Urinary incontinence, or leakage of urine, is a very common condition for women of all ages, ethnicities and backgrounds. Urine leaks may be as small as a drop, or it may be a flow of urine that can’t stop, which feels like urinating oneself.
According to a study by the American Urogynecologic Society, the prevalence of urinary incontinence ranges from 36.8% for women aged 20 to 29 years to 83.2% among women 70 years and older. The condition typically peaks among women aged 50 to 60.
The good news about urinary incontinence is that it’s very treatable.
Symptoms and impact of urinary incontinence
Due to the symptoms of urinary incontinence, women may experience embarrassment or social anxiety about their need to use the restroom often or potential leakage. The condition affects patients when they’re doing things as simple as drinking a glass of wine or laughing too hard, which may cause them to miss social events and important life moments. Urinary incontinence may affect sexual function and sleep patterns, and depression and anxiety may also be common.
Besides leakage of urine, symptoms of urinary incontinence may include:
UTIs may create an unfortunate cycle for many women, as urinary incontinence makes them more likely to contract UTIs, but chronic UTIs also makes them more likely to experience urinary incontinence.
Who gets urinary incontinence?
Urinary incontinence is most often a side effect of aging, which is why it’s so common among women aged 50 and over. The condition is also very common among pregnant women due to increased pressure on the bladder. Urinary incontinence during pregnancy often resolves itself after delivery. Many treatment options are unavailable to women during pregnancy to protect the safety of parent and baby, but after delivery, if symptoms persist, treatment options may be explored.
Medical and chronic conditions may impact bladder function, such as multiple sclerosis (MS) and Parkinson’s disease. Weight gain and obesity in general can also lead to urinary incontinence. High blood pressure and chronic constipation are also common causes. Stress urinary incontinence is often caused by years of heavy lifting and straining, especially among those who work in fields that require this as part of their job.
Treating urinary incontinence
There are a number of treatments for urinary incontinence that may ease or fully stop symptoms. Urogynecologists will explore different treatment options depending on what type of urinary incontinence a patient is struggling with, how severe the problem is, and what they may have tried in the past. A treatment plan should be a shared decision between patient and healthcare provider based on what outcomes are most important to the patient.
Medications for urinary incontinence work by relaxing the bladder muscle. We can think of the bladder as a big balloon surrounded by a dome of muscle that squeezes and makes people urinate. With urinary incontinence, those muscles squeeze when they shouldn’t. Medications work as a targeted muscle relaxer that instead of relaxing the whole body, just relaxes the bladder muscles.
For older patients, medications may cause some negative side effects, such as dry mouth and constipation, and more serious side effects, like memory loss and confusion. Outpatient procedures, such as urethral injections or Botox injections in the bladder, may be a more appropriate fit for these patients.
Urogynecologists may also pursue operating room-type procedures, such as mid-urethral slings and sacral nerve stimulation:
Mid-urethral slings are considered the gold-standard treatment for urinary incontinence and overactive bladder. The minimally invasive procedure places a permanent synthetic sling under the urethra to provide more resistance or pressure to keep it closed.
Sacral nerve stimulation implants a pacemaker-like device into the patient’s back with a wire that connects to the nerve endings near the spinal cord that control the bladder and bowel. The procedure takes about 30 minutes and uses X-ray to place the device. The MRI-safe, rechargeable battery lasts for 20 years, meaning this treatment option is often a “set it and forget it” solution and completely retrains the way that the bladder and bowel function.
For patients who are unable to be cleared for these procedures, treatments such as tibial nerve stimulation may be a more appropriate fit. This acupuncture procedure doesn’t require anesthesia and can be successful, with plenty of room for modification to fit patient needs.
Pelvic floor therapy can be very restorative for overactive bladder and stress urinary incontinence. Many of the exercises taught during pelvic floor therapy sessions may be done at home, and there are apps and YouTube videos that, while they aren’t a replacement for pelvic floor therapy sessions with a physical therapist, may get people started on the program. Treatment plans aren’t a one-size-fits-all, and physical therapists may include more on a patient’s exam and program than is covered in at-home exercises.
While urinary incontinence is a common condition, it shouldn’t be considered normal for women to suffer from it. Many advancements have been made in treatment so that women don’t have to live with the condition. For example, diabetes and hypertension are also common, but we don’t expect people to live without treatment. Urogynecologists, like those at Northwestern Medicine Central DuPage Hospital, can help restore quality of life and dignity.
