Urinary incontinence is an extremely common condition, affecting as many as 45% of women in America. The risk factors and causes of leakage in women are extremely varied. Take comfort in knowing that this condition is often very treatable. But, in order to know what the best treatment options are, the possible sources must be determined.
The predisposing risk factors for incontinence are numerous. Many of these – such as smoking, chronic constipation, obesity, alcohol consumption, caffeine intake, poor glycemic control and exposure to dietary irritants such as carbonation, artificial sweeteners, acidic foods and spicy foods – you can control to reduce your current symptoms or future risk.
Other life events such as previous pregnancy, childbirth, hysterectomy and getting older you may have less control over. There are a large variety of medicines that may contribute to incontinence including many cardiovascular medicines and diuretics, sedatives, muscle relaxants and Parkinson's treatments. Likewise, many medical disorders themselves can result in bladder leakage - most commonly diabetes, neurological disorders such as multiple sclerosis, Parkinson's or spinal injuries, connective tissue disorders and of course, urinary tract conditions, such as urinary tract infection, interstitial cystitis, stones or bladder cancer.
Many women may experience some mild occasional leakage when they are younger, and then note a sudden worsening around menopause. This is no coincidence as estrogen helps to keep the connective tissues of the pelvis and urinary tract healthy. With the lack of estrogen that accompanies menopause, the supports to the bladder and urethra weaken. Also, bladder capacity reduces as we get older, so we need to go to the restroom more frequently. With reductions in physical agility it can sometimes be difficult to get to the toilet in time. Also many medical disorders that may predispose one to incontinence, such as hypertension, vascular disease, neurological disorders and diabetes, become more prevalent as we get older.
The treatment options offered depend greatly on the type of incontinence an individual is having. Most of us know someone who experiences some degree of stress incontinence, the typical leakage that occurs with coughing, sneezing or exercise and is due to relaxation in the structural support of the urethra. Since this is mainly an anatomical problem, it is usually addressed with physical therapy, mechanical support (pessary) or surgery (such as TVT sling).
The other most common type of incontinence in women is urge incontinence or detrusor instability, when the nerves feeding the muscles or bladder wall muscles themselves fire at times they shouldn't, giving one the sudden urge to go, with subsequent leakage if you can't get to a restroom quickly. This is more a medical than surgical issue and is often easily treated with medications. Often one may experience a combination of both, referred to as mixed incontinence. Some women have an over-distended bladder that, much like a stretched out balloon, is unable to contract well and stays too full, resulting in overflow incontinence. And others may have weakness in the muscles of the urethra that are necessary for keeping urine in the bladder, or intrinsic sphincter deficiency.
As the sources and types of urinary incontinence are very complex, it is best to have this evaluated by a gynecologist or urologist with experience in female incontinence and pelvic surgery.