Urinary incontinence is a condition that affects the lives of many people. When you have incontinence, you may experience bladder control problems and leak urine. This leak is often uncontrollable and can negatively affect your life. This condition can occur at any age but is more common in women over the age of 50. Although it is more common in older women, it can also affect younger women. It's not a normal part of aging or just a problem you have to live with.

Your urinary system consists of the kidneys, ureters, bladder, and urethra. They filter, store, and remove waste from your body. Your kidneys are your body's filters. Waste products are excreted from your blood by the kidneys and form urine. Urine is then collected by two thin tubes called ureters in the bladder, where the urine will be collected until it's time to leave the body. Your bladder is like a storage tank. When the bladder is filled up, the brain sends a signal that it is time to urinate. By relaxation of a muscle called the sphincter, urine leaves the bladder and the urethra allows urine to flow freely out of the body.

When this system works smoothly, you usually have time to go to the bathroom before urinating and you will not experience any urine leakage. Urinary incontinence may occur when any of these organs and parts we have mentioned do not function properly. This can happen for many different reasons throughout your life.

Many people think that urinary incontinence is a normal part of aging. Incontinence can happen to anyone. However, it is more common in certain groups and at certain times in your life. Incontinence is much more common in women than men. This is often related to pregnancy, childbirth, and menopause. Each of these experiences can cause a woman's pelvic floor muscles to weaken over time.

While it's true that your risk of urinary incontinence increases as you get older, there are treatments available to help you manage this condition. Incontinence should not impair your quality of life or prevent you from being active.

What Causes Urinary Incontinence?

There are many different reasons why you may experience incontinence. These reasons may vary depending on whether you are a woman or a man. Some causes are temporary health conditions that usually go away after being treated. In these cases, your incontinence also usually stops once the condition is treated. Incontinence can be caused by long-term (chronic) medical conditions. When you are experiencing leak issues due to a chronic condition, it's often something you need to manage over a longer period.

Causes of temporary or short-term urinary incontinence may include:

• Urinary tract infections (UTI): Infections in your urinary tract (urethra, ureters, bladder, and kidneys) may cause pain, and/or you may feel the need to urinate more frequently. The frequent urge to urinate usually goes away after treatment.
• Pregnancy: As your uterus gets bigger during pregnancy, the pressure it puts on the bladder increases. Most women who experience urinary incontinence during pregnancy find that it goes away in the weeks after giving birth.
• Medications: Some medications used for hypertension (diuretics) or antidepressants may have side effects.
• Drinks: When you cut down on beverages that can cause you to urinate more often, such as coffee, tea, and alcohol, your need to urinate often decreases.
• Constipation: Chronic constipation (hard and dry stools) can cause bladder control problems.

Causes of chronic or prolonged incontinence may include:

• Pelvic floor disorders: When you have a problem with your pelvic floor muscles, it can affect the functioning of your organs, including your bladder.
• Stroke: It can cause you to have problems with muscle control. This condition may also involve the muscles that control your urinary system.
• Diabetes: When you have diabetes, your body produces more urine. This increase in the amount of urine can cause incontinence problems in the form of leakage. In addition, peripheral neuropathy due to diabetes can affect bladder function.
• Menopause: Menopause is another period of change in a woman's body where hormone levels change rapidly, and the pelvic floor muscles can also weaken.
• Multiple sclerosis (MS): If you have MS, you may lose control of your bladder, which can lead to urinary incontinence.

You may feel uncomfortable talking to your doctor about incontinence. However, if urinary incontinence is frequent or is affecting your quality of life, it is important to seek medical help.

Is Urinary Incontinence More Common in Women?

Incontinence is much more common in women than men. This is mostly caused by pregnancy, childbirth, and menopause. Each of these situations can lead to bladder control problems. Pregnancy can be a short-term cause of urinary incontinence, and bladder control problems usually resolve after delivery. Some women may experience urinary incontinence after childbirth due to pressure on their pelvic floor muscles. When these muscles are weakened, you are likely to experience incontinence in the form of leakage.

Menopause causes your body to go through many changes. During menopause, your hormones (especially estrogen) change, and this can change your bladder control.

Does Pregnancy Cause Urinary Incontinence?

During pregnancy, your body goes through many physical changes. When your uterus stretches to hold the growing baby, your bladder is compressed by the expanding baby and your bladder holds less urine than before. The urgency to urinate may increase during pregnancy because your bladder cannot hold as much urine as before. It can make your daily activities more difficult towards the end of pregnancy.

Another cause of urinary incontinence during pregnancy is the weakening of your pelvic floor muscles. These muscles are the support structures of all the organs in your pelvis. During pregnancy, they can stretch and weaken as your uterus expands.

What Are the Symptoms of Urinary Incontinence?

The main symptom of incontinence is urinary incontinence. This may be a persistent drip of urine or an occasional leaking experience, more or less in quantity.

