Topics in Gynecology - Urinary Incontinence
The problem of female urinary incontinence is a common one. As many as 10 to 25 percent of women under the age of 65 have reported a problem with leakage of urine at some point; however, many are too embarrassed to seek help. The problem can be so severe as to socially isolate some women as they forego interactions with friends and family for fear of having an accident.
There are several types of incontinence, but the more common ones involve excessive urge to void (urge incontinence) and leakage with cough, laugh or sneeze (stress incontinence). In the case of urge incontinence, the bladder muscle spasms and contracts, allowing the involuntary release of urine. The causes of the spasms may vary from chronic infection to stones or polyps or even over-distention of the bladder. The condition is sometimes referred to as overactive bladder.
Stress incontinence involves loss of anatomic support of the urethra (the muscular tube channeling urine out of the body from the bladder) and the body of the bladder. These organs are then displaced toward the vagina during any event that causes increased abdominal pressure such as coughing. This loss of support may result from vaginal delivery or menopausal decreases in circulating estrogen levels among other things.
Mixed incontinence, a combination of the stress and urge variety, is also quite common; however, the two types are treated in a fundamentally different way. In general, urge is treated with medications and changes in voiding habits, whereas the treatments for stress incontinence are often surgical. For this reason, it is essential to distinguish exactly which form (or combination of forms) the patient has before deciding on treatment.
In many cases, the distinction can be made based on the patient’s description of their problem and simple urinary tests available in the office. Urodynamics testing can help plan a treatment approach by mapping out the extent of the leakage problem and charting any bladder spasms that occur while the bladder is being filled.
It is always wise for a woman to first seek relief of her incontinence with a combination of treatments to include changing her voiding habits, altering her diet and intake of fluids (especially caffeine), and exercising the pelvic floor muscles. These simple modifications of lifestyle can have enough effect to keep a woman more dry on average. The second step is often the initiation of a medication to curb bladder spasms. Antispasmodics for the bladder can be quite effective even in cases where stress urinary incontinence predominates; however, they are most effective for the urge variety. Bladder medications can be expensive and be accompanied by disturbing side effects such as dry mouth and constipation. If these treatments are ineffective, surgery may be appropriate.