The Agency for Healthcare Research and Quality (AHRQ), an arm of the Department of Health and Human Services, recently published an exhaustive report on urinary incontinence (UI), calling it an age-old problem, but pointing out that women don’t need to suffer with it in the same way past generations did. “People are much more aware that urinary incontinence is a problem, and they’re more willing to go for help,” says researcher Jean F. Wyman, PhD, APRN, who has worked in the field of incontinence since the early 1980s and who stresses that when women do get help it can change their life.
Today, we have a better understanding of urinary incontinence and know that age isn’t the only risk factor. Pregnancy, childbirth, menopause, hysterectomy and obesity are among other risk factors that can occur across a woman’s lifespan. These reasons help to explain why a quarter of all young women experience urinary incontinence, along with half the women in middle age or after menopause and up to three quarters of older women.
Urinary incontinence also affects women very differently, with leaking that can range from slightly bothersome to debilitating, severely impacting quality of life even when using with the best adult incontinence pads and other incontinence products.
To present a big picture look at the treatment of urinary incontinence among women for AHRQ, an independent team of investigators at the Minnesota Evidence-based Practice Center, including Dr. Wyman, analyzed nearly 900 studies and parsed through the findings. The review looked at treatment options including pelvic floor muscle training using Kegel exercises; bladder training, which includes voiding on a set schedule; medical devices and weight loss. Said Wyman, “This report was unique in that we tried to compare the benefits of drugs as well as non-pharmacological treatments, and we looked at the harms of treatments.”
Understanding Your Urinary Incontinence
The quick definition of urinary incontinence is the involuntary loss of urine. But it’s important to understand the type of urinary incontinence you have before you can find the right treatment. Stress incontinence can typically be traced to a problem with the sphincter muscle that helps control urine flow, a problem that results in leakage during everyday actions like coughing or sneezing. Urgency incontinence is marked by an involuntary loss of urine associated with a sudden and compelling urge to go. Overactive bladder is usually characterized by a frequent urge to go, including having to get up during the night; about a third of those women experience urge urinary incontinence, too. It is possible to have both stress and urge incontinence; that’s usually referred to as mixed urinary incontinence.
There are various risk factors for each kind of urinary incontinence—these can overlap—and, more importantly, different treatments. Stress incontinence is more common in younger women in association with pelvic floor trauma and prolapse of the uterus, both of which are often related to vaginal delivery and may require surgical treatment to put the uterus back into its normal position so that it doesn’t affect the bladder. Urgency and mixed urinary incontinence are more common in older women and related to an overactive bladder with or without a sphincter that’s not working properly.
The urinary tract and how it works
Think of the urinary tract as your body’s drainage system that removes urine and other extra fluids. The body can only urinate properly if all of the body parts in the urinary tract work together in perfect harmony.
Bladder: The bladder is located in the pelvis, nestled between the pelvic bones. This muscular balloon-like organ expands in size as it fills with urine. We’re capable of only limited control over our kidneys. We have no control over how the kidney functions, but we typically have control over when it empties, which is known as urination. It’s the primary function of the bladder to fill with urine until an individual deems it necessary to urinate.
A healthy bladder can typically hold around 2 cups of urine, but this can vary person by person. The frequency of urination is entirely dependent on how quickly the kidney produces the urine that fills the bladder.
As it fills with urine, the muscles of the bladder will be in a relaxed state. When the bladder is full (or near full) the brain will be notified by a signal that it’s time to use the bathroom. That’s when we feel an urge to urinate. When the person goes to relieve themselves, the bladder deflates as it’s emptied through the urethra.
Kidneys: Located beneath the rib cage on each side of the spine, your kidneys act as the body’s filter. If you’ve ever taken anatomy, you’d recognize this organ due to its unique beanlike shape.
On a daily basis your kidneys process and filter around 120 to 150 quarts of blood. As a result, 1 to 2 quarts of urine is created. Unlike the bladder, you have no control of your kidneys, and they work 24/7.
Ureters: Think of ureters as the tubing system of the urinary tract. It’s the job of these small tube-like muscles to transport urine from the bladder to the kidneys.
An in-depth look at the various types of urinary incontinence in women
Women have to deal with various types of UI:
- Stress incontinence
- Urgency incontinence
- Mixed incontinence
- Other types of incontinence
Urgency incontinence is appropriately named, as it occurs when a woman loses urine after experiencing a strong desire to relieve herself. Due to this strong urge, she may experience involuntary contractions to the bladder which is the most common cause of urgency incontinence. Another common trigger is abnormal never signals which could also lead to involuntary bladder contractions.
