ evidence report on treatment for overactive bladder in women 2009. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov. Published August 2009. Accessed January 11, 2010.
3/5/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Vardy MD, Mitcheson HD, Samuels TA, et al. Effects of solifenacin on overactive bladder symptoms, symptom bother and other patient-reported outcomes: results from VIBRANT—a double-blind, placebo-controlled trial. Int J Clin Pract. 2009;63(12):1702-1714.
12/3/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK. Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.
12/13/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. Recommendations for the management of urge urinary incontinence in women. Agency for Healthcare Research and Quality website. Available at: http://www.guideline.gov/content.aspx?id=16322. Published May 2010. Accessed December 13, 2010.
3/5/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012 Oct 17;10:CD007471.
4/29/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Chang SR, Chen KH. Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum. Obstet Gynecol. 2014;123(3):568-577.
7/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mangera A, Apostolidis A, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981-990.
- Reviewer: Adrienne Carmack, MD
- Review Date: 12/2013 -
- Update Date: 07/28/2014 -