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Female Urinary Incontinence

With approaching menopause and during the years that follow, normal aging and declining estrogen levels may affect the lining of the urethra (the tube through which urine empties from the bladder), causing it to become thin and the surrounding muscles to weaken. As a result, a woman may have involuntary leakage –called incontinence (especially when sneezing, coughing, laughing, or lifting), more frequent urination, urgency (suddenly needing to urinate even though the bladder may not be full), nocturia (getting out of bed to urinate several times during the night), and painful urination. Other common causes of these problems are urinary tract infections, other medical conditions (such as nerve disorders), and certain prescription drugs (like diuretics and tranquilizers). Therefore, a diagnosis must confirm the exact cause –one should not just assume its old age or menopause.

Early diagnosis and treatment can often completely cure the problem; if a complete cure is not possible, at least comfort can usually be improved. Although as many as 40% of women aged 45 to 64 have urinary incontinence, fewer than half seek help –often because of embarrassment or the misconception that the condition is an inevitable consequence of aging and cannot be treated.

Causes

  • Urinary tract infections
  • Lack of Estrogen
  • Anatomical weakness from childbirth injuries, congenital problems, or previous pelvic surgery
  • Bladder Tumors–especially if there is blood in the urine
  • Irritable or unstable bladder
  • Medications–fluid pills, tranquilizers and anti depressants, drugs for high blood pressure, ulcers
  • Neurological disease–disorders of nerves, the spinal cord or brain which effect bladder functioning such as strokes, multiple sclerosis, diabetes, or degenerative disk disease of the spine

Assessment

A thorough assessment involves a comprehensive medical history and physical examination– both general and neurological, and an examination of the urine for blood and signs of infection. If these studies are unremarkable, some simple measures make by taken to try to relieve the symptoms such as treatment of an infection, pelvic floor exercises, changing of medications, or topical hormones. If things are do not improve with a reasonable period of time, further assessments of the functioning of the bladder and kidney may be necessary including looking inside of the bladder with a cystoscope, checking the urine for the presence of malignant cells, and studies of the function of the bladder through pressure studies called urodynamics. If specific functional abnormalities are founds, medications may be used to improve the functioning of the bladder and give better control. If the problem is an anatomical weakness of the bladder supports (and this is the most common cause of persistent incontinence, particularly in women age 30-60) then surgery may be indicated.

Surgical Approaches

There are many surgical approaches including vaginal, abdominal, and laparoscopic approaches. Today, most repairs for urinary incontinence are done vaginally. These include repairing weakness in the pelvic floor with sutures, using synthetic slings and/or meshes or injecting “bulking agents” around the urethra. . The type of repair depends on the specific anatomical problem. There is no single approach to meets the needs of everyone. Depending upon the problem, the repair may be done either by a gynecologist or urologist.