Almost every woman knows what it is like to lose bladder control at some time during their life. There are different types of female urinary incontinence. The two common types many women experience are stress urinary incontinence, such as when sneezing, or exercising or urge incontinence, when you need to pee and sometimes just can’t make it to the toilet on time.

Loss of bladder control often causes embarrassment, impacts confidence and can even interfere with personal relationships. Although more women are now talking about experiencing urinary incontinence, many more women still feel uncomfortable seeking help and treatment from their doctor.

What Causes Female Urinary Incontinence?

Loss of bladder control is caused by a weak pelvic floor. The pelvic floor muscles control the bowel movements and bladder function. Female urinary incontinence is caused by a weakening of the muscles at the neck of the bladder. This can happen for a number of reasons; common causes include:

• Pregnancy
• Childbirth
• Menopause

Other causes of female urinary incontinence include:

• Surgery that can damage pelvic floor muscles, such as a hysterectomy.
• Injury to the pelvic region.
• Pelvic organ prolapse (POP).
• Obesity and being overweight puts extra pressure on the bladder, which can make the bladder weaker and unable to contain as much urine.
• Chronic constipation and excessive straining.
• Nerve damage caused by medical conditions, such as multiple sclerosis and diabetes.

Pelvic floor dysfunction and weaker pelvic floor muscles can also cause various other conditions, including:

• Feeling pressure in the pelvic region or rectum
• Muscle spasms in the pelvis
• Pain in the rectum
• Constipation
• Faecal incontinence
• Obstructive defecation (inability to pass stools through the digestive tract)
• Lower back pain
• Pain during intercourse.

No woman should put up with symptoms of pelvic floor dysfunction or a weak pelvic floor. Not only does it affect quality of life, some conditions such as pelvic organ prolapse are likely to worsen with time, reducing the treatment options. Other conditions such as obstructive defecation can be a sign of more serious underlying medical issues.

Diagnosis of Female Urinary Incontinence

Treatments for urinary incontinence will depend on a diagnosis to determine the correct course of action. Going to the doctor to discuss urinary incontinence may feel embarrassing, but remember, doctors are not fazed by any illness or medical condition.

Diagnosing urinary incontinence will require your doctor to have a detailed assessment of your health, what you drink and how often, when and how often you urinate and how often you experience loss of bladder control. It can be helpful to keep a diary with this information the week before your appointment to give to your doctor.

How is Urinary Incontinence Diagnosed?

The first thing your doctor is likely to do following a discussion of the above information is a physical exam. This may involve coughing when standing to see if this causes a loss of bladder control. Other tests used to diagnose urinary incontinence include:

• Bladder stress test to monitor urine leakage caused by stress incontinence.
• Urine test and urine culture to check for a urinary tract infection (UTI) and blood or sugar in your urine.
• Imaging tests such as X-rays or ultrasound.

You may also be asked to wear an absorbent pad until you experience urine leakage. The pad is then returned to be weighed and provide an estimate of how much urine is leaked. When surgery is needed, you may be required to have urodynamic testing, which includes:

• Uroflowmetry test to measure your urine flow rate.
• Pressure flow studies to measure changes in pressure in the bladder.

Cystometry tests to measure differences in pressure in the bladder when your bladder is at different levels of fullness.

• Post-void residual volume test, which is done after you empty your bladder to measure how much urine remains.
• Electromyogram (EMG) test to record the electrical activity of the muscles.
• Cystourethrogram X-ray of the bladder and urethra during urination.
• Cystoscopic exam, using a thin tube with a light to enable the doctor to look inside your urinary tract.

The Latest Treatments for Female Urinary Incontinence

In most cases, the first course of action once a diagnosis has been made will be non-invasive treatments, such as pelvic floor exercises to help strengthen your pelvic muscles. Kegel weights or kegel balls and pelvic floor training devices can help you do your pelvic floor exercises correctly. Not all women like using appliances, and some find they trigger urinary tract infections. The good news is that pelvic floor exercises can be done easily without them.

