Incontinence (Leaking)

Urinary incontinence (also known as bladder incontinence) is the involuntary loss of urine from the bladder.

Yes. The most common types of urinary incontinence in women are:

• Stress urinary incontinence: This refers to the loss of urine with physical activity like coughing, sneezing, walking, and straining.
• Urge urinary incontinence: This is urine leakage preceded by a strong urge to urinate.
• Mixed urinary incontinence: This is a combination of stress and urge incontinence.
• Overflow urinary incontinence: This is leakage which happens when the bladder cannot empty normally.

The loss of urine can have different causes, and each cause is treated differently. The most common cause of stress urinary incontinence is vaginal childbirth. Other causes of stress incontinence include obesity and prior prolapse repair surgery.

The causes of urge incontinence are less well known, but women with vaginal prolapse are known to be at higher risk for urge incontinence. Post-menopausal women tend to be at higher risk for urge incontinence, and stress incontinence surgery can also increase the risk of developing urge incontinence.

The cause of overflow incontinence is urinary retention, which is most often caused by severe prolapse, stress incontinence surgery, or rarely, tumors.

Unexpected urine leakage, or unexpected wet underwear or pads are indications of bladder incontinence.

Stress urinary incontinence is diagnosed by a medical professional who looks for and sees a jet of urine from a woman’s urethra during coughing or straining. Urge urinary incontinence is diagnosed when unintended urine leakage occurs during bladder filling. Urge incontinence can also be diagnosed if a woman leaks urine associated with an urge that she cannot delay or postpone.

Urinary incontinence is not life threatening, but it can dramatically affect a woman’s quality of life. Very rarely, tumors can cause urge incontinence, so it is a good idea to have your incontinence evaluated by a pelvic floor specialist to determine if it can safely be ignored.

There are generally no ill effects to doing nothing about your urinary incontinence. A woman can usually safely manage the bladder leakage with absorbent pads and/or specialized underwear. However, the incontinence should be evaluated by a qualified pelvic floor doctor to determine if the incontinence can be ignored.

Yes. Nonsurgical treatments for stress incontinence include:

• Pelvic floor physical therapy and exercises
• Pessaries
• Vaginal inserts

Nonsurgical therapy for urge incontinence includes:

• Bladder retraining therapy (sometimes called timed voiding)
• Vaginal electrical stimulation
• Tibial nerve stimulation
• Medications
• Pelvic floor physical therapy

Decreasing caffeine intake can also help to decrease urge incontinence symptoms.

Surgical options for stress incontinence include:

• Vaginal slings (which can be made from a woman’s own tissues or from synthetic material)
• Urethral bulking agents
• Laparoscopic/robotic bladder neck suspensions

For urge urinary incontinence, Botox® injection into the bladder muscle and sacral neuromodulation (a kind of bladder pacemaker) are both effective treatment options.

Normally, stool is stored in a part of the large bowels (known as the rectum) until a woman decides to empty her bowels. The rectum is a flexible tube, whose exit is controlled by muscles of the anal sphincter complex and the levator ani (also known as the pelvic floor muscles). The stool is held in the rectum because the rectal tube expands, while the anal sphincter and pelvic floor muscles contract, preventing the exit of rectal contents. Normally, these muscles can prevent rectal contents from leaking, even during strenuous straining and coughing activities. Sometimes these storage mechanisms fail, and the result is unintended leakage of stool. This is called fecal incontinence, or bowel incontinence.

Fecal incontinence can involve loss of solid stool or liquid stool.

Bowel incontinence in women has several causes. For solid stool incontinence, one possible cause may be weakness of the pelvic floor muscles and/or weakness or disruption of the anal sphincter complex. Pelvic organ prolapse, especially rectocele, can contribute to constipation and bowel incontinence.

There are many different possible causes of liquid fecal incontinence, many of which are diet related. Evaluation of liquid fecal incontinence should begin with a careful, detailed evaluation by your primary care doctor.

In women who complain of stool loss, there is a test called a defecogram (also called defecography) which can help to diagnose fecal incontinence. The defecogram is a type of X-ray study which can show the movement of the rectal contents during straining and defecation attempts. This test is also good at identifying anatomic conditions that may affect bowel-emptying function.

Usually not, but because fecal incontinence can have many different causes, it is important to have this problem evaluated by a doctor to rule out a serious underlying problem.

Once the life-threatening causes of bowel incontinence are ruled out, nonsurgical treatments can include stool bulking agents like fiber supplements, as well as pelvic floor physical therapy, and injectable anal mucosal bulking agents.

Surgical treatment of fecal incontinence is often guided by the results from a defecography study and sometimes also a dynamic, rectal contrast pelvic MRI. Ideally, surgical therapy should begin with correcting any significant pelvic organ prolapse that may be present. Often, correction of significant prolapse can lead to improved bowel emptying, which can reduce or correct the leakage problem. Other surgical therapies include a technique known as sacral neuromodulation, which is a kind of pacemaker for the bowels, and anal sphincteroplasty, which is a reconstruction of the anal sphincter complex.