Sudden onset of incontinence, or urine leakage, should always warrant a trip to the doctor. There are several different causes of urine leakage and it’s important to identify prior to any treatment being initiated. The more common types of incontinence in women are stress urinary incontinence and urgency urinary incontinence.
Stress urinary incontinence is caused by a weakness in the sphincter muscle of the urethra (the muscle holding the urethra closed), a highly mobile urethra, or both. A highly mobile urethra is seen when the pelvic floor tissues are weak and relaxed. Women will experience leakage of urine with activity, such as coughing, laughing, sneezing, and exercising. The most common risk factor for stress urinary incontinence is having a history of a vaginal childbirth, but it can occur in anyone due to other factors such as muscle strength and activity level. For example, women who do very heavy weightlifting may experience stress urinary incontinence while lifting heavy weights, but if they never did such activities, they might not experience incontinence.
Urgency urinary incontinence is urine leakage that happens when a sudden urge comes on and there is not enough time to make it to the bathroom. This can also be described as having a sudden “got to go” feeling. These conditions both tend to worsen gradually over time, but some people will not pay too much attention to them until the leakage gets bad enough to impact quality of life. This type of incontinence is also more common in older people, and the incidence increases with age. For some people the cause is as simple as drinking too much fluid or caffeine, but it is usually caused by an overactive bladder.
Many people have mixed incontinence, with symptoms of both stress urinary incontinence and urgency urinary incontinence causing urine leakage. In this situation the urologist would typically address the type of incontinence that is most impacting your quality of life first, as the treatments are quite different.
A urinary tract infection or UTI, can also cause urine leakage. The most common symptoms of a UTI are pain with urination, urgency of urination (sudden need to go), frequency, and passing only small amounts of urine at a time. UTI is caused by bacteria that enter the bladder, and it is diagnosed based on a combination of symptoms, as well as a urine test. When bacteria enter the bladder, it sets off an inflammatory response that can be painful and cause the bladder to function abnormally. In addition, a UTI will not cause stress urinary incontinence, or leakage of urine with coughing, laughing, sneezing, or exercise. If the leakage has been present for several years, and does not improve with antibiotics, it is not likely to be caused by infection.
In the absence of pain or other UTI symptoms, however, urine leakage associated with urgency to void is most likely due to an overactive bladder. With an overactive bladder, the bladder muscle itself can squeeze urine out without your permission, causing leakage. In some cases, this is caused by anatomic abnormalities, like pelvic organ prolapse, but in most cases the cause is not known. More benign, behavioral causes should also be investigated. A change in diet, such as increase in fluid intake, caffeine, and alcohol, can all make urine leakage happen.
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