FAQs Female Incontinence

Urinary incontinence is the unintentional or involuntary passing of urine. There are many causes of urinary incontinence, the most common being related to pregnancy, childbirth and menopause. Other causes can include infection, medication, weak bladder muscles, complications from surgery or chronic diseases such as diabetes.

Women experience urinary incontinence twice as often as men. Pregnancy and childbirth, menopause, and the composition of the female urinary tract account for this difference. Both women and men can have trouble with bladder control from neurological (nerve) injury, strokes, multiple sclerosis, birth defects and physical problems associated with ageing. Older women have more bladder control issues than younger women do. Loss of bladder control in women can be attributed to problems with the muscles that help to hold and release urine and can be made worse by menopause.

• Stress incontinence – the most common form of incontinence in women. Physical movement such as coughing, sneezing and exercising can cause small amounts of urine to leak.
• Urge incontinence or overactive bladder – an uncontrollable urge to urinate or leaking large amounts of urine at unforeseen times including during sleep, after drinking a small amount of water, or even when you touch water or hear it running.
• Mixed incontinence – combination of stress and urge incontinence occurring together.
• Overflow incontinence – leaking small amounts of urine that the bladder hasn’t completely emptied. This could be due to nerve damage or an obstruction.
• Transient incontinence – leaking urine on a temporary basis due to a medical condition or infection that will go away once treated. It can be triggered by a urinary tract infection, medication, mental impairment, restricted mobility or severe constipation.

• Medical history
• Physical examination
• Fluid test – drinking plenty of fluids in order to test how much the bladder can hold and how well your bladder muscles function.
• Urinalysis – a urine sample is tested for signs of infection or other causes of incontinence.
• Urodynamics – a special technique is used to measure pressure in the bladder and the flow of urine.
• Stress test
• Blood tests – a blood sample is tested to assess kidney function and to investigate possible problems that may cause incontinence.
• Ultrasound – sound waves are used to take a picture of the kidneys, bladder and urethra, so any problems that could cause incontinence can be seen. Also residual urine can be estimated in a poorly emptying bladder.
• Cystoscopy – a thin tube with a tiny camera is placed inside the urethra to view the inside of the urethra and bladder to seek out possible abnormalities.

Accidental leaking of urine can be caused by extra weight. If you are overweight, diet and exercise may help you lose weight and this may improve urinary incontinence.

Some foods and drinks can cause incontinence, such as caffeine (in coffee, tea, cola drinks, chocolate) and alcohol. Restricting these foods and liquids in your diet may help reduce incontinence. Drinking too many fluids may also be a cause. Though we are taught that drinking lots of water is healthy, drinking too much can actually lead to problems. Unless you’re an elite athlete, keep your daily fluid intake (of all types of drinks) to around two litres – more if you’re exercising or in a hot environment. Make sure you consult with your doctor before making any major changes in your fluid intake.

There are a number of ways to treat incontinence:

• Exercise – simple exercises to strengthen the muscles around the bladder, called pelvic floor exercises, can help both men and women. Doing these exercises for a few minutes a day can help to reduce or cure stress leakage especially when combined with weight loss in an overweight person.
• Electrical stimulation – brief doses of electrical stimulation are used to strengthen muscles in the lower pelvis. The strengthened muscles can aid in reducing both stress incontinence and urge incontinence.
• Biofeedback – a measuring device to make you more aware of your body’s functioning. A wire connected to an electrical patch is linked to a screen to show you when muscles contract, so you can learn to gain control over bladder muscles.
• Timed bladder training – this technique helps train your bladder to hold urine better. With bladder training you can change your bladder’s schedule for storing and emptying urine.
• Dryness aids – absorbent pads or underwear help, but are not a cure. Some people also use urinals beside their beds when they sleep if they suffer from urge incontinence.

Anticholinergic medicines (also known as antimuscarinic medicines) such as oxybutynin prevent urge incontinence by relaxing muscles of the bladder. The most common side effect of the medication is a dry mouth, although large doses has been know to cause blurred vision, constipation, an elevated heartbeat and flushing.

For stress incontinence, duloxetine may be considered as an alternative to surgery. It works by acting on the nerve signals that control the bladder’s sphincter muscle. Common side effects include dry mouth, nausea, fatigue and difficulty sleeping.

Oestrogen may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.