Patient information: Urinary incontinence in women

URINARY INCONTINENCE OVERVIEW

Urinary incontinence, also known as urinary 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. Urinary frequency, the need to run to the bathroom frequently, is another bothersome problem that can affect women.

There is no need to live with urine leakage or frequency because effective treatments are available. 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 information: Urinary incontinence treatments for women".)

More detailed information about incontinence is available by subscription. (See "Clinical presentation and diagnosis of urinary incontinence" and "Treatment of urinary incontinence".)

TYPES OF URINARY INCONTINENCE

The two most common types of urine leakage in women are urge and stress incontinence. People with both stress and urge incontinence are said to have mixed incontinence.

Urge incontinence — In people with urge incontinence, there is a sudden, overwhelming need to urinate. You may leak urine on the way to the toilet. Common triggers of urge incontinence include unlocking the door when returning home, going out in the cold, turning on the faucet, or washing your hands.

Some people with urge incontinence also have to go to the bathroom frequently during the day and/or night. Frequency is defined as the need to urinate more often than other people (normal is considered to be eight times in 24 hours).

Stress incontinence — Stress incontinence occurs when the muscles and tissues around the urethra (where urine exits) do not close 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 have had children.

Mixed incontinence — Mixed incontinence is the combination of both urge and stress incontinence.

Overactive bladder — People with overactive bladder have a sudden, overwhelming urge to urinate, but may or may not leak urine before getting to the toilet. People with overactive bladder often have to go to the bathroom during the day and/or night.

Other types of incontinence — In addition to stress and urge incontinence, there are other, less common types of urinary incontinence.

• The bladder does not empty completely, causing leakage when the bladder becomes overly full. This is called overflow incontinence.
• Incontinence may be caused or worsened by medical problems, medications, and/or difficulty with thinking clearly.

INCONTINENCE DIAGNOSIS

Although leaking urine is an embarrassing problem, talking about it with your healthcare provider is the first step in getting help. (See "Epidemiology, risk factors, and pathogenesis of urinary incontinence".)

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?
• Do you ever leak stool (smears or pieces of stool)?

Bladder diary — A bladder diary is a record of how much urine you make and how frequently you go. You may also be asked to write down how much fluid you drink and activities that caused leakage (table 1 and algorithm 1). This diary provides 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) is usually done to look for signs of infection or blood in the urine. Blood tests may be ordered to measure the kidney function.

Urodynamic testing — A urodynamic test is a test that measures how much urine your bladder can hold, what makes you leak urine, and determines if 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.

INCONTINENCE TREATMENT

The treatment options for urinary incontinence are discussed in a separate topic review. (See "Patient information: Urinary incontinence treatments for women".)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: Pelvic floor muscle exercises
Patient information: Urinary incontinence treatments for women

Professional Level Information:
Clinical presentation and diagnosis of urinary incontinence
Epidemiology, risk factors, and pathogenesis of urinary incontinence
Evaluation and management of women with persistent/recurrent stress incontinence
Lower urinary tract symptoms in men
Midurethral slings for treatment of stress urinary incontinence in women
Pelvic floor disorders associated with pregnancy and childbirth
Surgical treatment of stress urinary incontinence in women
Treatment of urinary incontinence
Vaginal pessary treatment of prolapse and incontinence
Patient information: Pelvic floor muscle exercises

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/urinaryincontinence.html, available in Spanish)

• The American Urogynecology Association

      (www.mypelvichealth.org/)

• National Association for Continence

      1-800-BLADDER
      (www.nafc.org)

• Simon Foundation

      (www.simonfoundation.org)

• National Institute of Diabetes & Digestive & Kidney Diseases

      (http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/)

• Continence Worldwide (Continence resources outside the United States)

      (www.continenceworldwide.com)

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