There are several types of urinary incontinence or leakage that women experience. The two main types are stress incontinence and urge incontinence.

However, a majority of women have mixed incontinence which is a combination of both types of incontinence. It can be an embarrassing problem for patients, and many will wait years for evaluation and treatment. We encourage patients to be seen sooner as incontinence is a common condition and there are many treatment options.

Stress urinary incontinence (SUI)

Stress incontinence is loss of urine with increase abdominal or pelvic pressure. Most women will notice leakage with cough, sneeze, laugh, jump or exercise. SUI is caused by weakness of the urinary sphincter or pelvic floor muscles. The increased abdominal pressure causes the urethra to slip through the hammock of the pelvic floor and allows urine to leak.

Urge urinary incontinence (UUI)

Urge incontinence is loss of urine with involuntary squeeze of the bladder muscle. Most women will notice leakage when they are on their way to the bathroom or after an urge to urinate. UUI is caused by a spasm of the bladder that overwhelms the ability of the pelvic floor / urinary sphincter to hold urine.

Causes & Risk Factors

Stress Incontinence

Stress urinary incontinence is caused by weakening of the pelvic floor. Therefore, factors that increase risk of SUI are pregnancy, childbirth, aging / menopause, obesity and previous pelvic and abdominal surgeries. Some women will have SUI during and after pregnancy that resolves with delivery and weight loss.

Urge Incontinence

Urge incontinence is caused by involuntary bladder contractions and can be seen with overactive bladder (link to OAB page). Several factors can increase spasticity of the bladder and lead to urinary leakage including dietary irritants, stress, UTIs, underlying medical conditions, urinary tract abnormalities, hormonal change and obesity.

Diagnosis

To diagnose your urinary incontinence your provider will ask you many details about your leakage including when it is occurring, how often, how long it has been occurring and how many pads you wear. He/she will complete a physical exam, check your urine and determine how well you are emptying your bladder. Your provider may also recommend cystoscopy (look inside the bladder with a camera) and/or bladder pressure and flow testing. From this information the provider will be able to determine what type of incontinence you have and how it could be treated.

Treatment

Treatment options are based on the type of urinary incontinence or the predominate feature.

Stress Incontinence

Behavioral modification

  • Timing urination and keeping the bladder empty can decrease the amount and frequency of leakage
  • Kegel exercises, pelvic floor physical therapy and pelvic floor muscle trainers
  • These modalities focus on strengthening the pelvic floor

Surgical management

Placement of a synthetic mid-urethral sling supports the urethra and decreases or eliminates leakage. There are several types of sling procedures including retropubic, trans-obturator and single incision slings. Your provider will review the sling types at your consultation visit. All synthetic sling procedures are outpatient procedures.

Urge Incontinence

Urge incontinence can be treated with behavioral modification, pelvic floor physical therapy, medications, intravesical Botox injections or neurostimulation. These are the same treatments for overactive bladder.

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