Learn the different types of urinary incontinence and the underlying causes.
Urinary incontinence is common and nothing to be embarrassed about. The important thing to remember is that treatments can help. Your clinician will work with you to help determine what’s causing your urinary incontinence.
Incontinence means involuntary urine leakage. Sometimes it happens with a cough or laugh, and sometimes it happens with that “gotta go, gotta go” feeling, and sometimes it just happens. What is important to know is that all incontinence isn’t created equal. There are different types of urinary incontinence with different causes, and each type requires a different course of action.
“Bring it up with your primary care physician or your gynecologist,” said Dr. Daniel Biller, a gynecologist and executive medical director for Vanderbilt Center for Women’s Health. “Those clinicians can refer you to specialists to help reduce leakage and bladder symptoms, improving your quality of life.”
Stress incontinence
One type of urinary incontinence is known as stress incontinence. An example of stress incontinence is experiencing leakage when one coughs, sneezes, exercises or laughs.
“Stress in this context does not mean anxiety,” Biller said. “Stress in our world means pressure from the outside, specifically outside the bladder. Stress incontinence is not actually a bladder problem. It is a problem with the urethra holding it.”
Stress incontinence is usually caused from changes that occur from pregnancy, labor and/ or delivery.
“You don’t have to live with it. We have solutions that can improve your life and get you back to doing the things you love.”
“Prior to pregnancy, the urethra is suspended by a ligament that helps hold it in place,” Biller said. “So, when one coughs, laughs or sneezes, that ligament kinks the urethra like a garden hose.”
The “kinking” prevents leakage from the outside pressure.
“The theory is that pregnancy itself damages that ligament, resulting in loss of the natural kinking mechanism and leading to the loss of urine,” Biller said. Treatments are directed at this area.
Stress incontinence is a common occurrence.
“It makes you normal, but you don’t have to live with it,” Biller said. “We have solutions that can improve your life and get you back to doing the things you love.”
Urge incontinence
Urge incontinence, also referred to as overactive bladder, is an issue with the bladder itself.
“The patient feels the same thing,” Biller explained. “She has urine coming from the urethra onto her pad or her clothes, but this is a completely different type of leakage from stress incontinence.”
Urge incontinence most commonly occurs when the bladder spasms involuntarily.
“About 20% of the time we do find an organic cause of the bladder spasm and direct treatment here,” Biller said. The most common culprit is a urinary tract infection. “We always check the patient’s urine, to make sure she doesn’t have an infection that’s easily treatable.”
Other causes of overactive bladder that can prompt the bladder to spasm include coffee, alcohol, artificial sugar and tea. Tea is high in oxalates.
“About 20% of the time we do find an organic cause of the bladder spasm and direct treatment here. We always check the patient’s urine, to make sure she doesn’t have an infection that’s easily treatable.”
“If oxalates combine with calcium in the kidneys, they can form crystals or stones,” Biller said. “When those come down to your bladder, your bladder is going to spasm.”
Other medical conditions like diabetes, Parkinson’s disease and multiple sclerosis are common conditions that can cause a dysfunction between the nerves and the bladder resulting in urge incontinence.
Additionally, prolapse of the uterus or vagina may lead to emptying problems.
“If patients don’t empty completely,” Biller said, “they can have a bladder spasm.”
In some scenarios, incomplete emptying may be a side effect of a medication you take. That’s why a thorough evaluation regarding incontinence symptoms also involves a review of a patient’s prescriptions.
Finally, it’s important to know that if you’re experiencing leakage, you may have components of both types: stress and urge incontinence.
“The solutions that we can offer usually address both if needed, or the individual need, depending on what the workup demonstrates,” Biller said.
Back to a fuller life
As women’s health and urogynecology experts, the Urogynecology and Pelvic Reconstructive Surgery team at Vanderbilt offers personalized care for females experiencing bladder-related symptoms and conditions. These experts are here to help find answers and treatment so you can live a fuller life. Call 615-343-5700.