There are a number of common triggers for women who experience urgency incontinence. These include touching water, hearing running water, drinking a small amount of water as well as being in an area with a cold temperature, such as the freezer section at the grocery store.
In addition to these common triggers, factors such as certain types of medication, liquids, medical conditions, and anxiety can exacerbate urgency incontinence.
Furthermore, damage to the bladder muscles, bladder nerves, brain and spinal cord can cause the bladder to contract involuntarily.
There are a few factors that can specifically affect the bladder muscles and nerves:
- If you incur an injury
- Alzheimer’s disease
- Parkinson’s disease
- Multiple Sclerosis
Ultimately, urgency incontinence is a sign that your bladder is overactive. That means that abnormal nerves in your body are signaling your bladder at inopportune times, such as when you’re in line at the grocery store vs. when you’re sitting on a toilet. This will cause your muscles to squeeze without warning which in turn causes leakage.
Stress incontinence occurs when the bladder experiences force or pressure that causes urine to leak out. For example, laughing, sneezing, coughing or physical activities can cause stress incontinence. Pregnant women frequently experience stress incontinence due to the physical changes in the body during pregnancy.
Weak pelvic floor muscles can result in the bladder moving in a downward motion, pushing it out of the range of the sphincter to hold it in place properly. Thus, when the bladder is under stress urine may leak out. Stress incontinence is most common in women.
As the name implies, mixed incontinence occurs when an individual experiences both urgency and mixed incontinence at the same time.
Other Types of Incontinence
The above are the most common forms of incontinence, but there are other types of incontinence that people have to deal with.
Transient incontinence occurs when an individual experiences UI for a short span of time. This specific condition is typically caused by a temporary condition or medication. These include:
- Short-term mental impairment
- Contracting a urinary tract infection which can irritate the bladder and cause complications
- Chronic coughing which puts pressure on the bladder
- Constipation which puts pressure on the bladder
- Short-term restricted mobility
- Alcohol consumption
- Caffeine consumption
Functional incontinence occurs when a physical barrier, such as a physical disability or physical obstacle stops an individual from reaching the bathroom in time. This can even occur if a person has issues communicating—such as a foreigner in a country with an unfamiliar language—or with someone who has a mental disability, such Alzheimer’s disease.
Further examples include wheelchair bound individuals who can’t get up when it’s time to go to the restroom as well as those who suffer with arthritis which can make it difficult to walk fast enough to get to the bathroom in time.
Overflow incontinence occurs when the bladder doesn’t empty properly when it fills up, thus causing a spillover. Overflow incontinence can be diagnosed by your doctor.
Overflow incontinence is typically brought on by weak bladder muscles. It can also occur if your urethra is blocked. Your bladder muscles can be weakened by diabetes and other types of diseases, such as urinary stones and tumors. Overflow is the rarest form of incontinence in women.
Treatment of Urinary Incontinence: Can It Help?
When talking about the success of urinary incontinence treatment options, the researchers point out that improvement in urinary incontinence is defined very differently by patients and by scientists. For women, improvement means living with fewer restrictions on their activities and a lessening of bothersome bladder symptoms, especially urine leakage. Researchers define improvement as a decrease in the amount of lost urine during adult pad tests or a significant decrease in the frequency of leakage episodes. So the success of any given treatment really depends on whether you feel it improves your quality of life.
Standard incontinence treatments for women include lifestyle changes like going to the bathroom on a regular schedule and moderating the timing and amount of beverages you drink, pelvic floor muscle training, electrical stimulation and, for predominantly stress incontinence, surgical treatments. In addition, several drugs have been approved for adults with overactive bladders, with or without urge incontinence.
According to the report, the benefits from the two lifestyle changes, pelvic floor muscle training and bladder training, rated high, along with electrical stimulation. Weight loss, another lifestyle change, improved urinary incontinence in obese women. Among those who are candidates for urinary incontinence drugs, 1 of every 8 to 12 women (depending on the specific drug) achieved continence; others found some degree of improvement, but side effects caused a certain percentage of women to stop taking them.
The bottom line: You may be able to improve symptoms of urinary incontinence with one or more approaches that make sense for you. Today there are a wide variety of incontinence products that can help you manage your urinary incontinence while leading an active life. Kegels and bladder training cost nothing to try and may help urge urinary incontinence the most. Surgery might seem like an extreme option, but if you have the type of urinary incontinence that can be helped by it, you may regain so much quality of life that it’s the right choice. Start by working with an experienced urologist to explore your options.