Urinary Incontinence in Women

TEAM KNIX / YOUR BODY

Of the 25 million adult Americans suffering from some form of urinary incontinence, 75-80% of those are women (source). 

You might expect that if a condition like incontinence, which can have tremendous impact on lifestyle and emotional stress, is so widespread among women, it would be widely understood. That couldn’t be less the case. 

Many women wait over 6 years from when they first experience symptoms to when they receive a diagnosis. Like other female complaints, like period pain, women’s complaints can often be dismissed by doctors as just “the hand we’re dealt”.

It’s no wonder then that half of us don’t even bother seeing the doctor about these things!

But incontinence deserves to be better understood. Indeed, “urinary incontinence” as a blanket term to explain any and all forms of involuntary bladder leakage is a bit misleading. That’s because there are different kinds of incontinence, and while they result in amounts of urine leaking, the “why” can be very different. Let’s explore…

Urinary Incontinence: An Overview

Urinary incontinence is any experience of involuntary peeing or urine leakage. This could be sudden and infrequent - like if you get a horrible fright. Or it could be persistent and recurring - even in some cases something people live with daily.

It impacts both men and women, though  it is more common in women - occurring almost twice as much. Pregnancy, childbirth, and menopause are major reasons for the increased prevalence of incontinence in women as compared to men. Though anatomically a female urethra is shorter than a man’s, so that may also be a factor.

Symptoms of urinary incontinence can seem deceptively similar; loss of urine. But when you look more closely there may be more going on. Urinary incontinence in women can also be accompanied by other symptoms, like a sudden urge to urinate, bladder contractions or a feeling of pressure on your bladder.

But… What Normally Happens When You Pee?

Your brain and bladder work together to control urinary function. 

The bladder stores urine until you are ready to release it and the muscles of your pelvis hold the bladder in place. The muscles of the bladder are usually relaxed and hold urine in the bladder and the neck of the bladder is closed. 

The urethra is the tube that carries urine from the bladder to outside the body. The sphincter muscles are closed around the urethra. When those muscles do their job, urine does not leak outside the body by accident.

When you are ready to pee, your brain lets the bladder know. This causes the bladder muscles to contract which forces urine out through the urethra. The sphincter also opens up when the bladder contracts, allowing the urine to pass through the urethra and leave the body.

Incontinence happens when urine leaks outside your control and intention to pee.

Incontinence may occur for many reasons and, indeed, there are different “types” of incontinence with different causes and treatment options. While your doctor is the best person to provide you with a full and proper diagnosis and treatment plan, there are some steps you can take independently to manage incontinence, and even to prevent.

You’ll also want to ‘manage’ incontinence day-to-day with lifestyle products like leakproof underwear. These can help you fully participate in your life without fear of a leak at an inopportune moment.

5 Different Types of Female Urinary Incontinence

At a high level, there are 5 different types of female urinary incontinence that can be experienced. While the outcome is the same (involuntary release of urine), each one has subtle differences. That said, there are also overlaps between the different kinds of incontinence. Plus, it’s possible to experience more than one kind, as you’ll see.

1. Urge Incontinence

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Urge Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

An impossible-to-ignore feeling that you need to go right this second or you’ll burst, even if you just went or felt fine just minutes before.

  • Neurological conditions like Parkinson’s or MS
  • Overactive bladder (OAB)
  • Pregnancy
  • Childbirth
  • Menopause
  • Trauma to the bladder and urethra from surgery
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Biofeedback therapy
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

We all experience the urge to pee - it can even be urgent when we’ve had excess fluid intake (alcohol or carbonated drinks in particular) or have been stuck without access to a bathroom for too long. But most of us can manage to ‘hold it’ until we find a washroom.

For some people, though, an urgent urge to urinate comes seemingly out of nowhere. It can happen even if they’ve urinated recently and or felt completely normal just a minute ago. And if they can’t get to a bathroom in time, an accident may happen. This is urge incontinence.

Urge incontinence may be caused by a miscommunication between your brain and your bladder. There can be false messages that the bladder is full and needs emptying. Or “too late” nerve signals that you need to urinate.

Because it also involves the brain, urge incontinence can sometimes be linked to neurological conditions like Parkinson’s Disease and multiple sclerosis (MS). But urge incontinence can also be caused by pregnancy (which puts pressure on the bladder), childbirth, menopause or trauma from surgery.

Urge incontinence can also be caused by an overactive bladder (OAB) - though it’s important to note that an overactive bladder does not always cause incontinence and is not itself considered a disease. OAB can be caused when the muscles in your bladder are too active.

Treatment options for urge incontinence can include biofeedback therapy, which seeks to give you greater awareness of your body’s physiological responses and help control the bladder muscle. Exercises to strengthen the pelvic floor muscles (i.e. Kegels) can help too; while they won’t eliminate the urge, they can help ensure it doesn’t lead to a leak.

