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If you have ever urinated when you didn’t mean to, you may have urinary incontinence (UI). It is a common problem in both men and women. The Urology Care Foundation says that half of women and a quarter of men experience this problem.

Everyone does not have the same degree of incontinence. Some women may leak a little urine throughout the day. Other women may accidentally release the entire contents of their bladders and require incontinence pads or briefs. Although this problem can be embarrassing, it is treatable.

How the Bladder Works

To understand incontinence, it helps to understand how the bladder works.

The bladder’s job is to store urine until you are ready to void, or urinate. When you urinate, urine passes from your bladder through a tube called the urethra to the outside of your body.

On the urethra, there is a sphincter, which is like a ring of muscle. This sphincter contracts or squeezes the urethra to keep it closed. When you try to urinate, you relax this sphincter to let urine flow through it until the bladder is empty at which time it will again contract to maintain continence.

Pelvic Floor Dysfunction and Urinary Incontinence in Women

The urethra also passes through the pelvic floor. The pelvic floor is the lowest part of your abdomen, between your hip bones. It is made up of muscles, tissues, and ligaments. These tissues work to hold your pelvic organs – like your bladder — in place.

When the pelvic floor becomes weak or damaged and doesn’t work correctly, this is called pelvic floor dysfunction. If you have pelvic floor dysfunction, your organs and other structures can move out of their natural positions.

For example, your bladder or urethra can lean against your vagina, or your bowels can lean against your bladder. If your bladder is leaning, you might not be able to empty it completely. If something is leaning on your bladder, you may feel like you need to urinate all the time. Any unnatural pressure on your bladder signals to your brain that your bladder is full. This pressure can also force urine out or allow your bladder to leak.

If your pelvic floor dysfunction is caused by nerve damage, you may have reduced feeling in this area. For instance, you don’t realize that your bladder is full or your urinary sphincter is relaxed when it should be contracting.

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Types of Urinary Incontinence

Stress UI

This type of UI is caused by increased pressure on the bladder and pelvic floor. For example, when exercising, sneezing, coughing, or laughing. This type of incontinence can be exacerbated by being overweight or during pregnancy.

Urgency UI

Urgency is the sudden feeling that you need to urinate and it is difficult to postpone urination. Urge incontinence is when this feeling of urgency is followed by leaking urine in small or large amounts. Women who have an overactive bladder and have a frequent sensation of bladder fullness and urgency are experiencing this type of incontinence.

Overflow UI

This is an involuntary loss of urine due to a weak bladder muscle or blockage that prevents the patient from emptying their bladder. Sensations of bladder fullness are not experienced and when the bladder muscle becomes too full with urine, overflow incontinence is ensues.

Functional UI

A physical or mental obstacle prevents you from getting to the toilet quickly enough causing incontinence. Examples of this would be patients with dementia or in those who cannot get to the toilet quickly due to use of a cane or walker.

Mixed UI

This is a combination of two types of UI listed above. For example, female patients will often have both urge and stress incontinence.

Risk Factors for Urinary Incontinence

UI is a common problem, and it has a number of risk factors. Having one of these risk factors does not mean that you will develop UI. However, if you have any risk factors you’re more likely to develop UI than someone without any. Having more than one further increases your risk. Some women with UI have no risk factors.

One of the largest studies of urinary incontinence was published in the American Journal of Obstetrics and Gynecology in 2006. Although this meta-analysis is a little older, risk factors for conditions like UI do not change. This study included women ages 37 to 54, and identified the risk factors as follows:

Pregnancy and Childbirth

This is the strongest risk factor in younger women. Having more than one vaginal birth increases the likelihood that a woman will experience incontinence. Women with two vaginal births had around a 60 percent increased risk of UI.

Women who have had cesarean section (C-section) deliveries seem to experience less UI. However, the British Journal of Obstetrics and Gynecology in 2015 wrote that C-section does not completely eliminate the risk of UI.

There may be two causes for this. First, pregnancy itself stresses the pelvic floor. Second, some women attempt to have a vaginal birth before a C-section is performed.

Obesity

Women who are obese were found to be 2.5 times more likely than women of a normal weight to have UI.

Smoking

Smoking increased the risk of UI by 20 to 34 percent.

Hysterectomy

Women who had a hysterectomy had a “modest” increase in risk over women who did not have a hysterectomy.

Age

This is the strongest risk factor for older women.

Underlying medical conditions

Underlying medical conditions such as poorly controlled diabetes or neurologic conditions can increase risk.

Treatment

Urinary incontinence is an embarrassing but treatable condition. If you are experiencing any of these types of incontinence it is important to seek evaluation by a healthcare provider. There are different treatments available to address each type of incontinence and they range from behavioral modifications to medication changes to surgery.

Sources

Urinary Incontinence. The American College of Obstetricians and Gynecologists. Link

What is urinary incontinence. Urology Care Foundation. Link

Medications which potentially can cause incontinence symptoms. The Simon Foundation for Continence. Link

About Urology

The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. U.S. News & World Report ranks UPMC Presbyterian Shadyside among the best hospitals in the country for urological care.