Leaking Urine? You’re Not Alone.

Aug 16, 2023

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By Rebekah Ross, MD, Sunflower OB/GYN at William Newton Hospital

If you’re a woman who has noticed persistent urine leakage, you’re in good company. About half of adult women experience urinary incontinence at some point in their lives. Some write it off as “old age.” Some suffer in silence. Some are too embarrassed to discuss it at all. But the truth is urinary incontinence is a medical condition and there are treatment options available.

Types of Incontinence

Because there are multiple types of incontinence, and each one is treated differently, treatment of urinary incontinence starts with identifying the cause. Stress urinary incontinence is leakage with activities that increase pressure in the pelvis, like coughing, sneezing, laughing, or lifting something heavy. The underlying cause of stress urinary incontinence is weakness of the vaginal and urethral muscles, so it is more common in older women and women who have had vaginal deliveries. But it can occur in anyone!

Stress urinary incontinence sometimes occurs in the presence of a cystocele, which is when the bladder prolapses into the vagina because the vaginal tissue is too weak to support it. Cystoceles can cause both incontinence and difficulty voiding.

Urge incontinence (also called “overactive bladder”) is caused by bladder spasms. Women with urge incontinence report sudden, uncontrollable urges to urinate right away. If they don’t race to the bathroom, they leak or wet themselves. Usually there are no obvious triggers; these urges come out of nowhere.

Overflow incontinence occurs when a woman is unable to empty her bladder completely. A woman with overflow incontinence often feels like she is leaking constantly, but when she tries to void, the stream is weak, very little urine is expressed, or she struggles to go at all. Most of the time, overflow incontinence is caused by a dysfunctional bladder muscle. Numerous conditions can impair the bladder muscle and cause persistent urinary leakage, including:

• Strained bladder muscle from overfilling
• Nerve damage from a spinal injury
• Multiple sclerosis
• Chronic medical problems
• Scarred bladder from radiation

Medical Conditions That Cause Urinary Leakage

Before making a diagnosis of incontinence, it’s important to rule out medical causes of urine leakage, because many of these are easily treated. It’s not unusual to have more than one cause of leakage at the same time. These are just some of the medical conditions that can cause leakage: a urine infection, medications, uncontrolled diabetes, caffeine, alcohol, and a fistula between the bladder and the vagina (rare in the USA).

Diagnostic Tests

Doctors will usually do a full history and physical exam before diagnosing a woman with incontinence. A vaginal exam is particularly important for diagnosing cystoceles. The exam is often followed by some blood and urine tests to rule out medical causes. Cystometrics is a set of tests (usually done by urogynecologists) to measure very specific things: how much the bladder will hold, how much urine is left after voiding, and the pressure needed to void. Cystometrics is not done on everyone with incontinence — it’s most useful for diagnosing causes of incontinence that are not immediately obvious or aren’t responding to usual treatments.

Treatments

Every form of treatment works best in combination with healthy habits. Maintaining a healthy weight, controlling blood sugars, limiting diuretic drinks like coffee, sodas, and alcohol, and using the bathroom every three to four hours are all practical ways to practice good urinary habits. For stress urinary incontinence, there are four main treatment options, including:

• Pelvic floor exercises (also known as Kegel exercises) can be done at home and are designed to strengthen the muscles that control urine flow.
• A pessary is a plastic structure (usually a ring, although there are other shapes) that sits in the vagina and pushes the bladder back into place. Pessaries must be removed, cleaned, and replaced periodically to prevent infections and vaginal ulcers, but this can be done at home.
• Bulking agents are synthetic fluids like collagen or silicone that are injected directly into the bladder channels to make them stiffer and less likely to leak.
• Surgeries are available to correct cystoceles and over-mobile bladder channels. Anterior repair surgery pushes sagging bladders and vaginas back into a more normal location. Vaginal taping surgeries place a slim tape below the urethra to give it additional support.

The mainstay of urge incontinence is medication. There are a variety of medications, some of which are tailored for specific age groups and people with certain medical conditions. Sometimes people need to try more than one before they find something that works.

Talk to your OB/GYN or primary care provider – they are here to help. And if needed, they can refer to urogynecologists, who are specialists in the treatment of urinary incontinence.