Female urinary incontinence
Einstein Health Glossary
ICD 10 - R32
What is female urinary incontinence?
Urinary incontinence is the involuntary loss of urine, meaning it happens without the woman’s intention. It can affect hygiene, quality of life, and social interactions, leading to embarrassment, reduced social and physical activities, and even isolation.
Many women do not report urinary incontinence symptoms to their doctors, either because they believe it is normal or because they feel ashamed.
Incidence in Brazil
In Brazil, although many women do not report urinary incontinence, it is estimated that 11% to 23% of the female population is affected. Prevalence increases with age: between 50 and 75 years old, it affects 20% to 35% of women, and after 75 years, 25% to 50%.
Types
The main types of urinary incontinence are:
- stress urinary incontinence: involuntary urine loss during physical effort such as coughing, sneezing, lifting, jumping, laughing, or even walking or standing up. It usually results from a malfunction of the urethra or the pelvic floor muscles that support it
- overactive bladder: characterized by a sudden urge to urinate, which may or may not be accompanied by urine loss (urge incontinence), without a urinary tract infection. It is caused by involuntary contractions of the bladder muscle (detrusor) outside of normal urination times
- mixed urinary incontinence: when urine loss occurs due to both stress incontinence and overactive bladder
- overflow incontinence: when the bladder loses the ability to signal fullness and to contract properly, leading to overflow. Urine loss usually occurs as dribbling. This is common in women with uncontrolled diabetes, stroke, or spinal cord injuries
Causes
Increased intra-abdominal pressure: pregnancy, obesity, chronic cough, chronic constipation, intense or improperly guided physical exercise.
- trauma: vaginal delivery (natural or with forceps), perineal injury, or previous surgeries such as hysterectomy
- collagen deficiency: genetic, smoking, menopause
- neuropathic diseases: spinal cord injury, central or peripheral neuropathy, diabetes
Symptoms
Involuntary urine loss when coughing, laughing, or making during physical effort, or a sudden urge to urinate that may lead to leakage.
Diagnosis
- based on the patient’s clinical history
- physical examination helps confirm the diagnosis and investigate associated conditions such as genital prolapse
- sometimes, a voiding diary and additional tests are needed, such as: urodynamic study, transperineal ultrasound, or even magnetic resonance imaging (MRI)
Treatment
- lifestyle changes: balanced diet, avoiding prolonged bladder retention, urinating every 3 hours on average, reducing fluid intake at night, avoiding alcohol and caffeine, reducing citrus food intake, and managing conditions like diabetes and urinary infections
- clinical treatment for stress incontinence: pelvic floor physiotherapy, treatment of genital hypotrophy (topical estrogen and/or laser therapy)
- surgical treatment for stress incontinence: sling procedure (gold standard), Burch colposuspension (non-sling), periurethral injection
- clinical treatment for overactive bladder: pelvic floor physiotherapy and/or posterior tibial nerve stimulation, oral medications (anticholinergics, tricyclic antidepressants, beta-3 agonists)
- surgical treatment for overactive bladder: botulinum toxin injection into the bladder and sacral neuromodulation
Prevention
Weight control, well-guided physical exercise or pelvic floor physiotherapy, avoiding prolonged bladder retention, urinating every 3 hours on average, reducing fluid intake at night, avoiding alcohol and caffeine, reducing citrus food intake, and managing conditions like diabetes and urinary infections.