Urinary incontinence is a condition that impacts both men and women. Defined by the involuntary leakage of urine, UI more commonly impacts women than men. Since incontinence is classified as a non-life-threatening condition, many women find themselves suffering in silence, dealing with the symptoms and residual impacts in secret.
Two experts from the University of Alabama at Birmingham offer clarity on the condition and recommendations for women wrestling with the weight of incontinence’s impact on quality of life.
Understanding the types and risk factors
There are two main types of urinary incontinence: stress and urge. Stress urinary incontinence refers to leakage from physical exertion. This specifically relates to an increase in intra-abdominal pressure that occurs with activities such as sneezing, coughing, lifting or even going from a sitting to standing position.
“We think about stress urinary incontinence as more of an anatomic problem,” said Gena Dunivan, M.D., director of the Division of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics and Gynecology. “The muscles and tissue that are used to support the bladder and the urethra are not as strong as they used to be.”
Urge urinary incontinence is the loss of control of urine associated with the urge to urinate. This type is oftentimes associated with a syndrome called overactive bladder, which may also include urinary frequency, urinary urgency, and/or nocturia (awakening at night to urinate).
It is not unusual for a woman to be incontinent in the immediate postpartum period. However, incontinence is also common as women age, especially when they go through menopause. Dunivan emphasizes that although this is common, that doesn’t mean it is normal.
Tracey Wilson, M.D., professor in the UAB Department of Urology, says too often women adopt this condition as a normal act of aging, or something to be expected after having children, when that is not the case.
“Regardless of the age of the patient, experiencing incontinence can be embarrassing and isolating for women,” Wilson said.
Psychological and social impact
Severe cases of urinary incontinence can commonly impact the mental health of those afflicted. Social isolation, lifestyle limitations, anxiety and depression are unintended outcomes that women may face from untreated urinary incontinence.
“They can have social withdrawal simply because they are afraid of leakage occurring in a public space,” Dunivan said. “While this isolation can lead to depression, the psychological toll of living with a condition that feels out of one’s control is frequently underrecognized.
Lifestyle and treatment options
Urge incontinence is commonly linked to an overactive bladder, a condition in which muscles in the bladder contract involuntarily, even when the bladder is not full. Other patients may have a neurologic condition that predisposes them to problems with urinary control, such as multiple sclerosis or spinal cord injury. Initially, healthcare providers will monitor and adjust fluid intake and bathroom habits to better mitigate symptoms and reduce the inconvenience of urinary frequency and accidents. This is commonly referred to as behavioral modifications.
Wilson says behavioral changes can significantly improve the quality of life in those dealing with overactive bladder.
“We always want to identify the cause,” Wilson said. “We evaluate the detailed history and daily habits of the patient, including how much fluid they are drinking, what they are drinking and when they are drinking it.”
Other treatment options include medication, neuromodulation and chemodenervation.
UAB now offers an implantable form of posterior tibial nerve stimulation.
When it comes to stress urinary incontinence, there are no medications that can effectively correct the condition. Treatment options may include pelvic floor therapy, pessaries (a removable device placed in the vagina), and surgery.
“Anytime we can work to strengthen the pelvic floor, that is going to help these conditions,” Dunivan said.
Wilson and Dunivan say incontinence does not have to be normalized no matter the stage of life. There are treatment pathways available.
“What’s important to understand is there are options available for those going through this,” Dunivan said.
Wilson says behavioral and pharmacologic plans are only the first step.
“There is not one straightforward treatment that can be given for every case of incontinence,” Wilson said. “However effective treatment options are available and are focused on improving the patient’s quality of life. This is why it is important to see a doctor and consult an expert, because suffering in silence should not be the resolution.”