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urinary incontinence in women

Causes of Incontinence in Women

Accidental release of urine is a very common and embarrassing problem, especially among older women. Most health care providers will encounter female patients with incontinence. Primarily because of the physical stress of pregnancy on the bladder, incontinence in women occurs 2-3 times more often than incontinence in men. In women over 40, one study suggested that over 60% experienced incontinence at least once a month. Consequently, it is important for health care providers to be aware of the risk factors to help women with incontinence find effective management strategies.

Types of Incontinence in Women

There are four types of incontinence in women. Some women may experience only one, while others may have "mixed incontinence," or more than one type:

  • Stress Incontinence: this is the most common type of bladder control issue causing incontinence in women, occurring when a woman does an activity that puts pressure on her bladder such as lifting, sneezing, coughing, laughing, or exercising
  • Urge Incontinence: also called "spastic bladder" or "overactive bladder," this type of incontinence in women is when a woman has a strong need to urinate, and cannot hold the urine in until reaching a restroom
  • Overflow Incontinence: frequent dribbling of urine because the bladder doesn't completely empty

Most Common Causes of Incontinence in Women

Some causes of incontinence can be traced to an easily treatable medical condition, like a urinary tract infection or constipation. In more chronic situations, the most common cause of incontinence in women is damage to the pelvic floor muscles as a result of pregnancy, childbirth, and the weakening of all muscles with age. Other physical changes are also causal:

  • Menstruation and menopause hormone changes that weaken bladder and urethra
  • Pelvic surgery
  • Problems with bladder muscles and urethra
  • Weakened pelvic floor muscle due to age and activity
  • Spinal cord injury

Stress incontinence in women is often a result of having weak pelvic floor muscles, or a weak sphincter muscle at the neck of her bladder. Sometimes the way the sphincter muscle closes can be the problem.

Urge incontinence can be caused by bladder contractions that override the sphincter muscles, which control the muscles of the urethra that take urine from the body. Bladder function can be damaged by diseases like diabetes, stroke, Parkinson's, or multiple sclerosis - which may damage the bladder nerves. While causes of incontinence in women can sometimes be identified, in many cases, the cause of urge incontinence can't be clearly determined because several risk factors may be involved.

Risk Factors for Incontinence in Women

Women’s incontinence risk factors include:

  • Aging
  • Pelvic surgery or a C-section
  • Obesity and high BMI
  • Hysterectomy
  • High number of abortions
  • Nerve damage due to diabetes, stroke, or injury
  • Reoccurring urinary tract infections
  • Heavy use of diuretic drinks containing caffeine or alcohol
  • Use of sedatives, blood pressure medicines, or muscle relaxants

Management Strategies for Incontinence in Women

The type of incontinence, severity, and underlying cause needs to be considered in any management strategy. Often, a combination of strategies may be needed. Any underlying medical condition like infection, constipation, or drug induced incontinence should be treated first. Other management strategies include:

  • Behavioral Training: incontinence in women can often be improved by using behavioral techniques such as bladder training to lengthen the time between trips to the toilet, double voiding to help empty the bladder more completely, scheduled toileting trips, and fluid and diet management, including weight loss and changes in physical activity.
  • Pelvic Floor Exercises: training in Kegel exercises, which strengthen the pelvic floor muscles through regular sets of contractions, is often very effective, especially for women with stress incontinence. Physical therapists, biofeedback, or electrical stimulation can also be used to strengthen muscles in the pelvic floor.
  • Medications: medications such as anticholinergics, mirabegron, alpha blockers, and topical estrogen can sometimes be of assistance.
  • Medical Devices: temporary devices like a urethral insert can plug leakage before specific activities, or a pessary ring can be inserted all day by women who have incontinence caused by a prolapse.
  • Interventional Therapy and Surgery: individuals that do not get help from other management strategies may consider bulking material injections, botox injections into the bladder muscle, nerve stimulators for the bladder, prolapse surgery, bladder neck suspension, or the Sling procedure to create a mesh around the urethra.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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