Urinary Incontinence in Women

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Urinary incontinence is a condition that affects many women but is often underreported due to embarrassment or the misconception that it’s a normal part of ageing. While it’s common, it’s not something you simply have to live with. Whether it’s occasional leaks when laughing or sneezing, or a more persistent urge to urinate that’s hard to control, urinary incontinence can impact your daily life. Fortunately, there are a variety of effective treatments available.

What Is Urinary Incontinence?

Urinary incontinence is the involuntary leakage of urine. It can happen occasionally or frequently, and can range from a few drops during physical activity to a complete loss of bladder control. While it can occur at any age, it’s more common in women after childbirth or during menopause due to changes in pelvic floor strength and hormone levels.

Incontinence is not a disease itself, but a symptom of an underlying issue. There are several different types, and identifying the specific type is essential to choosing the right treatment.

What Are the Types of Urinary Incontinence?

There are several forms of urinary incontinence that affect women:

Stress Incontinence

Leakage occurs during physical activity or pressure on the bladder — such as laughing, coughing, sneezing, exercising, or lifting heavy objects. It’s often related to weakened pelvic floor muscles, commonly after childbirth or with ageing.

Urge Incontinence (Overactive Bladder)

A sudden, intense urge to urinate followed by an involuntary loss of urine. It may be accompanied by frequent urination or waking up multiple times at night to urinate. This is caused by involuntary bladder muscle contractions.

Mixed Incontinence

A combination of both stress and urge incontinence, where symptoms of both types are present.

Overflow Incontinence

The bladder does not empty completely, leading to continuous dribbling of urine. It’s less common and may be related to nerve damage or obstruction.

Functional Incontinence

Incontinence related to physical or cognitive impairments — for example, being unable to reach the toilet in time due to arthritis or mobility issues.

What Causes Urinary Incontinence in Women?

The causes of urinary incontinence can vary depending on the type, but common contributing factors include:

• Pregnancy and vaginal childbirth
• Menopause and hormonal changes
• Ageing and muscle weakening
• Obesity
• Chronic coughing (e.g., due to smoking or asthma)
• Pelvic organ prolapse
• Nerve damage (e.g., from diabetes, spinal injury, or surgery)
• Urinary tract infections (UTIs)
• Certain medications (e.g., diuretics, sedatives)

A full evaluation helps determine whether your symptoms are linked to a single cause or multiple factors.

What Are the Symptoms?

The main symptom is involuntary urine leakage, but this can present in different ways:

• Leaking during exercise, laughing, or sneezing
• Sudden, uncontrollable urge to urinate
• Frequent trips to the bathroom
• Difficulty holding in urine when there’s no nearby toilet
• Waking multiple times at night to urinate
• Constant dribbling or feeling that the bladder is never fully empty
• Irritation or infections due to dampness

How Is Urinary Incontinence Diagnosed?

Diagnosing incontinence starts with a comprehensive consultation, where your doctor will ask about your symptoms, medical history, childbirth experiences, and lifestyle factors.

You may also undergo:

• Physical and pelvic examination
• Urinalysis to check for infection or blood
• Bladder diary to track fluid intake, urination patterns, and leakage episodes
• Post-void residual test to measure how much urine remains in the bladder after urinating
• Urodynamic studies to evaluate bladder pressure and function
• Cystoscopy (in some cases) to look inside the bladder and urethra

Getting a proper diagnosis will allow your doctor to recommend a targeted treatment plan.

When Should You See a Gynaecologist?

You should seek medical advice if you:

• Experience involuntary urine leakage
• Need to urinate very frequently or urgently
• Avoid activities or social situations due to bladder concerns
• Feel that your bladder never fully empties
• Experience urinary symptoms that are getting worse over time

Early diagnosis and treatment can lead to better results and fewer complications down the road.

How Is Urinary Incontinence Treated?

The right treatment depends on the type and severity of incontinence, as well as your personal goals and preferences. Most women benefit from a step-by-step approach, starting with conservative methods.

Lifestyle and Behavioural Changes

• Bladder training to increase the time between toilet visits
• Reducing caffeine, alcohol, and carbonated drinks
• Managing fluid intake (not too much or too little)
• Losing weight if overweight
• Avoiding constipation through diet and hydration
• Scheduled bathroom trips to reduce accidents

Pelvic Floor Exercises (Kegel Exercises)

Strengthening the pelvic floor muscles can significantly reduce stress incontinence. A pelvic floor physiotherapist can guide you in doing these exercises correctly and consistently.

Medications

• Medications to relax the bladder in urge incontinence
• Topical oestrogen (for postmenopausal women) to support vaginal and urethral tissue
• Other medications based on underlying causes

Devices and Interventions

• Vaginal pessaries to support the bladder and reduce leakage in women with pelvic organ prolapse
• Urethral inserts or disposable devices for temporary control
• Btx injections into the bladder muscle (for urge incontinence)

Surgical Options

Surgery may be considered for women with moderate to severe incontinence who don’t respond to other treatments. Options include:

• Sling procedures to support the urethra
• Bladder neck suspension
• Artificial urinary sphincter (in rare cases)

Surgical treatments are often very effective, but not every woman is a candidate. Your doctor will help you weigh the benefits and risks.