Division of Urology

Female Incontinence

Incontinence, the loss of urine or bladder control, affects more than one in three adult women. Although incontinence often causes embarrassment, it can be managed with proper medical care. Urologists at Brigham and Women’s Hospital (BWH) are experts at diagnosing and treating incontinence. We understand how sensitive bladder control problems can be for women, and offer a relaxed and private setting to evaluate patients and tailor customized treatment plans.

Risk Factors for Female Incontinence

Factors that contribute to an increased risk of developing urinary incontinence include:

  • Advanced age
  • Obesity
  • Cigarette smoking
  • Kidney disease
  • Diabetes
Causes of Female Incontinence

Incontinence can be caused by multiple factors including lifestyle habits, physical problems and medical conditions. Causes of temporary and persistent urinary incontinence include:

  • Bladder irritation caused by infection, dietary irritants or kidney stones
  • Urinary tract or vaginal infections
  • Medications
  • Diseases and disorders of the nervous system
  • Pelvic surgery
  • Diabetes
  • Delirium
  • Pregnancy and childbirth
  • Menopause
  • Overactive bladder
  • Weakness of certain muscles in the pelvis
  • Weakness of the tissues holding the bladder in place
  • Weakness of the sphincter muscles surrounding the urethra
  • Birth defects
  • Spinal cord injuries
Symptoms of Female Incontinence

Symptoms associated with incontinence in women include:

  • Pain related to urination without a proven bladder infection
  • Increased rate of urination without a proven bladder infection
  • Frequent bladder infections
  • Progressive weakness of the urinary stream
  • Needing to rush to the restroom and/or losing urine
  • Abnormal urination or changes in urination related to a nervous system problem
  • Leakage of urine that prevents activities
  • Leakage of urine that began or continued after surgery
  • Leakage of urine that causes embarrassment
Types of Female Incontinence

Some women with urinary incontinence experience minor leaks of urine while others frequently wet their clothes. The following are types of incontinence:

  • Stress incontinence is leakage that occurs with activities that increase abdominal pressure such as coughing, sneezing, laughing, lifting and running.
  • Urgency incontinence or overactive bladder is a sudden, strong urge to urinate that you cannot control. Some women leak urine with no warning.
  • Mixed incontinence is a combination of urge and stress incontinence.
  • Overflow incontinence happens when the bladder does not empty and the urine amount exceeds the bladder’s capacity. Frequent urination and leaking results.
Diagnosis of Female Incontinence

Tests and procedures to determine incontinence in women include:

  • Medical history
  • Physical exam
  • Urinalysis
  • Cough stress test
  • Cystoscopy enables an urologist to view the inside of the bladder and urethra via a thin tube.
  • Urodynamics tests help your doctor or nurse see how well your bladder and sphincter muscles work.
  • Voiding diary
Treatment for Stress Incontinence

Your urologist may recommend the following treatments for stress incontinence:

  • Non-Surgical
    • Behavioral modification
    • Weight loss
    • Quitting smoking
    • Pelvic floor rehabilitation
    • Biofeedback/electrical stimulation
    • Medications
  • Surgical
    • Urethral injection, a minimally invasive procedure done under local anesthesia that uses a cystoscope and small needle to close the urethral mucosa.
    • Sub-urethral or TVT (tension-free vaginal tape) sling, a minimally invasive surgical procedure that applies a narrow strip of material under the urethra to provide support.
    • Other procedures to improve urethral support

Less common procedures:

  • Retropubic urethropexy (Burch)
  • Pubovaginal slings
  • Artificial urethral slings
Treatment for Urgency Incontinence/Overactive Bladder

Treatment for urgency incontinence may involve:

  • Botox injection
  • Behavior modification
  • Pelvic floor rehabilitation
  • Fluid intake management
  • Medications
  • Neuromodulation

Treatment for Overflow Incontinence

Treatment for overflow incontinence may involve:

  • Medication or surgery to remove possible obstruction
  • Self-catheterization
Prevention of Incontinence
An easy prevention technique is to learn and practice pelvic floor exercises at a young age, before the onset of urinary incontinence. It is also recommended that women experiencing mild symptoms be evaluated by a BWH urologist. Early treatment will prevent serious future problems.
What You Should Expect
You will receive a thorough diagnostic examination and receive treatment by a board-certified urologist who specializes in female incontinence. Our goal is to alleviate or eliminate symptoms so you can return to everyday life.
Multidisciplinary Care
Brigham and Women’s Hospital practices a multidisciplinary approach to patient care, routinely collaborating with colleagues in other medical specialties. If your urologist discovers that an underlying illness has contributed to your incontinence, you will be referred to an appropriate BWH physician for an evaluation.
Resources

Go to our online health library to learn more about urology diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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