What Causes Urinary Incontinence in Women? From our Healthcare Partner, Scripps

Urinary incontinence usually involves problems with the muscles and nerves that help the bladder hold or pass urine.

“Your doctor should complete a thorough evaluation before planning treatment,” says Dr. Raizada.

What causes urinary incontinence?

Urinary incontinence affects twice as many women as men. It is more common as women advance in age and it is also due to multiple factors.

According to the US Office on Women’s Health, 4 in 10 women, aged 65 and older, suffer from urinary incontinence.

Family history, childbirth trauma, lifestyle choices, obesity in addition to advancing age may contribute to urinary incontinence in women of all ages. Four in 10 women get urinary incontinence during pregnancy, though it usually goes away after childbirth. These life events that are unique to women may affect the bladder, urethra and other muscles that support these organs.

“The bladder is a complex structure,” Dr. Raizada says. “When we release urine, the body of the bladder pushes the urine and the neck of the bladder simultaneously relaxes. When we need to store urine, the opposite happens. The body of the bladder relaxes and the neck the bladder tightens to hold the urine in the bladder. Any disruption in the process can lead to bladder disease.”

There are two major types of urinary incontinence: urge and stress. Women who have both have what is called mixed incontinence.

Urge incontinence becomes more common with advancing age. It occurs when an overactive bladder abruptly contracts, causing a strong, sudden urge to urinate with little control. “Often, you’re running to the restroom and even before you get there, there is a loss of urine and you’re having accidents,” Dr. Raizada says.

Stress incontinence is the result of a weak bladder neck. Women lose urine with activities like laughing, coughing, sneezing or exercising. “It has nothing to do with mental stress, but it can cause mental stress,” Dr. Raizada says. “It has more to do with physical pressure or stress on the bladder.”

A complete history and physical exam are usually done to identify the cause of a bladder control problem. Your doctor may refer you to a urologist or a urogynecologist if more specialized testing is needed.

 An evaluation may include:

• Urine test to check for infection and other causes of incontinence
• A post-void residual urine test to assess amount of urine left in bladder after urinating
• Keeping a diary to track how often you urinate and leak
• Ultrasound to take pictures of the kidneys, bladder and urethra
• Bladder stress test, which involves coughing to examine loss of urine
• Cystoscopy, which uses a thin tube with a tiny camera, to look for damaged tissue in the urinary tract
• Urodynamics, which involves inserting a thin tube into bladder, filling it with water and checking how much fluid bladder can hold

Many times, lifestyle changes that can be done at home can halt or improve the condition, including:

• Pelvic floor exercises (Kegel exercises)
• Losing weight to reduce pressure on the bladder
• Training your bladder by scheduling bathroom visits
• Treating constipation by eating more fiber
• Limiting drinks with caffeine, carbonation or alcohol
• Quitting smoking

Kegel exercises are exercises to strengthen the pelvic floor muscles and improve bladder control. Four in 10 women improve their symptoms after trying Kegels.

“Urinary incontinence is caused by weak muscles along the urinary tract. It’s important to know that you can improve those muscles,” Dr. Raizada says, citing one common treatment.

“They are easy to do,” says Dr. Raizada. “You lie down and squeeze the muscles you use to stop a stream of urine and then relax those muscles and repeat this exercise. A doctor, nurse, or pelvic floor physical therapist can help you with this proven technique.”

Your doctor may also recommend one or more of the following treatments if what you’re doing at home is not enough:

• Medication to help relax bladder muscles and increase amount of urine bladder can hold
• Botox injections in the bladder, also to relax bladder muscles and increase amount of urine bladder can hold
• Biofeedback

In certain situations, and under proper doctor care, surgery is an option. It is generally not recommended if you plan to get pregnant in the future.

For symptoms of stress leakage, a mid-urethral sling can be a very effective surgery. “You go home the same day and if you have a desk job you can start work the following week,” Dr. Raizada says.

For symptoms of urge leakage, electrical stimulators can be effectively used to restore bladder function. This surgery also goes by the name of sacral neuromodulation. It is a go-home the same day surgery as well.