Urinary Incontinence in Women

If you have bladder issues, you're not alone. Urinary incontinence is a common condition that affects millions of women every year.

Incontinence may be a minor issue for some people. But for others, it's a major problem that affects all aspects of their everyday life.

Often, embarrassment and shame prevent people from seeking care for urinary incontinence. But you don’t have to deal with incontinence or “just live with it.” Bladder issues, like many other health concerns, are easier to treat the earlier you detect the problem.

At UPMC, we have treatment options that can help with urinary incontinence.

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On this page:

• What Is Urinary Incontinence?
• What Are the Symptoms of Urinary Incontinence?
• How Do You Diagnose Urinary Incontinence?
• How Do You Treat Urinary Incontinence? 

What Is Urinary Incontinence?

Doctors define urinary incontinence as the unintentional passing of urine or loss of bladder control.

Although urinary incontinence problems are most common in post-menopausal women, they can affect women of any age. About half of adult women report having urine leakage at one time or another.

How common is urinary incontinence?

As many as 18 million women of all ages are unable to predict when and where they'll urinate.

What are the types of urinary incontinence?

The types of urinary incontinence in women are:

• Stress urinary incontinence — An involuntary loss of a small amount of urine when you laugh, cough, sneeze, or exercise. It's typically due to pelvic floor weakness.
• Overactive bladder (urgency incontinence) — When you have a strong, sudden urge to pee. It's usually caused by bladder spasms but may also be because of a disrupted or abnormal message from the brain to the bladder.
• Mixed incontinence — When you experience both stress incontinence and urgency incontinence.

What causes urinary incontinence?

Bladder control is a complex process that involves the brain, spinal cord, and muscles of the bladder and pelvis. Loss of bladder control can be caused by many problems with any of these components.

Some causes of urinary incontinence include changes in muscles because of:

• Aging.
• Pregnancy and childbirth.
• Birth defects.
• Degenerative changes associated with aging, such as difficulty walking and memory loss.
• Dementia.
• Injuries to the pelvic region or the spinal cord.
• Neurological diseases, such as multiple sclerosis and Parkinson’s disease.
• Pelvic surgery.

What are urinary incontinence risk factors and complications?

Urinary incontinence risk factors 

Risk factors for having an uncontrollable bladder include:

• Bladder infection.
• Diabetes.
• Menopause.
• Damage to pelvic floor muscles from childbirth.
• Previous pregnancy or childbirth.
• Urinary tract infection, kidney infection, or kidney stone.
• Weak bladder muscles.
• Weight gain.

Complications of urinary incontinence

• A leaky bladder may lead to:
• Urinary tract infections (UTIs).
• Kidney issues.
• Decreased physical activity.
• Sexual dysfunction.
• Depression.
• Social isolation.

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What Are the Signs and Symptoms of Urinary Incontinence?

Urinary incontinence affects everyone differently.

You may have urinary incontinence if you leak pee:

• Climbing stairs.
• Coughing and sneezing.
• During intercourse.
• Getting up from a chair.
• Jumping or exercising.
• Laughing.
• Lifting, bending, or stretching.

Other signs of urinary incontinence are:

• Feeling like your bladder is never completely empty.
• Getting up more than once at night to pee.
• Going to the bathroom more than seven times per day.
• Having frequent leaking episodes.
• Having frequent uncontrollable urges to urinate that may result in incontinence.
• Leaking urine due to triggers, such as putting your key in the door or hearing running water.
• Leaking urine as soon as you need to go to the bathroom.
• Leaking urine even when you drink small amounts of liquid.

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How Do You Diagnose Urinary Incontinence?

Because urinary incontinence can be caused by different issues and there's more than one type, your doctor will need to run tests to make a diagnosis.

Tests to diagnose urinary incontinence

Tests your doctor might order include:

• Blood work.
• Urinalysis.
• X-ray.
• Urodynamic evaluation.

Urodynamic evaluation

Your doctor may order urodynamic tests that evaluate how well your bladder is working. Urodynamic tests can be simple or complex and can provide a range of measurements.

A urodynamic evaluation can show:

• How much urine you produce.
• The rate at which your bladder empties.
• The volume of urine remaining in your bladder after you pee.
• The amount of urine in your bladder when you feel the need to pee.
• How much urine your bladder can hold before an involuntary loss of urine occurs.

A urogynecologist will evaluate the results of your urodynamic tests to determine if your bladder is functioning normally. They'll also recommend appropriate treatment, if needed.

What is a voiding diary?

