Urinary incontinence is the leakage of urine and is common problem among women. There are several disorders can lead to urinary incontinence. Some problems are anatomical in nature where the support structure of the bladder in compromised and results in incontinence (stress incontinence). Other causes are functional in nature where the bladder begins to squeeze out urine despite attempts to resist the incontinence (urgency). Of course, both types of incontinence can occur at the same time. In most cases, urgency incontinence is addressed with medicines. Anatomical causes of incontinence usually require surgery to correct.
The evaluation of incontinence frequently includes a history and physical, a urinary diary, urinalysis and bladder testing (multichannel urodynamics). Accurate diagnosis is essential to effective treatment and appropriate use of surgery. The management of female incontinence is based on the underlying diagnosis. In some cases, lifestyle modificatios including weight loss, limiting caffeine, smoking cessation, management of fluid intake, and voiding schedules can work very well. Physical therapy and Kegel Exercises are simple measures to minimize urinary leakage.
When conservative measures are ineffective, medicines are can be helpful for urge incontinence. For stress incontinence, a pessary may be used for women who are not good surgical candidates. A pessary is a piece of molded plastic that is inserted vaginally to support the bladder to avoid incontinence. Alternatively, bulking agents are sometimes injected to narrow the urethra when the valve of the bladder (sphincter) does not close completely. When symptoms are severe, surgery may be necessary.
Surgery for female incontinence falls into two basic groups. Suspension procedures such as Burch urethropexy uses stiches to support the neck of the bladder to maintain continence. Alternatively, a sling made of biologic or synthetic material is placed to cradle the urethra behind the pubic bone to correct the incontinence problem.