Urinary incontinence in women. Jeannine Miranne, MD, Division of Urogynecology at Brigham and Women’s Hospital, discusses urinary incontinence, which affects 17 percent of all American women. Risk factors for urinary incontinence include older age, childbirth, obesity, and menopausal status.
Urinary incontinence is defined as involuntary loss of urine or a loss of urine beyond one's control. It can be divided into three main sub-types. Urgency incontinence is urine loss with a sudden urge or uncontrollable desire to void. Stress incontinence is urine loss with sneezing, coughing, laughing, and other physical activities that increase the pressure in the belly. Mixed incontinence occurs when a woman has symptoms of both urgency and stress incontinence.
First line treatment for all types of urinary incontinence includes behavioral and dietary modifications: limiting fluid intake to 64 ounces daily and cutting down on foods and drinks that are irritating to the bladder, such as coffee, tea, soda, artificial sweeteners.
In addition to behavioral and dietary modifications, there are other treatment options. Pelvic floor physical therapy can be recommended for women with urinary incontinence. This is particularly helpful in women who have difficulty identifying their pelvic floor muscles or in contracting them effectively.
For stress incontinence, additional options for treatment include using a pessary, which is an inter-vaginal support device. Other treatment options for stress incontinence include peri-urethral bulking bulking agent injection, which involves injecting a filler in the urethra to bulk it up to help prevent urine loss, and surgery. Sling procedures can also be performed.
The mainstay of treatment for urgency incontinence is medication to relax the bladder muscle so that it doesn't squeeze as often, preventing urine leakage.
Additional options for the treatment of urgency incontinence include Botox injections in the bladder muscle and a procedure called InterStim, which involves placement of a device similar to a cardiac pacemaker.
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