You can leak urine in a variety of situations and for various reasons:

• During exercise.
• During coughing.
• During laughing.
• During sneezing.
• Having the urge to urinate but not being able to go to the toilet on time.
• Having to get up in the middle of the night to urinate (nocturia).

Does the Risk of Incontinence Increase in Advanced Age?

As you age, the muscles that support your pelvic organs may also weaken. If you have a chronic health condition, especially if you have given multiple births, and if you've gone through menopause, you may be at higher risk of developing incontinence over the years. It is important to talk to your healthcare provider as soon as possible about the risks of incontinence and how you can manage it without affecting your daily life.

How Is Urinary Incontinence Diagnosed?

Often, the diagnostic process for incontinence begins with a conversation with your healthcare provider about your medical history and bladder control problems. You will usually be asked the following questions during the examination: “How often do you urinate?” “Do you leak urine between the times you go to the toilet, how often does this happen, and how much urine do you leak each time?”, “How long have you had incontinence?” These questions can help your doctor find your type of incontinence. When asked about your medical history, it is important to list all of your medications, as some medications can cause incontinence. It is important to remember details about your past pregnancies and each birth as well. 

How to Diagnose Urinary Incontinence?

• Physical examination: During this examination, your doctor will look for any physical cause that may be causing your urinary incontinence. He/she will do this with a gynecological and/or pelvic examination.
• Urine tests: A urinalysis may be requested to look for any condition affecting your kidneys. Urinalysis and urine culture may also be requested to rule out the presence of infection.
• Pelvic ultrasound: Ultrasound is a painless and routine method that is applied in practice conditions and helps visualize your internal organs by using sound waves without irradiation. In this way, information about the uterus, ovaries, and bladder (size, a mass occupying space, any other pathology) can be obtained easily and quickly.
• Stress test: During this test, your doctor will ask you to cough in order to evaluate your urinary incontinence in cases of increased intra-abdominal pressure, such as coughing-sneezing in the office, and will see if there is any urine leakage.
• Cystoscopy: The cystoscope is a thin, flexible tube with a camera at the end that is inserted through the urethral exit to get a close look inside the urinary tract. This tool provides a more detailed view of whether there are any problems with your urethra and bladder.
• Urodynamic test: This test includes several tests to check how much fluid your bladder can hold and how well your urethral sphincter muscle (the muscle that keeps your urethra closed) is working. A part of this test may involve placing a tube into your bladder to fill it with fluid. Thus, it controls how much your bladder can actually hold, namely its capacity.
• Pad test: He/she may give you a pad to catch leaked urine. At the end of the test, this pad will be checked to see how much urine you have lost.

He/she may recommend keeping a diary for a few days so you can track the leak while you are at home. Be sure to write down how often you urinate, how much you urinate each time, your urine leakage between urination, and the activity you do during which you leak urine. Thus, you can determine how often and in what situations you experience incontinence by writing it down.

How to Treat Urinary Incontinence?

There are many different factors your doctor will consider when creating a treatment plan for your incontinence. Your doctor will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment available for incontinence: medications, lifestyle changes, and surgery.

Medications for Incontinence Treatment

Some medications stabilize muscle contractions that cause problems with an overactive bladder. Other medications also have the opposite effect, i.e., they relax the muscles to allow your bladder to empty completely. Hormone replacement therapies can support the restoration of normal bladder function by replacing estrogen, which is often reduced during menopause.

Lifestyle Changes to Manage Incontinence

Sometimes there are changes in your daily life that can really help with urinary incontinence. These changes include exercises you can do to strengthen your pelvic floor muscles, changes in your daily habits, and an improved diet. Sometimes, these changes result in improvement and additional treatment may not be needed.

• Emptying your bladder on a regular schedule. This is also called timed voiding.
• Emptying your bladder before physical activities. If you plan to exercise or do any physical activity, plan to empty your bladder before the activity begins to prevent leakage.
• Avoiding lifting heavy objects. Ask for help if you need to carry something large.
• Doing regular Kegel exercises to strengthen your pelvic floor muscles.
• Avoiding drinking tea, caffeine, or other fluids excessively before starting an activity. If you experience frequent urination and incontinence at night, avoid having a drink just before bedtime.
• Maintaining a healthy body weight. Having excess body weight can be a cause of incontinence. You can reduce the risk of incontinence by eating healthily and exercising. 

Procedures and Surgeries for Incontinence Treatment

If the non-invasive treatment options that we have listed have failed to treat your incontinence, there are several procedures that your doctor may recommend. These procedures range from simple injections to more complex surgeries (Botulinum toxin injections (Botox®), Neuromodulation devices, sling operations (TOT/TVT/mini sling)). You and your doctor can decide which option is right for you based on the type of incontinence you have and your symptoms.