Urinary Incontinence in Women: Causes & Treatment

Urinary incontinence (UI) in women is more common than you realize, and it is not something you simply have to “live with” as you age.  

Urinary incontinence means uncontrollably leaking pee, which can occur during activities like sneezing, coughing, laughing, or exercising.

Temporary or short-term causes of incontinence may include urinary tract infections (UTIs), pregnancy, or after delivery, certain medications, etc. Chronic causes of incontinence may include overactive bladder, stroke, diabetes, menopause, multiple sclerosis (MS), etc.

The good news? Most women have treatment options depending on why the urine leakage is happening and what type of urinary incontinence you have. 

Treatment may include lifestyle changes, pelvic floor exercises, bladder training, medicines, devices, minimally invasive procedures, and surgery. Consult your doctor to diagnose the underlying cause of UI and determine the right treatment approach with your doctor. 

Quick Overview: Urinary Incontinence in Females

Read the table below to get a quick idea of UI in women.

What Is Urinary Incontinence (UI)?

UI is the involuntary loss of urine or loss of bladder control that predominantly affects women of any age group. It is wrongly considered a part of normal aging; UI has been reported to have widespread physical, psychological, and social impacts on the individuals and the caretaker.

The severity can range from occasional urine leakage when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time. This frequent or significant urine leakage can interfere with daily life; therefore, don't hesitate to see your doctor. For most people, simple lifestyle and dietary modifications or medical care can treat symptoms of urinary incontinence.

Urinary incontinence is not an inevitable part of aging; however, the risk can increase with age.

Types of incontinence include:

Causes Urinary Incontinence in Women

There isn't one single cause of urine leakage. Urinary incontinence can be caused by everyday habits, underlying medical conditions, or physical problems. 

Pregnancy, childbirth, menopause, UTIs, constipation, overactive bladder, certain medications (including water pills (diuretics) and antidepressants), neurological conditions, and changes in the pelvic floor can all contribute.

Pregnancy & childbirth

Pregnancy, followed by hormonal and physical changes, puts extra pressure on the bladder as the uterus (womb) grows and affects the pelvic floor. Your pelvic floor muscles support organs in your pelvis, such as the bladder and bowel.

During childbirth, especially vaginal delivery, the pelvic floor muscles and supporting tissues may become stretched or weakened. Sometimes, this can contribute to stress incontinence or other bladder-control issues.

Menopause

After menopause, there is a decline in the levels of estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can contribute to incontinence.

Pelvic floor weakness

Your pelvic floor muscles support organs in your pelvis, like your bladder and bowel, and contribute to bladder control. When these muscles become weak or do not coordinate properly, urine leakage can happen.

That's why pelvic floor exercises, commonly called Kegel exercises, are a crucial part of urinary incontinence treatment, particularly for stress incontinence.

Urinary tract infections (UTI)

A UTI can irritate the bladder, causing urgency, frequent urination, and sometimes temporary urine leakage.

Constipation

Ongoing straining during bowel movements can put stress on pelvic muscles, leading to weakness over time.

Constipation can contribute to urinary symptoms because your rectum sits close to the bladder and shares some nerve pathways. The rectum is the last part of the large intestine, which holds waste (stool) until your body is ready to push it out.

Other medical conditions

Neurological disorders (multiple sclerosis (MS) and Parkinson’s disease), diabetes, stroke, and other conditions can interfere with the functioning of nerves and muscles responsible for bladder control.

Certain medicines (water pills (diuretics) and antidepressants) and drinks (coffee and alcohol) may also worsen urinary symptoms in some people.

Symptoms of Urinary Incontinence

The main symptom is, of course, urine leakage during activities like exercise, laughing, coughing, sneezing, bending over, or having intercourse.

But other symptoms may be present:

• Peeing more than 8 times per day (frequent urination)
• Feeling that the bladder hasn't completely emptied
• Waking up repeatedly at night to urinate. Peeing more than twice (nocturia)
• Wetting the bed (enuresis)

Symptoms Indicating Possible Types:

How to Cure Urinary Incontinence Permanently?

