Understanding urinary incontinence: Causes, types, and treatment

Urinary incontinence is a prevalent and often underdiscussed medical condition that affects people of various ages. This involuntary leakage of urine can significantly impact an individual's quality of life. In her latest online article, Dr Aneta Obloza explores the different types of urinary incontinence, their common causes and risk factors, methods of diagnosis, and available treatment options.  

Types of urinary incontinence:  

Urinary incontinence manifests in different forms, each with its unique characteristics: 

Stress urinary incontinence (SUI): Occurs during physical activities such as laughing, coughing, running, walking, or engaging in sexual activity.  

Urge incontinence: Characterised by a sudden and compelling desire to pass urine, which is difficult to defer.  

Mixed urinary incontinence: Involves a combination of involuntary urine leakage during physical exertion or effort and urgency.  

Common causes and risk factors:  

Several factors contribute to the development of urinary incontinence, including:  

Age: The prevalence and severity of urinary incontinence increases with age.  

Obesity: Increases the odds of urinary incontinence threefold.  

Pregnancy and deliveries: Especially vaginal births, including forceps or vacuum-assisted deliveries.  

Family history: Genetic predisposition may play a role.  

Medical conditions: Such as diabetes, stroke, depression, fecal incontinence, menopause, past hysterectomy, radiotherapy, and dementia.  

Lifestyle factors: Caffeine, alcohol, artificial sweeteners, smoking, and certain medications.  

Diagnosis and treatment options:  

Diagnosing urinary incontinence involves a detailed history, ancillary tests like bladder diaries, quality of life questionnaires, and urodynamic tests. Treatment options vary based on the type of incontinence:  

Urinary urgency/Urge leakage:  

• Oral tablets (anticholinergics or mirabegron).  
• Vaginal estrogen pessaries or cream.  
• PTNS (Percutaneous Tibia Nerve Stimulation).  
• Botox injection to the bladder muscles.  
• SNS (Sacral Nerve Stimulation).  

Stress urinary incontinence:  

• Continence pessaries (Uresta or Contiform).  
• Oral tablet Duloxetine.  
• Bulkamid - a gel injected at the bladder neck.  
• Colposuspension - open surgery with supporting sutures.  
• Autologous fascial sling - a procedure using tissue harvested from the stomach lining.  

Prevention and lifestyle changes:  

Maintain a healthy lifestyle with a normal BMI. Perform pelvic floor exercises, ideally guided by a specialist.  

• Avoid constipation and straining.  
• Manage conditions like asthma, COPD, and diabetes.  
• Quit smoking.  

Seeking medical help:  

Consult a urogynecologist if lifestyle changes, pelvic floor exercises, and weight loss have not improved urinary leakage. A comprehensive assessment, including history, examination, and tests, will guide personalised treatment goals.  

Urinary incontinence is a common condition that can significantly impact daily life. Understanding its types, causes, and available treatments empowers individuals to take proactive steps towards managing and improving their symptoms. Seeking timely medical advice and adopting a healthy lifestyle are crucial in addressing urinary incontinence effectively. 

Dr Aneta Obloza is an esteemed urogynaecologist. You can schedule an appointment with Dr Obloza on her Top Doctors profile.