Case Study: Urinary Incontinence
Here, a reader wants to know about the causes and treatment for urinary or stress incontinence.
Q: I am a 55-year-old woman and when I cough or sneeze, I “leak” a bit of urine. Why is this happening, and is there treatment available?
Dr. Zachary Levine answers: What you are describing is urinary or stress incontinence, the involuntary leakage of urine. While it can be embarrassing to talk about and so is underreported to doctors, it is very common. Up to 35 per cent of people over the age of 60 experience urinary incontinence, with women twice as likely as men to experience it.
Urinary incontinence is more common in women because of childbirth stretching the pelvis and its muscles and/or because of a different anatomy than men, with a shorter urethra that allows easier passage of urine. And the prevalence of incontinence increases with age – 17 per cent ages 40 to 59, 23 per cent ages 60 to 79 and 32 per cent after age 80.
Stress incontinence occurs when urine leaks with increased intra-abdominal pressure, such as when you cough, sneeze or laugh or do heavy lifting. It is caused by decreased strength of the urinary sphincter and pelvic floor muscles.
Risk factors for stress incontinence are female gender, pregnancy and childbirth, increasing age, obesity and smoking. Treatments include behavioural changes (decreasing excess fluid intake, more frequent urination, not smoking, losing weight), pelvic floor muscle training (kegel exercises), medications that help strengthen the sphincter muscles, pessary insertion (a medical device inserted into the vagina, either to provide structural support or as a method of delivering medication) to help reposition and close the urethra and, when necessary, surgical repair.
Dr. Zachary Levine is an Assistant Professor in the Faculty of Medicine at McGill University Health Centre and medical correspondent for AM 740 (a ZoomerMedia property).