Your urogyn may ask you to keep a diary of your bathroom habits. This voiding diary or bladder diary keeps track of how much you drink and pee.

Together, urodynamic tests and a voiding diary can provide valuable details about your bladder.

An accurate diary gives your urogynecologist a clear picture of:

• How often you go.
• How often you leak.
• What you drink.
• How often you drink.

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How Do You Treat Urinary Incontinence?

Many people are embarrassed or ashamed by a loss of bladder control, and mistakenly believe nothing can be done to correct it. But that's not the case — we have a range of treatment options for urinary incontinence.

The two different types of urinary incontinence — urgency incontinence and stress incontinence — are treated differently. Not every treatment will work for every person, and some people will need a mixture of treatments for the best outcome.

Drinking less water isn't a good way to solve either kind of urinary incontinence because it may cause dehydration. Concentrated urine caused by dehydration can irritate the lining of the bladder and urethra and make your incontinence worse. Drinking two to three quarts of water a day may actually help.

But some fluids, like alcohol and caffeinated drinks, may make your incontinence worse. Stop drinking any fluids two to three hours before bedtime.

Treatments for urgency incontinence

Urgency incontinence is usually treated through behavioral modification and medicine to control bladder spasms.

Behavioral approaches to urgency incontinence

These therapies may be helpful in treating urgency incontinence:

• Scheduled toileting — When you're prompted to empty your bladder at a predetermined timed interval and not wait until you have an urge to go.
• Bladder retraining — A form of scheduled toileting in which the length of time between bathroom trips is gradually increased to enable your bladder to hold larger volumes of urine. This therapy trains the bladder to wait for longer time periods and has proved effective in treating urgency and mixed incontinence.
• Pelvic muscle rehabilitation — This technique involves training the pelvic muscle. You'll do exercises alone or in conjunction with biofeedback therapy, vaginal weight training, and pelvic floor stimulation to stimulate pelvic nerves.

Medicine to treat urgency incontinence

Your doctor may prescribe medications to relax the bladder and reduce spasms or instability. These drugs help prevent your bladder from contracting spontaneously.

Other treatment options for urinary incontinence

If other treatments provide only some or no relief, there are other treatments that may be recommended.

They include:

• BOTOX^® — Works by relaxing the overactive bladder muscles, increasing to bladder’s ability to store urine and reducing urinary incontinence. The Botox injection goes directly into the bladder muscle in a procedure done under local anesthesia in a doctor’s office. A small camera enables the urogynecologist to visualize the bladder for placement of the injection.
• InterStim^® — A small, surgically implanted device that's programmed to provide mild electrical stimulation to your sacral nerves at the base of your tailbone. The sacral nerves are responsible for sending messages to your brain related to bladder and urinary function. Electrical stimulation helps improve communication between the brain and the sacral nerves so your bladder and pelvic floor muscles can function properly.

Stress incontinence treatments

Stress incontinence is usually treated with physical therapy and a procedure known as a midurethral sling.

Physical therapy for stress incontinence

For stress incontinence, treatment options can consist of physical therapy, pelvic floor exercises, or an over-the-counter product called Imprezza™, which stabilizes the urethra during increased abdominal pressure.

Surgery for stress incontinence

Midurethral sling

Midurethral sling surgery uses a piece of synthetic material to stabilize the urethra and help it to close. The procedure helps prevent bladder leaking when coughing, sneezing, laughing, or exercising, and can provide cure rates up to 90%.

The midurethral sling procedure usually is performed as an outpatient surgery. It has been used in the U.S. for 20 years with significant clinical data that supports its treatment outcomes and safety profile with minimal risk.

Bladder neck sling

The bladder neck sling uses your own native tissue to stabilize the urethra. Bladder neck slings can be performed for people who don't want synthetic material placed or who've had complications from midurethral slings.

Periurethral bulking

Periurethral bulking is a procedure that can be done in addition to the sling.

For stress incontinence caused by weakened muscles that close the urethra, a substance can be injected around the urethral muscles to create bulking. The bulking improves the ability to close the urethra and prevent incontinence.

Periurethral bulking can be done in the office or in the operating room.

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Why Choose UPMC for Urinary Incontinence Care? 

Bladder issues don’t have to stop you from enjoying life. UPMC has effective treatments for urinary incontinence.

Our providers have many years of experience treating women with these conditions. Treatments vary from behavioral modification and physical therapy to advanced surgical techniques that can maximize your quality of life with minimal-to-no downtime.

By UPMC Editorial Staff. Last reviewed on 2024-09-05.