Emsella Treatment

The Emsella treatment is one of the latest non-invasive treatments for urinary incontinence. The treatment is delivered by a medical device called the Emsella chair, and all you have to do is sit down, fully clothed. The Emsella chair stimulates at a supramaximal level using electromagnetic technology, which means the brain is not controlling the contractions. This means that in just one 28-minute session; the pelvic floor is stimulated to do approximately the same as 11,200 pelvic floor contractions. Emsella’s own scientific study has shown that 95% of patients said that they had noticed a significant improvement in quality of life , after receiving the Emsella chair treatment.

Body Lipo Lincoln, founded by Louise White, a leading incontinence and women’s health expert, was one of the first clinics to offer the Emsella chair treatment. She said,

“ I had problems with bladder control and stress incontinence for 20 years and after just one session on the Emsella chair I noticed a difference. As a medically led clinic, I want to get people talking about incontinence without feeling embarrassed so that people can get the help they need.”.

This treatment is completely painless, and once completed, you can carry on as normal with your day. For maximum results, a course of six weekly treatments is recommended, although some women may need extra sessions.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS delivers pulses of electricity through wires that your doctor will insert in your vagina to stimulate the nerves in the bladder and increase the strength of bladder muscles.

Biofeedback

Biofeedback is used to help you learn how to control your pelvic muscles properly and involves a therapist placing an electrical patch on your skin over your bladder, which is linked to a screen so you can see when your muscles contract to help you to learn how to control them with pelvic floor exercises.

Vaginal Pessaries

Vaginal pessaries are most often prescribed when there are signs of a prolapse. They have been developed to be smaller and more comfortable and are normally made of silicone. Simple to use, you insert them into your vagina to help support the pelvic muscles. There are two types, either a non-disposable pessary in the shape of a ring or doughnut that your doctor will need to prescribe to ensure you have the correct size. The other type is a disposable pessary that looks similar to a tampon and is thrown away each day after use. Some women swear by vaginal pessaries, and other women find they cause urinary tract infections or find them uncomfortable.

Hormone Replacement Treatment (HRT)

When urinary incontinence has started during or after the menopause, you may be prescribed estrogen in creams, rings, or patches. Estrogen helps to strengthen the urethra and vaginal muscles and tissues. There are risks associated with HRT, including increased risk of cardiovascular (heart) disease, breast cancer and blood clots.

Medication

Stress incontinence can be treated with prescription medications. The most widely used are oxybutynin (Ditropan; Oxytrol), which is available in pill form or as a skin patch and tolterodine (Detrol), in pill form. This type of medication may not completely get rid of urinary incontinence, and how much you benefit will depend on a reduction in loss of bladder control and feeling the need to urinate urgently..

Botulinum Toxin (Botox)

Botulinum toxin (Botox) injections into the bladder are a treatment for an overactive bladder and urge incontinence, and the results normally last for approximately three months. The results vary; occasionally, there will be no improvement, or symptoms may worsen. Another risk is that botox injections can prevent you from being able to pass urine. This means you will need to use a catheter for up to 12 months until the effects have completely worn off.

Urethral Bulking

This procedure involves injecting bulking agents into the wall of the urethra, which makes it narrower and can help prevent stress incontinence. This is not a permanent solution, and associated risks include urine retention, which prevents you from urinating and means a catheter will be required to enable the passing of urine. Another issue with urethral bulking is the increased risk of urinary tract infections.

Surgery

Surgery for urinary incontinence is normally the last resort and is not suitable for women who want to have more children. There are two main types of surgery recommended:

1. Sling surgery, which normally uses your own body tissue (autologous sling), formed into a sling to help support the neck of your bladder.
2. Colposuspension surgery, which lifts the neck of the bladder and uses stitches to hold it in place.

You may also have heard of vaginal mesh surgery that uses synthetic mesh. This is not available in the UK due to the high associated risks and complications.

Coping and Support with Urinary Incontinence

The distress of urinary incontinence should not be underestimated, and you should not feel that it is a minor issue that you should just cope with. Although using pads can be a helpful way to cope in the short term, they won’t improve bladder control.