This post contains affiliate links, which means the website may earn a small commission at no extra cost to you if you make a purchase through them. The HerHealth101 team only recommends products that align with our mission to support women’s health, and is not a reflection of any specific author. Your support helps keep this site growing. Thank you!
Do you find yourself suddenly having a more difficult time holding your urine?
Urinary incontinence is a common and often embarrassing condition that affects millions of people worldwide. It’s defined as the involuntary loss of urine and can have a significant impact on one’s quality of day to day life. But there are many different types of urinary incontinence, so let’s dive into discussing the common symptoms, risk factors, and explore available treatment options.
Stress Incontinence:
Stress incontinence is the most common type of incontinence in women, but can also affect men. According to the National Association for Continence (yes, there’s an entire organization dedicated to this), approximately 15 million adult women in the United States experience stress incontinence. It is characterized by leakage of urine during physical activities, or activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or exercising. This is often due to weakened pelvic floor muscles which play a crucial role in supporting the bladder and maintaining urine control. These muscles can be damaged during pregnancy and childbirth, along with the muscles surrounding the urethra which can cause urethral sphincter dysfunction. A history of pelvic surgery can also compromise the pelvic floor, and certain medical conditions, such as chronic cough, connective tissue disorders or neurological issues can affect continence. Obesity is also a risk factor by putting additional pressure on the bladder and pelvic floor muscles.
Fortunately, stress incontinence is often easily treatable. In the short term, small devices such as pessaries can help with mild cases of leakage. Pelvic floor physical therapy is a good place to start, as well as implementing behavioral strategies such as timed voiding and fluid management to help regulate bladder function. In cases of obesity, weight management can also alleviate pressure on the bladder. The ultimate treatment option though, is a simple surgical procedure: a sling placement that provides support to the urethra and prevents urine from coming out. So, if you are sick and tired of having to avoid your favorite physical activities due to urinary incontinence, you should talk to your urogynecologist about getting a sling placement procedure.
Urge Incontinence:
Also known as Overactive Bladder (OAB), this form of incontinence affects around 40% of women in the United States, but can affect men also. It is a condition often associated with a sudden, intense urge to urinate, followed by involuntary urine loss. You may find yourself making frequent trips to the bathroom, both during the day and night. This condition is often associated with an overactive bladder muscle, called the detrusor muscle. The detrusor muscle is the one that squeezes the bladder when you pee, but in patients with urge incontinence, this muscle is contracts too often and when it is not supposed to.
There are several treatment options available for urge Incontinence. Behavioral techniques, like bladder training and scheduled voiding can be helpful, as well as lifestyle modifications such as avoiding bladder irritants like caffeine and alcohol. Pelvic floor physical therapy can also improve bladder control. There are two main classes of medications that can be prescribed, either anti-cholinergic medications or beta-3 adrenergic agonists, and for women who prefer to avoid systemic effects of medications, injecting Botox into the bladder can help relax bladder muscles and stop the urgency. Alternatively, neuromodulation can help “retrain” bladder nerves and normalize bladder activity.
Overflow Incontinence:
Overflow incontinence affects both genders, but is less common among women, occurring mostly men due to enlarged prostate issues. This type of incontinence is characterized by a constant dribbling of urine due to an inability to empty the bladder completely. The individual may notice a weak or intermittent urine stream, despite a full bladder, and have to strain during urination in an effort to push it all out. One reason for this can be a bladder outlet obstruction, where there is a physical obstruction blocking or restricting the flow of urine. This is most commonly due to an enlarged prostate in men, but can also be caused by strictures, tumor or pelvic organ prolapse. Another cause of overflow incontinence can be due to weak or damaged bladder muscles or nerves from trauma or chronic conditions such as diabetes or multiple sclerosis. Certain medications such as anticholinergics or alpha-blockers can also interfere with normal bladder function.
This diagnosis is often made by measuring something called the Post-Void Residual (PVR). This is done using an ultrasound test to see how much urine is left in the bladder after trying to void, as well as urodynamic testing to assess bladder function and pressures. Imaging techniques may also be utilized, as well as cystoscopy to visualize the urinary tract and identify any structural issues. Immediate treatments for overflow incontinence can include catheterization to empty the bladder, while long term treatments may require surgical interventions to remove any obstructions or repair prolapse. Ultimately, addressing the underlying condition is what will improve symptoms.
Functional Incontinence:
This type is often associated with the elderly and individuals and occurs when a person is unable to reach the bathroom in time due to physical or cognitive limitations. Unlike other forms of incontinence, functional incontinence is not directly caused by issues with the urinary system, but other factors that hinder a person’s ability to manage their bladder function, like arthritis, dementia, and mobility issues. Environmental factors can also contribute, such as a challenging layout of living spaces, lack of available assistive devices and a lack of caregiver support.
Treating this form of incontinence requires adapting external factors, such as changing the living space to make it more accessible, providing assisting devices and ensuring that caregivers are trained and available to assist with toileting needs. Implementing a voiding schedule can reduce the number of accidents, and the use of absorbent pads can help manage leakage and hygiene when leaks do occur.
You’re Not Alone:
Urinary incontinence is more common than most people realize and as you can see, a diverse condition that can significantly impact a person’s daily life. Understanding the various types, recognizing symptoms, identifying risk factors, and exploring treatment options are crucial steps towards managing and maintaining dignity for those affected by this condition. If you or someone you know is experiencing urinary incontinence, consulting with urogynecologist is the first step towards finding an appropriate and effective treatment plan.
About the Author:
Dr. Alexandra Dubinskaya is a board certified and fellowship trained urogynecologist and pelvic reconstructive surgeon. She is a sexual medicine specialist and the founder of the Los Angeles Institute of Pelvic and Sexual Health. Dr. Dubinskaya is also a Menopause Society certified provider. In her spare time, she is an educational content creator for women’s health on YouTube and social media as @DrUroGyn.
