Urinary incontinence is the medical term used to describe the condition of not being able to control the flow of urine from your body. An estimated 17 million women in the United States cope with urinary incontinence.

In women, the sphincter muscle is located below the bladder, surrounding the urethra. When the sphincter muscle tightens, it holds urine in the bladder. When the sphincter muscle relaxes, it allows urine to flow outside the body. The bladder and urethra must be well supported by the pelvic muscles and tissue to allow them to work together properly.
Urinary incontinence usually is caused by weakened or damaged pelvic muscles and tissue that prevent the urethra from closing tightly enough to hold urine in the bladder.

Types of Urinary Incontinence

There are five basic types of incontinence. In many cases, individuals experience symptoms of more than one type of incontinence. Proper diagnosis of the type of incontinence is an important factor in successful treatment. Urodynamic testing performed in the office may be necessary to determine your type of incontinence and the best treatment for you.

• Stress Incontinence—Occurs when you leak urine during a physical activity like lifting, exercising, sneezing and coughing.
  
• Urge Incontinence—Experiencing an overwhelming need to urinate, but being unable to hold it long enough to reach a toilet.
  
• Mixed Incontinence—A combination of stress and urge incontinence.
  
• Overflow Incontinence—When your bladder never completely empties, causing urine to overflow or leak.
  
• Functional Incontinence—Factors outside the lower urinary tract, such as weaknesses in physical and/or cognitive function.

Causes of Urinary Incontinence

Urinary incontinence in women can be caused by any single condition or combination of conditions such as those listed below.

• Pregnancy and Vaginal Childbirth—Weakened or damaged pelvic muscles and tissue can be the result of pregnancy and childbirth, causing the bladder and urethra to relax from their normal positions.
  
• Aging and Genetic Factors—Aging tends to worsen all forms of muscular injury. Changes in pelvic muscles can contribute to incontinence.
  
• Medical Conditions—Certain medical and neurological conditions, such as hysterectomies, spinal cord problems (e.g., spina bifida, spinal cord injury, malformation of the lower spine), multiple sclerosis, Parkinson's disease, stroke and diabetes can cause incontinence.
  
• Infections and medications—Urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.
  
• Obesity—While obesity does not cause incontinence, it does contribute to the condition due to the increased abdominal pressure.
  
• Smoking—While not a direct cause of incontinence, smoking may aggravate incontinence.

Many options are available for the treatment of incontinence, and these include:

• Behavior Therapies—For those who suffer from stress urinary incontinence, behavior therapy can be a treatment option. Techniques can teach you to control your bladder and sphincter muscles by:
  
  • Decreasing fluid intake
    
  • Prompting or scheduling voiding (used in women who can recognize some degree of bladder fullness)
    
• Pelvic muscle exercises—These exercises are commonly called Kegels and are used to strengthen the weak muscles surrounding the bladder.
  
• Protective Undergarments—Products such as pads, undergarment liners and absorbent underwear are worn to absorb urine that has leaked from the bladder.
  
• Catheter—An indwelling catheter, which is left in place 24 hours a day to continually collect urine in an external drainage bag.
  
• External Devices—A pessary device or stiff ring that is inserted into the vagina where it presses against the wall of the vagina and the urethra. The pressure helps reposition the urethra, preventing leakage.
  
• Biofeedback and Electrical Stimulation-A painless, in-office therapy whereby the patient learns to properly contract the muscles of the pelvic floor more efficiently resulting in improved urinary control.
  
• Bulking Injections—A bulk-producing agent, such as collagen, is injected to bulk up the urethral lining so the urethra can close more tightly.
  
• Medication—A number of medications can help bladder control problems due to urge incontinence. However, there are presently no medicines available to treat stress incontinence. If your doctor determines you have mixed (stress and urge) incontinence, you may find drug therapy helpful in addressing the urge component of your incontinence.
  
• Surgery—There are surgical options to treat urinary incontinence. These include:
  
  • Retropubic Suspensions—These surgical options are performed through an abdominal incision and elevate the urethra and bladder neck to a higher anatomical position.
    
  • Slings—A sling procedure is used to both elevate the urethra and treat a weakened urethral sphincter muscle. The sling serves as support for the urethra during increased abdominal pressure.
    
    • Bone fixated slings treat incontinence by supporting the urethra with a graft material that is secured to the pubic bone.
      
    • Self-fixating slings treat incontinence by supporting the urethra. The sling is made of a mesh material that is secured into place by friction and natural tissue in-growth.