Urinary incontinence can be defined as involuntary leak of urine. In adults it is more common in women of advanced age. It is estimated that more than third of women above 60 years oaf age suffer from urinary incontinence. It significantly impairs quality of life and causes hygienic difficulties. Many women fell embarrassed and therefore do not seek medical advice.
Urinary incontinence can be divided into several types; the most common is stress and urge incontinence. Stress incontinence means an unexpected leak of urine during spontaneous increase of intra-abdominal pressure, for example when you cough, laugh, etc. Urge incontinence is related to sudden uncomfortable urge to urinate that is impossible to control. Much less common type is so-called overflow incontinence that is associated with some bladder urine outflow disorders (see below).
The most common cause of stress incontinence is deterioration of muscles and ligaments of the pelvic floor that maintain correct position of the urethra and thereby ensure the proper sphincter function. Muscle weakening may be related to factors such as lack of physical activity, obesity and excessive and frequent increase of intra-abdominal pressure (chronic cough, carrying heavy objects, etc.). Difficulties usually worsen after menopause due to hormonal levels changes.
Urge incontinence may be caused by excessive irritability of the bladder, often intensified by other diseases like urinary tract infections, anatomically close growing tumors (e.g. bladder cancer, gynecologic tumors).
Overflow incontinence is less common. It is paradoxically caused by poor drainage of urine that accumulates in the bladder and starts to leak regardless of the patient’s will. It typically accompanies neurological diseases and disorders leading to impaired bladder emptying such as multiple sclerosis or injuries and defects of the spinal cord (e.g. spina bifida).
As mentioned above, main symptom is urine leak independent on human will that either is sudden and surprising or follows an uncontrollable urgency. Other symptoms may be present including frequent episodes of excessive urination during the day, burning sensations during urination and frequent nighttime urination.
This disorder falls within the competence of urologists and gynecologists. Particularly the gynecologists are closely interested in this issue and there is a whole sub-branch of gynecology that deals with urination problems in women (urogynecology). Gynecological examination consists of medical history (nature and frequency of problems, other symptoms, current medication, etc.) and physical examination of the patient. There are special questionnaires to help determine the type and degree of severity of incontinence. It is advisable to perform urinalysis to rule out urinary infection as the cause of urge incontinence. Abdominal ultrasound may exclude other organic diseases including local tumors. Gynecologists also use some special urodynamic testing to measure functional pressures in different parts of the urinary tract at rest and during increased intra-abdominal pressure. When doctors suspect a neurological cause, it is also necessary to ensure a neurological examination.
Basic prevention (and also treatment) of stress incontinence is regular strengthening of pelvic muscles and prevention of obesity. Some women after menopause may benefit from prescription of hormonal therapy but this can not be generally recommended. A very effective therapeutic option is gynecological surgical intervention when doctors apply special pelvic TVT tape (Tension-Free Vaginal Tape) that mechanically supports the urethra and thus allows proper function of the sphincter. If incontinence occurs as a secondary problem that is caused by other disease, it is advisable to treat the underlying cause.