After childbirth and menopause, stress incontinence is common, and most women over 50 will have had an “oops” moment. This does not mean you should accept and dismiss urinary incontinence as normal. There are various highly effective ways to treat urinary incontinence, and there is no reason to just put up with it. It is also important to speak to a doctor, so you can rule out any underlying medical conditions.
Types of Urinary Incontinence in Women
Many women experience one or more of the below types of incontinence:
- Stress — small amounts of urine leak during physical activity or when the bladder is under pressure such as when you laugh or cough.
- Urge — also referred to as overactive bladder syndrome, a sudden strong need to urinate occurs, and the urine often leaks just before reaching the toilet.
- Mixed — is a combination of stress and urge incontinence symptoms.
- Overflow — this causes a need to urinate frequently and, or a constant dribbling of urine.
- Total — can either cause a constant leaking of urine or large amounts of urine regularly leaking throughout the day and night.
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Causes of Urinary Incontinence in Women
Diagnosing the cause of urinary incontinence is critical to ensure the most appropriate treatment options are provided.
Stress and Urge incontinence
The most common cause of stress and urge incontinence are weak or damaged bladder, urethra and, or pelvic floor muscles, as a result of:
- pregnancy and vaginal childbirth
- menopause
- age
- obesity.
Less common causes include nerve damage as a result of:
- hysterectomy or pelvic surgery
- an accident or injury
- neurological conditions, such as multiple sclerosis (MS) or after a stroke
- diabetes.
Overflow incontinence
This is typically caused by an obstruction or blockage which makes it difficult to empty the bladder and can be a result of:
- bladder cancer (tumours)
- bladder stones
- constipation.
Total incontinence
This can result from:
- an accident or spinal cord injury
- fistulas
- kidney disease.
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Diagnosis of Urinary Incontinence in Women
The first part of a diagnosis will involve a full review of your medical history and any medications you take. Simple non-invasive diagnostic tests used to diagnose the cause of any urinary incontinence include:
- Stress test — with a full bladder, you will be asked to cough to assess the volume of urine passed.
- Uroflowmetry test — you urinate into a funnel or special toilet, which is attached to a machine that monitors urine flow rate.
- Blood test — to check kidney function
- Pelvic ultrasound/cystogram (bladder X-ray) — to check for tumours, bladder stones and fistulas.
Additional diagnostic tests that may be required include:
- Cystometric test —although it may feel slightly uncomfortable, this test does not hurt. First, a catheter empties the bladder, and then the bladder is filled with warm water until you need to urinate. During urination, bladder pressure and the volume of water released are recorded. You may also be asked to cough during a cystometric test to check for changes in bladder pressure.
- Cystoscopy — this involves looking inside the urethra and bladder with a thin tube called a cystoscope with a light and lens at the end of it. A cystoscopy is normally performed with a local anaesthetic gel and local anaesthetic injection. You can ask for sedation or a general anaesthetic if you are very nervous.
Treatment for Urinary Incontinence in Women
There are four main types of treatment for urinary incontinence in women:
- Medication — can be used to treat urge incontinence.
- Pessaries — ring-shaped devices usually made from silicone that are placed into the vagina, can be a simple and effective way to treat stress incontinence.
- Injections — there are two types of injections:
- Bulking material injections into the urethra tissue for treating stress incontinence. They will usually need to be repeated after 12 months.
- OnabotulinumtoxinA (Botox) injections into the bladder muscle for treating urge incontinence. On average, they need to be repeated every 7.5 months.
- Surgery — there are two main types of surgical procedures performed to treat stress incontinence:
- The Sling procedure typically uses your body’s tissue, called an autologous sling, to create a pelvic sling underneath your urethra and the bladder neck.
- Colposuspension, also called a bladder neck suspension, involves stitching the neck of the bladder into a lifted position.
Both types of surgery are usually performed under a general anaesthetic, as a day case.
All of the above treatment options are available through the NHS. You can learn more about urinary incontinence treatment by speaking with your GP. Alternatively, you can book an appointment without a GP referral to discuss urinary incontinence treatment options at the private hospital of St John and St Elizabeth in London by calling 020 7806 4098.
