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Obstetrics and Gynecology

Urinary Incontinence

Many women leak small amounts of urine at times. This can occur with certain movements, during pregnancy, or during other stress, such as coughing. Some women lose urine when they hear the sound of running water or when their hands are in water. Others find that they feel the urge to urinate and are not able to control it. When leakage of urine becomes frequent or severe enough to become a problem, it is called urinary incontinence.

About Urinary Incontinence
Urinary incontinence is more common in women than in men. It affects 10 percent to 25 percent of women under age 65 and 15 percent to 30 percent of women older than 60 who do not live in nursing homes.

Normal Voiding
The urinary tract is made up of:

Normal urination (also called voiding) occurs when a woman is able to empty her bladder when she has a natural desire to do so.

Types of Incontinence
There are three types of incontinence:

The most common type is urge incontinence. It occurs if the detrusor muscle the muscle wall of the bladder is overactive. This leads to loss or leakage of urine.

Stress incontinence occurs when the pressure inside the bladder (which moves urine out) is greater than the pressure in the urethra (which keeps urine in). It causes loss of urine during coughing, laughing, sneezing or physical activity.

In overflow incontinence, the bladder does not empty during voiding. This results in a steady leakage of small amounts of urine.

Symptoms
Women who have urinary incontinence may leak urine often. They may have to wear a pad to keep from wetting their clothes.

A woman with urinary incontinence also may have other symptoms:

Causes
There are many possible causes of urinary incontinence.

Urinary Tract Infection
Urinary incontinence may occur because of an infection of the urinary tract.

Pelvic Support Problems
Pelvic support problems occur when the tissues that support the pelvic organs are stretched and damaged. This allows the organs that they support to sag out of place.

Urinary Tract Abnormalities
Fistulas are abnormal openings between the urinary tract (urethra, bladder or ureters) and the vagina. These openings can allow urine to leak out through the vagina.

Neuromuscular Disorders
Neuromuscular disorders are problems with the nerves that control the function of the bladder and urethra.

Drug Therapy
Urinary incontinence may be a side effect of medications taken for some other condition.

Physical Limitations
Some women have nothing wrong with their bladder or urethra. They have conditions, such as arthritis, that prevent them from moving quickly.

Diagnosis
A number of steps may be needed to find the cause of urinary incontinence.

The first step often is a detailed medical history.

A pelvic exam also may be done. Other exams and tests used may include:

Treatment
There are many options for treatment.

Behavioral Treatments
The goal of behavioral treatment is to help a woman know why leakage occurs and how to avoid it.

Medication
Medications that help control muscle spasms can help prevent leakage.

Special Devices
Sometimes devices can be used to strengthen the pelvic muscles.

Surgical Treatment
Surgery has different risks than drug or behavioral therapy. If you are thinking about surgery, you should know the chances of success as well as the complications that could occur.

 

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