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Women’s Guide to Incontinence

Updated: Nov 24, 2023

Urinary incontinence affects one in four women. The condition worsens with age, and as a result, up to 75% of women over 65 report urine leakage [1]. Incontinence impacts all aspects of women’s health, including physical, social, and psychological health. Keep reading to learn more about the condition, its symptoms, and how to get the treatment you need.

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What Is Incontinence?

Incontinence happens when problems with the muscles and nerves that help the bladder hold or release urine arise [2]. Some people may leak urine when they cough or sneeze, while it may happen to others while they are exercising or jumping. Others may experience a sudden urge to go to the bathroom but are unable to get to the bathroom in time.

Common Types of Incontinence

The two most common types of incontinence impacting women are stress incontinence and urge incontinence.

Stress Incontinence

Stress incontinence refers to involuntary urine leakage in relation to physical activities, including:

  • Coughing

  • Sneezing

  • Laughing

  • Jumping

  • Running

  • Walking

“Stress urinary incontinence is a sphincter problem,” said Dr. Jocelyn Fitzgerald, urogynecologist and pelvic reconstructive surgeon at the University of Pittsburgh Medical Center. “And this is more related to childbirth and other chronic increases in your intraabdominal pressure, like chronic cough, chronic constipation, and obesity. It’s related to a weak pelvic floor; those muscles provide some element of support under the urethra that keeps women continent when they’re doing an exercise or when they’re coughing.”

Urge Incontinence

Although both forms of incontinence are stressful, urge incontinence is often referred to as having the higher distress score of the two. Urge incontinence is a compelling and sudden urge to use the bathroom that you can’t delay or postpone. This urge results in urine leakage.

“On the other side, urge urinary incontinence often comes from the opposite problem of stress incontinence, a pelvic floor that is too tight, almost in spasm,” Dr. Fitzgerald explained. “And that can cause some reflexive spasm in the bladder that leads women to feel this overwhelming urgency that’s impossible to defer.”

Urge incontinence is typically caused by the bladder’s inability to allow pressure-free storage of urine under normal bladder capacity. The bladder contracts, increasing pressure that creates a strong urge to go to the bathroom, often associated with urine loss.

Symptoms of Incontinence

Some of the most common symptoms of incontinence are:

  • Leaking urine when you cough, sneeze, laugh or exercise.

  • Frequent urination.

  • Feeling sudden and uncomfortable urges to urinate.

  • Waking up several times per night to pee.

  • Urinating while sleeping.

What Causes Incontinence?

Factors that can lead to incontinence are:

  • Pregnancy.

  • Childbirth.

  • Aging.

  • Menopause.

  • Neurological disorders, such as MS, Parkinson’s disease, stroke, and brain tumor.

  • Obesity.

  • Smoking.

  • Family history.

  • Consuming foods and drinks that irritate the bladder, including spicy foods, alcohol, and caffeine.

  • A pelvic floor disorder.

  • Bladder spasms (urgency incontinence)

Diagnosis and Treatment

The good news is there are several different treatment options available for people experiencing incontinence.

If you are experiencing any of the above symptoms, it’s important to meet with your healthcare provider, who may refer you to a urogynecologist. A urogynecologist first trains as an ob-gyn and then continues their training in the subspecialty of pelvic medicine and reconstructive surgery. A urogynecologist diagnoses and treats pelvic floor conditions.

Some treatment options for stress incontinence include:

  • Pelvic physical therapy: A pelvic physical therapist will teach you how to strengthen your pelvic floor, including Kegel and other exercises to help the pelvic floor muscles work more effectively (for people suffering from stress incontinence).

  • Bladder training: Bladder training teaches the patient to manage incontinence by changing their urination habits by lengthening the amount of time between trips to the bathroom, increasing how much urine the bladder can hold, and improving control over the urge to urinate.

  • Medication: Some medications work to calm overactive bladders and therefore are helpful for urge incontinence.

  • Avoiding irritating substances: If you are dealing with incontinence, you will likely be advised to stop consuming alcohol, caffeine, spicy foods, and sweeteners.

  • Medical devices: Some women opt to be treated with devices specifically designed to treat incontinence, including urethral inserts, which are small tampon-like devices inserted into the urethra before specific activities that trigger incontinence like running. The device acts as a plug to prevent leakage and is removed before urination.

  • Surgery: There are several surgical interventions available for incontinence, including sling procedures, bladder neck suspension, and prolapse surgery.

Contact Your Physician Today

If your incontinence negatively impacts your life, it’s essential to contact your primary care physician and possibly a urogynecologist. Despite the prevalence of incontinence, only 45% of women who experience weekly episodes of incontinence consult a health care provider [2]. Some women may avoid getting help because they’re embarrassed. It’s important to know there is nothing to be ashamed of and there are options available.


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