Female Urinary Incontinence

Women are more susceptible to stress incontinence, in particular, due to factors like childbirth, pelvic floor weakening, and hormonal changes during menopause. Correct identification of the type of incontinence is essential for effective treatment.

Fortunately, there IS treatment, including many new medical therapies and minimally invasive surgeries. The experienced urologists at Georgia Urology are skilled in the management and treatment of all types of urinary incontinence. Our patients benefit from these life-changing procedures by being able to resume their lives without anxiety and shame.

Types of Incontinence

Treatment and management begin with determining the underlying cause: urologic (urinary system-related) versus non-urologic (indirectly related). Non-urologic UI can stem from infection, certain medications, stool impaction, or psychological factors, and is typically self-correcting once the underlying cause is addressed. Urologic causes generally fall into four categories (stress, urgency, overflow, and mixed), each of which is related to physiological dysfunction of the bladder, the urethra, or both.

• Stress Urinary Incontinence (SUI): Leakage during physical activity, sneezing, coughing, or exercise; caused by weakened pelvic floor muscles, sphincter dysfunction, or lack of urethral support. Learn more about Female Stress Urinary Incontinence
• Urgency Urinary Incontinence (UUI): Sudden, strong urges to urinate, and may include frequency, urgency, and nocturia (often related to overactive bladder, or OAB)
• Overflow Incontinence: More common in men, and rare in women, but could result from advanced pelvic prolapse or previous surgical treatment for stress incontinence
• Mixed Incontinence: Combination of stress and urgency incontinence; very common in women and requires a dual approach to target the physiological stressors and the urgency
• Non-urologic causes: Medications, limited mobility, psychological or neurological dysfunction, infections, metabolic disease, vaginitis, or chronic constipation

Causes

Normally, urine is stored in a sac called the bladder, and incontinence can occur when the muscles that keep the bladder closed are weakened or overactive. Female incontinence often results from multiple interacting factors.

• Pelvic floor weakening from childbirth, aging, obesity, or chronic straining
• Hormonal changes during menopause affect tissue elasticity
• Neurologic disorders such as stroke or multiple sclerosis
• Prior pelvic surgery or pelvic organ prolapse, including prolapse of the bladder, vagina, uterus, rectum, or bowel
• Medications, infections (like urinary tract infections [UTIs]), or systemic medical conditions affecting bladder function
• Lifestyle factors: chronic straining or constipation, obesity, or smoking can worsen symptoms
• Certain foods and drinks that irritate the bladder, such as caffeine, carbonated drinks, spicy foods, and acidic foods
• Trauma such as spinal cord injury, irradiation, or other injuries to the lower urinary tract and pelvic organs

Symptoms

Because symptoms develop so gradually in many cases, you might not notice how much of an issue it has become. Symptoms can vary depending on the type of incontinence and its severity.

• Leakage during physical activity (SUI)
• Urgency with or without leakage (UUI)
• Mixed presentations combining stress and urgency symptoms
• Increased frequency, nocturia (urination at night that disrupts sleep), or incomplete bladder emptying
• Emotional and social impacts, including embarrassment, anxiety, and withdrawal from activities

Diagnosis

Your urologist will ask about your symptoms, past surgeries, prior treatment for incontinence, and any medications you take. If you have received previous treatment for incontinence, bring your records or X-rays to the appointment. The diagnosis will determine the best treatment or management for you. A thorough evaluation ensures proper diagnosis, and may include any or all of the following:

• Comprehensive medical history: onset, severity, triggers, prior surgeries, and impact on daily life
• Physical exam: Pelvic floor assessment and evaluation of associated tissues for signs of prolapse
• Urinalysis to rule out infection
• Imaging or urodynamics: Ultrasound, cystoscopy, or bladder function studies as needed
• Stress testing: Observation of leakage during cough or Valsalva maneuvers

Treatment

Often, multiple treatment options for each situation will exist, and it will be up to you and your urologist to select the best first option to try. Treatment is individualized and will likely combine multiple strategies.

• Lifestyle modifications: Weight management, hydration adjustments, and avoiding bladder irritants can help mildly alleviate symptoms.
• Kegels: Pelvic floor exercises guided by a physical therapist can support the surrounding musculature.
• Pessaries: Vaginal devices that support the bladder or urethra.
• Medications: Anticholinergics or beta-3 agonists for urgency or overactive bladder may help some patients.
• Surgery:
  • Female sling: Supports the urethra to prevent stress leakage and is an outpatient procedure with a high success rate.
  • Prolapse repair or urethrolysis: Corrects obstruction, prior surgical complications, or sagging organs.
  • Sacral neuromodulation (Axonics® and InterStim™ devices): Restores and improves nerve signaling by stimulating sacral nerves in the pelvic region related to the bladder.
  • Peripheral neuromodulation: An electrode delivers a low-intensity electrical current to the tibial nerve near the ankle to control the bladder. Percutaneous tibial nerve stimulation (PTNS) requires routine office visits for manual stimulation, whereas the eCoin Peripheral
  • Neurostimulator System is permanently implanted to deliver automatic and intermittent stimulation.
  • Bulkamid: Instead of surgery and slings, Bulkamid is an injection that reinforces the tissues of the urethra, increasing resistance against leakage with immediate, long-lasting results.
  • Botox: When incontinence stems from OAB, Botox temporarily calms muscle contractions in the bladder.
  • FormaV, Morpheus, and V-Tone are non-surgical and minimally invasive techniques that rejuvenate vaginal tissues to reduce vaginal laxity and urinary leakage.
  • A combination of therapies may be employed to optimize outcomes.

Prognosis

Urinary incontinence in women is treatable. With a thorough evaluation and targeted therapy, many women can achieve symptom relief, improved quality of life, and reduced risk of urinary tract infections or skin irritation. Early care can prevent long-term issues and help women regain confidence, activity, and social engagement.

Call Georgia Urology today to schedule an appointment and talk to an experienced urologist in one of our convenient Atlanta area locations.