Urinary Incontinence
Urinary incontinence is common and undertreated.
Urinary incontinence is common and undertreated.
It is estimated that up to 50% of women will have some urinary incontinence.
The General Longitudinal Overactive Bladder Evaluation – Urinary Incontinence (UI) (GLOBE-UI) is a population-based study on the natural history of UI in women aged over 40 years. Prevalence of UI was estimated by using the bladder health survey (BHS). Out of 7000 women- 47% responded and of them 41% suffered from urinary incontinence (1366). Only 25% of women with urinary incontinence seek help (339).
Women may be reluctant to seek assistance due to embarrassment, lack of knowledge about treatment options and fear of surgery.
Impact on health
Quality of life– Urinary incontinence is associated with depression and anxiety, work impairment and social isolation
Sexual dysfunction– Incontinence during sexual activity (coital incontinence), which may affect up to one-third of all incontinent individuals, and fear of incontinence during sexual activity both contribute to incontinence-related sexual dysfunction
Morbidity– skin irritation and perineal infection can occur with chronic cases of urinary incontinence. In older women, UI is associated with an increased risk of falls.
Risk factors
Age – Both the prevalence and severity of urinary incontinence increase with age. UI affects 3% of adult women under age 35, and 38% of women over age 60.
Obesity– Obesity is a strong risk factor for incontinence. Obese women have a nearly threefold increased odds of urinary incontinence compared with non-obese women. Weight reduction is associated with improvement and resolution of urinary incontinence, particularly stress urinary incontinence (SUI)
Parity– Increasing parity (how many babies a woman has given birth to) is a risk factor for urinary incontinence and pelvic organ prolapse
Mode of birth/obstetric delivery– Compared with women who have had a caesarean section, women who have had a vaginal delivery are at higher risk for stress urinary incontinence. However, caesarean delivery does not completely protect women from urinary incontinence
Family history– The risk of urinary incontinence, particularly urge incontinence, may be higher in patients with a family history
Others
Smoking increases a woman’s risk of UI.
Stress urinary incontinence has been associated with participation in high-impact activities.
Other risk factors for urge incontinence include recurrent urinary tract infections (UTIs) and bladder symptoms in childhood, including childhood nocturnal enuresis
Classification
Stress incontinence — Individuals with stress incontinence have involuntary leakage of urine that occurs with increases in intra-abdominal pressure (e.g., with exertion, sneezing, coughing, laughing) in the absence of a bladder contraction.
Urge incontinence — Women with urge incontinence experience the urge to void immediately preceding or accompanied by involuntary leakage of urine. The amount of leakage ranges from a few drops to completely soaked undergarments. Urge incontinence is more common in older women.
Overflow incontinence — Overflow incontinence typically presents with continuous urinary leakage or dribbling in the setting of incomplete bladder emptying.
Mixed incontinence – Contributing factors
In post-menopausal women, low estrogen levels contribute to urinary incontinence
Rare conditions, such as fistula and diverticula can occur as the result of vaginal birth trauma
Neurological conditions, such as stroke, Parkinson’s disease or diabetic neuropathy can cause bladder muscle damage or loss of control.
Bladder cancer and it’s treatments can cause UI
Evaluation
Usually, diagnosis can be made based on history taking and examination.
Some medications can contribute to urinary incontinence
Alcohol and caffeine intake have been associated with lower urinary tract symptoms
Caffeine intake exacerbates urinary incontinence due to its stimulant and diuretic effects
Impact on quality of life —The impact of the patient’s incontinence on her quality of life can be assessed informally by asking a few targeted questions or by using a validated questionnaire
Urine test- to check for blood/ abnormal cells and/or infection
Initial evaluation does not require invasive testing, such as urodynamic studies
Women’s Health Melbourne is a comprehensive CREI lead fertility and women’s health practice, offering the full spectrum of menopause and gynaecology services, together with natural and medical specialist fertility treatment modalities.
Written by Dr Tzippora Ben-Harim
Dr Tzippora Ben-Harim is a broadly trained specialist gynaecologist at Women’s Health Melbourne. Fluent in both Hebrew and English, Tzippi is known for her caring, compassionate approach, supporting women with gynaecological care through every life stage.