2. Stress Incontinence

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Stress Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

Urine leakage during physical exertion, whether it be exercise or more physical reactions like coughing, sneezing, laughing etc.

  • Childbirth
  • Trauma from surgery (e.g. hysterectomy)
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Menopause
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

Stress urinary incontinence (SUI) has nothing to do with emotional stress, but is about physical exertion. This can be the obvious physical exertion of doing exercise. But it can also include bodily functions and involuntary reactions like coughing, sneezing, even laughing and having sex.

When any of those exertions cause an involuntary loss of bladder control resulting in leakage of urine, it’s called stress incontinence. And the cause of stress incontinence is usually weakened muscles that become weaker when the body is experiencing the ‘stress’ of those exertions, so fails to hold in your pee.

Your pelvic floor muscles are, after all, just like any other muscle: They can be injured, damaged or weak because of age and not getting enough exercise. Damage to the muscles of the bladder and urethra can happen to women due to childbirth or trauma from surgery (e.g. hysterectomy). And weakened muscles can happen because of aging (menopause) and lack of exercise. This is one of the reasons why Kegel exercises (pelvic floor muscle training) is so often recommended as a good practice for all women..

3. Mixed Incontinence

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Mixed Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

A combination of stress and urge incontinence.

  • The same causes as stress and urge incontinence
  • Lifestyle changes
  • Medication
  • Bladder botox injections

Mixed incontinence is when a person experiences both urge and stress incontinence. It’s not uncommon to experience both issues with bladder control. Mixed incontinence is, in fact, the second most common form of incontinence in women. 

If you have mixed incontinence, you likely have weakened pelvic muscles in combination with other possible health concerns. Working with your doctor will help pinpoint causes, which will give you a range of treatment options to help restore bladder control.

Those treatments can include lifestyle changes, medication and bladder botox injections.

4. Overflow Incontinence

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Overflow Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

If the flow of urine “dribbles” or is unsteady, you may have overflow incontinence. The inability to completely empty your bladder can lead it to overflow and cause unexpected urine leaks.

  • Weak bladder muscles
  • Underactive bladder
  • Blockages in the urinary tract
  • Lifestyle changes
  • Surgery to remove blockages
  • Use of catheter

If you pee frequently but it has an unsteady, dribble-like flow of urine, this could point to overflow incontinence. With this type of incontinence, the bladder cannot empty when you pee and the amount of urine you eliminate may be small. And because your kidneys continually produce urine, this can lead your bladder to overflow later, without warning.

In addition to the stress this kind of sudden incontinence can cause, it also puts you at risk for urinary tract infections (UTI). This is because urine should be expelled from the body, but if the bladder isn’t emptying, the urine that remains can become a breeding ground for bacteria.

In women, overflow incontinence can be caused by weak bladder muscles, an underactive bladder or a blockage in the urinary tract. An underactive bladder can be caused by certain medications, diabetes, alcoholism and other medical conditions. Blockages in the urinary tract are sometimes caused by other surgeries or unusual growths.

Treatment for overflow incontinence varies from case to case, but may include surgery to remove urinary tract blockages, review of medications and lifestyle adjustments, or the use of a catheter.

5. Functional Incontinence

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Functional Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

This is when you experience urine loss, but the cause is not associated with any problems with the urinary system.

  • Neurological or psychological causes
  • Physical impairments like spinal cord injuries
  • Nursing assistance
  • Changing physical settings
  • Medications and therapies to address underlying medical condition

Functional incontinence is probably the easiest form of incontinence to understand, because it isn’t caused by any damage to the urinary system but usually by another medical condition.

This kind of incontinence can have neurological or psychological causes. It might be a mental health issue that causes a person to ignore their urge to pee, or a disease like Alzheimer’s disease that can impact a person’s self-awareness or judgement. 

But it can also be caused by physical impairments which prevent a person from acting on their need to urinate. These can include physical obstacles, such as spinal cord injuries and mobility issues.

Functional incontinence most often affects the elderly, and treatment often includes nursing assistance that includes bathroom reminders. Changing physical settings to ensure unimpeded access to bathrooms may also help. Other treatments can involve medications and therapies to improve the person’s physical and mental wellbeing.

Incontinence Can Also Be Temporarily Caused

Urinary incontinence can be brought on temporarily for a number of reasons. Most of the causes of temporary urinary incontinence in women are not too medically concerning.

Causes of temporary urinary incontinence include eating hot and spicy foods, or drinking too much. If this applies to you, it should pass in a relatively short time and it shouldn’t cause any stress - aside from maybe encouraging a little more restraint next time!