There is no single permanent cure for urinary incontinence.

Whether it is a "permanent cure" depends on the underlying cause and the treatment used.

Treatment depends on the:

• type, 
• severity, 
• underlying cause, 
• health history
• and personal preferences.

Your doctor will often start the treatment with the least invasive options and progress when necessary.

Treatment options for urinary incontinence

Behavioral techniques 

For example: bladder training; double voiding means urinating, then waiting a few minutes and trying again; scheduled toilet trips, fluid and diet management, etc.

Pelvic floor muscle exercises

For example, Kegel exercises; these techniques are particularly effective for stress incontinence but can also help address urge incontinence.

Medications 

For example, anticholinergics, mirabegron, alpha blockers, topical estrogen, etc.

Medical devices 

For example, urethral insert and pessary

Minimally invasive treatments 

These are considered when conservative treatments aren't enough.

Options can include urethral:

• Bulking injection
• Botox injections into the bladder for selected cases of urge incontinence
• Nerve stimulation or neuromodulation

Electrical stimulation 

Electrodes are inserted on a temporary basis into your rectum or vagina to stimulate and strengthen pelvic floor muscles.

Surgery for stress incontinence

For women with significant stress incontinence who require surgical treatment, mid-urethral sling procedures remain an established treatment option.

Some traditional methods (such as retropubic and transobturator) have extensive evidence behind them. More recent evidence has also supported selected single-incision sling approaches.

Lifestyle changes

• Reducing caffeine or alcohol if they trigger symptoms
• Managing constipation
• Maintaining a healthy weight
• Avoiding excessive fluid intake before activities or bedtime when appropriate
• Stopping smoking
• Urinating before activities that commonly cause leakage

What About New Treatments?

There is still ongoing research into female stress urinary incontinence.

Emerging approaches on which evidence is still developing include autologous muscle-derived cell therapy (myocytes) and adjustable continence therapy (ACT) using periurethral balloons.

These approaches are interesting because they aim to offer alternatives to traditional sling procedures.

For newer treatments, it is important to discuss the quality of evidence, long-term durability, potential complications, and availability with your doctor.

FAQs

How do doctors check for urinary incontinence?

Your doctor can diagnose incontinence by reviewing your symptoms and medical history and conducting a physical examination.

They may ask you questions, such as:

• How often do you pee?
• Do you wake up at night to urinate?
• Do you have difficulty emptying your bladder?
• What medicines and supplements do you take?
• Have you been pregnant or given birth?
• Do you leak pee between trips to the toilet?

Based on your symptoms, other testing may include urinalysis, a bladder diary, post-void residual measurement, ultrasound, or other bladder-function tests.

What is the difference between stress incontinence and urge incontinence?

Urge incontinence happens when you experience a sudden, intense need to urinate followed by involuntary urine leakage.

Stress incontinence is when there is urine leakage during certain activities, such as laughing, coughing, sneezing, running, jumping, or lifting heavy objects.

Conclusion

There are various reasons why you might not be able to hold your pee. Your risk for developing incontinence as you age might be higher if you:

• Have a chronic health condition, neurological disease, or diabetes.
• Are overweight.
• Have given birth.
• Have a smoking habit
• Are in postmenopause

This condition can have a negative effect on your life. Therefore, if you experience urine leakage with coughing, sneezing, or exercise, or a sudden, difficult-to-control need to urinate, consult your doctor.  There are often several ways to improve bladder control and get back to normal daily activities.

A doctor will help identify what type of urine leakage you have and personalize treatment (pelvic floor exercises, bladder training, and lifestyle changes, medicines, pessaries, injections, nerve stimulation, etc.) based on the findings and your personal preferences.

Disclaimer: This blog is for informational use. Contact a healthcare provider for accurate information about urinary incontinence in women.