Urinary Incontinence: The American College of Obstetricians and Gynecologists

The American College of
Obstetricians and Gynecologists
f AQ
FREQUENTLY ASKED QUESTIONS
FAQ081
GYNECOLOGIC PROBLEMS
Urinary Incontinence
What is urinary incontinence?
Are there different types of urinary incontinence?
What are the symptoms of urinary incontinence?
What causes urinary incontinence?
How is urinary incontinence diagnosed?
How is urinary incontinence treated?
What are some of the lifestyle changes that are used to manage urinary incontinence?
What is bladder training?
What types of physical therapy are used to treat urinary incontinence?
How are Kegel exercises done?
What devices are used to treat urinary incontinence?
What medications are used for treatment?
What are bulking agents?
What types of surgery treat urinary incontinence?
Glossary
What is urinary incontinence?
Leakage of urine is called urinary incontinence. Some women leak small amounts of urine. At other times, leakage of urine
is frequent or severe.
Are there different types of urinary incontinence?

There are several types of urinary incontinence:
Stress urinary incontinenceLoss of urine when a woman coughs, laughs, or sneezes. Leaks also can happen when a
woman walks, runs, or exercises. It is caused by a weakening of the tissues that support the bladder or the muscles of
the urethra.
Urge incontinenceLeakage of urine caused by overactive bladder muscles that contract too often or problems with
the nerves that send signals to the bladder
Mixed incontinenceA combination of both stress and urge incontinence symptoms
Overflow incontinenceSteady loss of small amounts of urine when the bladder does not empty all the way during
voiding. It can be caused by an underactive bladder muscle or blockage of the urethra.
What are the symptoms of urinary incontinence?

In addition to leaking urine, a woman with incontinence also may have other symptoms:
UrgencyA strong urge to urinate whether or not the bladder is full, often with pelvic pressure
FrequencyVoiding more often than she considers usual
Nocturia The need to void during hours of sleep

Dysuria Painful voiding
EnuresisBed-wetting or leaking while sleeping
What causes urinary incontinence?

Urinary incontience can have short-term causes and long-term causes. Short-term causes are easier to treat and include
the following:
Urinary tract infectionLoss of bladder control may be caused by an infection of the urinary tract. Infections of the
bladder (cystitis) are common in women. These infections are treated with antibiotics.
MedicationsLoss of bladder control may be a side effect of medications, such as diuretics.
Abnormal growthsPolyps, bladder stones, or less commonly, bladder cancer, can cause urinary incontinence.
Abnormal growths often cause urge incontinence and may be associated with blood in the urine. If you see blood in your
urine, or if you are unsure about the source of any bleeding, it is important to alert your health care provider right away.
Long-term causes include the following:
Pelvic support problemsThe pelvic organs are held in place by supportive tissues and muscles. These supporting
tissues may become torn or stretched, or they may weaken because of aging. If the tissues that support the urethra,
bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making it hard to pass
urine.
Urinary tract abnormalitiesA fistula is an abnormal opening from the urinary tract into another part of the body, such
as the vagina. It can allow urine to leak out through the vagina.
Neuromuscular problemsThese disorders can interfere with the transmission of signals from the brain and spinal cord
to the bladder and urethra.
How is urinary incontinence diagnosed?

A number of steps may be needed to find the cause of urinary incontinence. In some cases, there may be more than one
cause.
You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage. You
also should note how much liquid you drank and what you were doing when a leak occurred.
A pelvic exam will be done to detect physical conditions that might be linked to the problem. Lab tests also may be done
to detect a urinary tract infection. Other tests that assess how your bladder functions include the following:
Urodynamic testsThe bladder is filled through a catheter. These tests check the function of the urethra and bladder.
Postvoid residual volume testThe amount of urine that is left in the bladder after urinating is measured with an
ultrasound device or by placing a catheter in the bladder.
Stress testYou are asked to cough a few times with a full bladder. Any loss of urine is recorded.
CystoscopyA thin, lighted tube with a lens at the end is used to look inside the bladder and urethra.
Dye testA pad is worn after a nontoxic dye is put in the bladder. If the pad gets stained with the dye, there was a loss
of urine.
How is urinary incontinence treated?

