Urinary incontinence — the involuntary loss of urine from the bladder — represents one of the most under-recognized health issues affecting women.
Up to 50% of women suffer from urinary incontinence at some point in their lives, and approximately one third of women over age 60 leak frequently. Urinary incontinence costs Americans some $32 billion annually in loss of productivity, medications, surgery, and hygienic products. More important, however, is the impact on a woman's quality of life. Urinary incontinence often imposes significant limitations to physical activity, creates social isolation, and can even lead to emotional problems.
Unfortunately, most women either fail to realize that urinary incontinence is a true health condition, or they are too embarrassed to mention it to their doctor. There is a common misperception that urinary incontinence is simply an unavoidable and untreatable consequence of aging. This assumption deprives many women of the enjoyment of physical exercise, social activity, and even sexual relationships. In fact, most cases of urinary incontinence are very treatable.
Urinary incontinence usually results from involuntary bladder contractions (urge incontinence), anatomic laxity (stress incontinence), or a combination of both (mixed incontinence). Risk factors include age, childbirth, increasing weight, and diabetes. With urge incontinence, women typically feel a strong, sudden desire to void; but leak before reaching the restroom. Stress incontinence is characterized by leaking during activities like laughing, sneezing, coughing, jumping, or standing up from the seated position. Women with mixed incontinence have both urge and stress symptoms.
Urinary incontinence may improve somewhat with decreased caffeine intake, pelvic floor exercises (Kegel exercises), and scheduled bathroom visits to prevent the bladder from getting too full. For some women, lifestyle modifications are not enough, and medications to relax an overactive bladder or surgery that restores anatomic bladder support may be necessary. However, other disease processes such as infections, inflammation, fistulas, and neurological dysfunction (diabetic neuropathy, spinal cord disease, stroke) can lead to urinary incontinence. So it's important that women who experience bladder control problems be evaluated by their doctor to make sure that a more serious condition is not the cause.
The evaluation of urinary incontinence includes a thorough medical history, physical examination, urinalysis. Often, the evaluation also includes urodynamics testing. Multi-channel urodynamic testing — a safe, office-based diagnostic procedure that accurately identifies the specific cause of your urinary incontinence — can help your doctor determine if surgery is right for you. Urodynamic testing involves the placement of special catheters into your vagina and bladder. These catheters measure pressure and volume as your bladder is gradually filled and as you perform provocative maneuvers, such as coughing and bearing down, to reproduce your leaking. You are then asked to empty your bladder before the catheters are removed. Usually requiring about thirty minutes to conduct, urodynamic testing provides important information that enables your doctor to prepare the best management plan for you.