What is urinary incontinence?
Urinary incontinence is when urine leaks unintentionally. It is a common problem and many women have urinary leakage once a week or more.
The two most common types of urinary incontinence are stress incontinence and urge incontinence.
Stress incontinence is when you leak urine during an activity that causes pressure (or "stress") on the bladder. This can occur when you laugh, lift, cough or sneeze.
Urge incontinence is when you leak urine before you can get to the bathroom. You may also have frequent urges to urinate and wake up at night to urinate.
I can't hold my urine when I get the urge to urinate
Urge incontinence, also referred to as an "overactive bladder" or detrusor instability. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to a sense of needing to urinate. Women with this type of leakage may also experience frequent urges to urinate and frequent night time waking to urinate. This type of leakage is usually due to uncontrolled spasms of the bladder muscle. Although there are many potential causes of urge incontinence in women, usually, there is no specific illness identified.
I Leak when I cough, exercise, laugh or sneeze
Stress incontinence is the term used for leakage of urine that occurs during periods of increased abdominal pressure. Activities that increase abdominal pressure include laughing, coughing, sneezing, lifting, bending, or exercising. Stress incontinence is most commonly related to stretching and loosening of the pelvic floor resulting in a loss of support of the bladder. This loss of support is often related to childbirth, smoking, repetitive strenuous work or inherited tissue weakness.
What treatment options are available?
The choice of treatment depends on the type of incontinence a woman has and the severity of the urine loss.
Urge incontinence is caused by involuntary contractions of the bladder and therefore is commonly treated with medications, biofeedback or electrical stimulation to the nerves that control the bladder.
Stress incontinence is due to stretching and loosening of the pelvic muscles resulting in a loss of bladder support, therefore the goal of treatment is to restore pelvic support. Stress incontinence can be treated with pelvic muscle exercises such as Kegel exercises (download PDF), vaginal weights or physical therapy. It can also be treated with use of devices that "block" the urethra so that urine won't leak out, or support devices called pessaries. Surgery can also be used to treat stress incontinence.
What kinds of surgical options are available?
Surgery can cure most women with stress incontinence. The type of surgery used for treatment will depend on the severity of the stress incontinence. Surgical options now available range from minimal invasive procedures such as the SURx transvaginal system and the tension-free vaginal tape sling, to the more invasive Burch procedure for severe incontinence.
What is the "tension-free vaginal sling"
Tension-free vaginal tape is a minimally invasive procedure used to treat moderate incontinence. It employs a special gauze sling covered by a plastic coating, which is attached on each side of the bladder opening. This procedure is done as an outpatient and does not require the use of a bladder catheter.
What is the "Burch" procedure?
The Burch procedure or retropubic suspension is used in severe stress incontinence to correct the position of the bladder and urethra by sewing the bladder neck and urethra directly to the surrounding pelvic bone or nearby structures. It requires a general or spinal anesthetic and a three-day hospital stay. Recovery can be prolonged.
Where can I find out more about urinary incontinence?