There are many options for treatment. Often treatments are more effective when used in combination. Treatment options
include lifestyle changes, bladder training, physical therapy, devices, medications, bulking agents, and surgery.
What are some of the lifestyle changes that are used to manage urinary incontinence?
Making the following changes in your lifestyle, if they apply to you, may help the problem:
Lose weight. In overweight women, losing weight has been shown to decrease the frequency of urine leakage.
Avoid constipation. Repeated straining may damage the pelvic floor.
Drink less fluids and limit intake of caffeine, which is a diuretic.
Seek treatment for chronic coughing.
Stop smoking.
What is bladder training?

The goal of bladder training is to learn how to control the urge to empty the bladder and increase the times between
urinating to normal intervals (every 34 hours during the day and every 48 hours at night). After a few weeks of this
training, leakage may occur less often.
What types of physical therapy are used to treat urinary incontinence?

There are many types of physical therapy that can be done to treat urinary incontinence. One type, Kegel exercises, can
help strengthen the pelvic muscles. Kegel exercises, along with bladder training and modifying fluid intake, are often very
successful in treating stress incontinence and urge incontinence.
If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in womens pelvic
health. Biofeedback is a training technique that may be useful if you have problems locating the correct muscles.
How are Kegel exercises done?

Kegel exercises tone your pelvic muscles. Here is how they are done:
Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating).
Hold for up to 10 seconds, then release.
Do this 1020 times in a row at least 3 times a day.
Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. It may take
46 weeks to notice an improvement in urinary incontinence symptoms.
What devices are used to treat urinary incontinence?

A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence. Pessaries
support the pelvic structures, and some compress the urethra. They come in all shapes and sizes. They are useful for women
who do not want or cannot have surgery to correct their incontinence.
What medications are used for treatment?

Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge
incontinence. These medications also can help reduce the frequency of urination. Your health care provider will help you
decide which drug is most likely to work best for you.
What are bulking agents?

These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option
or has not worked. A substance is injected into the tissues around the urethra to add bulk. The urethra becomes narrowed,
decreasing leakage. This procedure can be done in a doctors office or clinic.
What types of surgery treat urinary incontinence?

Several surgical procedures have been developed to treat stress urinary incontinence (see the FAQ Surgery for Stress
Urinary Incontinence). You and your health care provider should discuss many factors, including your age, lifestyle, and
general health, before choosing to have surgery.
Glossary
Antibiotics: Drugs that treat infections.
Biofeedback: A technique in which an attempt is made to control body functions, such as heartbeat or blood pressure.
Bladder: A muscular organ in which urine is stored.
Catheter: A tube used to drain fluid or urine from the body.
Cystitis: An infection of the bladder.
Diuretics: Drugs given to increase the production of urine.
Dysuria: Pain during urination.
Fistula: An abnormal opening or passage between two internal organs.
Nocturia: The need to urinate frequently during the night.
Pelvic Exam: A manual examination of a womans reproductive organs.
Pessary: A device inserted into the vagina to support sagging organs.
Polyps: Benign (noncancerous) growths that develop from tissue lining an organ, such as that lining the inside of the uterus.
Ultrasound: A test in which sound waves are used to examine internal structures.
Urethra: A short, narrow tube that carries urine from the bladder out of the body.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.
Voiding Diary: A daily log in which a woman keeps track of how many times she urinates, her fluid intake, and the number
of times she leaks urine.
If you have further questions, contact your obstetriciangynecologist.
FAQ081: Designed as an aid to patients, this document sets forth current information and opinions related to womens health. The information does not dictate an exclusive course
of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual
patient, resources, and limitations unique to institution or type of practice, may be appropriate.
Copyright May 2011 by the American College of Obstetricians and Gynecologists. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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The American College of

Obstetricians and Gynecologists

Are there different types of urinary incontinence?

What are the symptoms of urinary incontinence?

Nocturia The need to void during hours of sleep

What causes urinary incontinence?

How is urinary incontinence diagnosed?

How is urinary incontinence treated?

What is bladder training?

What types of physical therapy are used to treat urinary incontinence?

How are Kegel exercises done?

What devices are used to treat urinary incontinence?

What medications are used for treatment?

What are bulking agents?

What types of surgery treat urinary incontinence?

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