Temporary urinary incontinence may also be a side effect of certain medications. Your doctor or pharmacist will usually caution you if this is the case with a medication you’ve been prescribed. If it gets too much, you can work with your doctor to explore alternative treatments.

One cause of temporary incontinence that does warrant a visit to your doctors is a urinary tract infection (UTI). Other symptoms of a UTI include a burning sensation when you pee or blood in the urine.

Risk Factors: What Increases Your Likelihood of Experiencing Urinary Incontinence?

Risk of incontinence is greater in women. Damage to the pelvic floor muscles or the muscles of the bladder and urethra can happen to women due to childbirth or trauma from surgery (e.g. hysterectomy). And weakened pelvic muscles can happen because of aging (menopause) and lack of exercise. 

Additional factors that increase the risk of stress incontinence include:

  • Age
  • Being overweight
  • Smoking
  • Family history
  • Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
  • Having been through pregnancy and childbirth
  • Having undergone certain pelvic surgeries (e.g. hysterectomy)
  • Dementia 

Lifestyle Changes You Can Make to Help

Whether incontinence is temporary or persistent, there are lifestyle changes you can make to manage and have excellent quality of life while living with incontinence.

Reduce risk factors: If you want another reason to quit smoking, reduce alcohol consumption or maintain a health weight, here it is. Of course, you can do these things for myriad medical reasons and while they don’t come with guaranteed health outcomes, the risk of many diseases and conditions will be lessened.

Do Kegel exercises / pelvic floor exercises: These exercises strengthen the pelvic muscles, which support the uterus, bladder, small intestine and rectum. There’s no reason to wait to start doing pelvic muscle exercises. But they may help if begun at any stage.

Try products like leakproof underwear: Experiencing incontinence can cause a great deal of embarrassment. It even prevents some people from participating in events and outings, leading to isolation, depression and shame. While you explore treatment options with your doctor, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels, that can hold up to 8 tsp of pee.

Time your bathroom breaks: Taking bathroom breaks on a schedule may help you manage urge and overflow urinary incontinence. Over time, you can increase the time between bathroom breaks.

Seeking Medical Advice: What to Expect & How to Prepare

If you experience incontinence, it’s something you should consider bringing up at your next medical checkup, or even booking an appointment to see your doctor about it. You may be shocked to learn that 50% of people ignore their experience of incontinence.

These are some of the questions your doctor may ask about your experiences of urinary incontinence:

  • How long have you been experiencing these symptoms?
  • Have your symptoms been continuous or occasional, have they worsened over time?
  • How often do you need to urinate?
  • When (time of day or night) do you experience urine leakage?
  • Is it difficult for you to empty your bladder?
  • Have you noticed any blood in your urine?
  • General lifestyle questions: Smoking, diet, alcohol and caffeine consumption etc.

And here are some questions you might ask your doctor:

  • What type of incontinence do I have?
  • What is causing my urinary incontinence
  • What tests should I expect?
  • Should I make lifestyle changes, like:
    • Bladder diary
    • Kegel exercises to strengthen pelvic floor muscles
    • Timed bathroom breaks
    • Diet changes, etc.
  • What treatment(s) do you suggest for me and why?
  • Without treatment, what will happen?
  • What are the side effects or risks associated with this treatment plan?

Your doctor will likely review your medical history and administer a physical exam before they provide medical advice.

Treatment of Urinary Incontinence

The lifestyle changes we outlined earlier in the article are probably where your doctor will start too:

  • Pelvic floor exercises
  • Bladder training
  • Dietary or fluid intake changes to minimize or eliminate diuretics like caffeine and alcohol

Depending on your individual experience and medical history, your doctor might also want to explore:

  • Medications, which can treat an overactive bladder or medication to relax the bladder
  • Medical devices, like urethral inserts or pessaries
  • Interventional therapies, such as Botox or nerve stimulators
  • Surgery, which can include sling procedures, pelvic organ prolapse surgery or bladder neck suspension

No matter what kind of urinary incontinence you experience, or what treatment plan you decide to follow, it’s unlikely to clear up overnight. For example, Kegel exercises are like any other form of exercise; they’ll take time to show results. 

Because of this, you’ll also want to make lifestyle changes so you can cope in the short term. Life shouldn’t come to a grinding halt just because you are experiencing incontinence and it’s important for your general wellbeing to stay active and social.

But many people who experience incontinence find it makes them withdraw from company and social situations because they’re worried about the embarrassment of an accident. To help manage this, explore some of the many lifestyle products on the market.

Super absorbent Knix leakproof underwear can hold up to 8 tsp of liquid (whether that’s sweat, blood or urine). Products like these can be a game changer for those experiencing incontinence, allowing them to remain active and social while exploring treatment options. 

The good news is that you shouldn't feel alone experiencing urinary incontinence... odds are many of your friends are going through the exact same thing.