Patient education: Urinary incontinence in women (Beyond the Basics)
- Emily S Lukacz, MD, MAS
Emily S Lukacz, MD, MAS
- Professor of Reproductive Medicine
- UC San Diego Heath System
URINARY INCONTINENCE OVERVIEW
Urinary incontinence, also known as accidental bladder leakage, is an embarrassing problem that affects millions of women. Although it is more common in older women, it can affect younger women as well. It is not a normal part of aging or something that you just have to live with.
This article discusses the different types of leakage and the tests that may be done during your evaluation. The treatment of incontinence and frequency is discussed separately. (See "Patient education: Urinary incontinence treatments for women (Beyond the Basics)".)
TYPES OF URINARY INCONTINENCE
The two most common types of urine leakage in women are stress incontinence and urgency incontinence. Incontinence may be caused or worsened by medical problems, medications, and/or problems with the brain due to a stroke or dementia.
Stress incontinence — Stress incontinence occurs when the muscles and tissues around the urethra (where urine exits) do not stay closed properly when there is increased pressure ("stress") in the abdomen, leading to urine leakage. As an example, coughing, sneezing, laughing, or running can cause stress incontinence. Stress incontinence is a common reason for incontinence in women, especially those who are obese or have given birth by vaginal delivery.
Urgency incontinence — In people with urgency incontinence (also called overactive bladder), there is a sudden, uncontrollable urge to urinate. You may leak urine on the way to the toilet. Common triggers of urgency incontinence include unlocking the door when returning home, going out in the cold, turning on the faucet, or washing your hands.
Many people with urgency incontinence also have to go to the bathroom more frequently than most people during the day and/or night. "Normal" frequency is considered to be eight times per day and once at night, but this depends on how much you drink and may increase if you drink more than 64 ounces of fluid in a day.
Mixed incontinence — Women with symptoms of both stress and urgency incontinence are said to have mixed incontinence.
Overflow incontinence — Overflow incontinence occurs when the bladder does not empty completely, causing leakage when the bladder becomes overly full. It may result in symptoms of either stress or urgency incontinence or both.
Although leaking urine can be difficult to talk about, it is often treatable with weight management for women who are obese, pelvic floor muscle exercises, and/or medications. Talking about it with your health care provider is the first step in getting help for this problem that is affecting your life.
Important questions to discuss include:
●When do you leak? (When you get a sudden urge, with coughing/sneezing, or does it occur without warning?)
●When did your leakage begin? Has it worsened or improved over time?
●Have you tried any treatments to reduce leakage?
●Are there any medications that you are taking that might be worsening the problem (diuretic medicine for high blood pressure or high doses of pain medications)?
●Have you seen blood in your urine or had fevers with bladder pain or other pelvic symptoms such as bulge or pressure? These symptoms should not be ignored and you should be evaluated by a clinician.
Bladder diary — A bladder diary is a record of how much urine you make and how frequently you go generally during a 24-hour period. You should write down how much fluid you drink and how much urine you make and record any leakage and the activities that caused leakage. This diary may provide useful information about the cause(s) and potential treatment of your leakage.
Tests — Simple tests may be done during an office visit to determine the type of leakage you are experiencing. This may include a cough test, when you are asked to cough while your doctor or nurse watches for urine leakage.
A urine test (urinalysis and sometimes a urine culture to test for bacteria) is usually done to look for signs of infection or blood in the urine. Blood tests may be ordered to measure the kidney function.
A test to see how well you empty your bladder when urinating may be done. This can involve inserting a small catheter in the bladder or a simple ultrasound.
Urodynamic testing — For a urodynamic test, small catheters are placed inside the bladder and vagina (or rectum) to measure how much urine your bladder can hold, what makes you leak urine, and whether there are problems emptying the bladder. This test can be done in the office and may be recommended if you are planning surgery for urine leakage or if the cause of your leakage is not clear.
The treatment options for urinary incontinence are discussed in a separate topic review. (See "Patient education: Urinary incontinence treatments for women (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Urinary incontinence (The Basics)
Patient education: Pelvic muscle (Kegel) exercises (The Basics)
Patient education: Urinary incontinence in men (The Basics)
Patient education: Neurogenic bladder in adults (The Basics)
Patient education: Surgery to treat stress urinary incontinence in women (The Basics)
Patient education: Treatments for urgency incontinence in women (The Basics)
Patient education: Pelvic organ prolapse (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Evaluation of women with urinary incontinence
Lower urinary tract symptoms in men
Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth
Pelvic organ prolapse and stress urinary incontinence in women: Combined surgical treatment
Stress urinary incontinence in women: Persistent/recurrent symptoms after surgical treatment
Treatment of urinary incontinence in women
Surgical management of stress urinary incontinence in women: Choosing a primary surgical procedure
Vaginal pessary treatment of prolapse and incontinence
Surgical management of stress urinary incontinence in women: Choosing a type of midurethral sling
Surgical management of stress urinary incontinence in women: Retropubic midurethral slings
Surgical management of stress urinary incontinence in women: Transobturator midurethral slings
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/urinaryincontinence.html, available in Spanish)
●National Institute of Diabetes and Digestive and Kidney Diseases
●Voices for PFD (Pelvic Floor Disorders)
●National Association for Continence
●National Institute of Diabetes & Digestive & Kidney Diseases
●Continence Worldwide (Continence resources outside the United States)
- Herzog AR, Fultz NH. Prevalence and incidence of urinary incontinence in community-dwelling populations. J Am Geriatr Soc 1990; 38:273.
- DuBeau CE, Levy B, Mangione CM, Resnick NM. The impact of urge urinary incontinence on quality of life: importance of patients' perspective and explanatory style. J Am Geriatr Soc 1998; 46:683.
- Fantl JA, Newman DK, Colling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline, No. 2, 1996 Update, AHCPR Publication No. 96-0682. Public Health Service, Agency for Health Care Policy and Research, Rockville, MD. www.ahrq.gov/clinic/uiovervw.htm (Accessed on September 07, 2006).
- Brown JS, Bradley CS, Subak LL, et al. The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Ann Intern Med 2006; 144:715.
- Wyman JF, Choi SC, Harkins SW, et al. The urinary diary in evaluation of incontinent women: a test-retest analysis. Obstet Gynecol 1988; 71:812.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.