URINARY INCONTINENCE OVERVIEWUrinary incontinence, also known as accidental bladder leakage, is an embarrassing problem that affects millions of women. Although it is more common in older women, it can affect younger women as well. It is not a normal part of aging or something that you just have to live with.This article discusses the different types of leakage and the tests that may be done during your evaluation. The treatment of urinary incontinence and overactive bladder is discussed separately. More detailed information about incontinence is available by subscription. TYPES OF URINARY INCONTINENCEThe two most common types of urine leakage in women are stress urinary incontinence and urgency urinary incontinence. Urinary incontinence may be caused or worsened by obesity, medical problems (such as poorly controlled diabetes or urinary tract infections), constipation, medications, and/or problems with the brain due to a stroke or dementia.Stress urinary incontinence — Stress urinary incontinence occurs when the muscles and tissues around the urethra (where urine exits) do not stay closed properly when there is increased pressure ("stress") in the abdomen, leading to urine leakage.Normally, the front wall of the vagina and muscles under the urethra provide a backboard for the urethra to squeeze closed on during activities. When there is weakening of the support of the urethra or the urethra muscle does not close well, any increases in abdominal pressure result in leakage (like stepping on a garden hose in sand). As an example, coughing, sneezing, laughing, or running can cause stress urinary incontinence. Stress incontinence is a common reason for incontinence in women, especially those who are obese or have had vaginal deliveries.Urgency urinary incontinence — In people with urgency urinary incontinence (also called overactive bladder), there is a sudden, uncontrollable urge to urinate. You may leak urine on the way to the toilet. Common triggers of urgency incontinence include unlocking the door when returning home, going out in the cold, turning on the faucet, or washing your hands.Many people with urgency urinary incontinence also have to go to the bathroom more frequently than most people during the day and/or night. "Normal" frequency is considered to be eight or fewer times per day and once at night, but this depends on how much you drink and may increase if you drink more than 64 ounces of fluid in a day. Urgency urinary incontinence can also happen due to damage to the nerves that control the normal reflexes of the bladder. Strokes, spinal cord injuries, or other neurologic diseases such as Parkinson disease can cause a woman to lose sensation or control over their bladder.Mixed urinary incontinence — Women with symptoms of both stress and urgency urinary incontinence are said to have mixed incontinence.Overflow urinary incontinence — Overflow urinary incontinence occurs when the bladder does not empty completely, causing leakage when the bladder becomes overly full. It may result in symptoms of either stress or urgency urinary incontinence or both. It may be caused by obstruction of the urethra (as with prior pelvic reconstructive surgeries, presence of advanced vaginal prolapse beyond the opening of the vagina) or from a weak bladder muscle (generally caused by overstretching of the bladder muscle either acutely or over long periods of time or from poor diabetes control or neurologic disorders).INCONTINENCE DIAGNOSISAlthough leaking urine can be difficult to talk about, it is often treatable with weight management for women who are obese, pelvic floor muscle exercises, and/or medications. Talking about it with your health care provider is the first step in getting help for this problem that is affecting your life.Important questions to discuss with your provider include:●When do you leak? (When you get a sudden urge, with coughing/sneezing, or does it occur without warning?)●When did your leakage begin? Has it worsened or improved over time?●Have you tried any treatments to reduce leakage?●Are there any medications that you are taking that might be worsening the problem (diuretic medicine for high blood pressure or high doses of pain medications)?●Have you seen blood in your urine, had bladder pain, or back pain with fevers; or other pelvic symptoms such as accidental bowel leakage, numbness of the labial area, or a bulge beyond the opening of the vagina? Do you have severe constipation? These symptoms should not be ignored and you should be evaluated by a clinician for urinary tract infection and other pelvic conditions.Bladder diary — A bladder diary is a record of how much urine you make and how frequently you pee during a 24-hour period. You should write down how much fluid you drink and how much urine you make, and you should record any leakage and the activities that caused leakage. This diary may provide useful information about the cause(s) and potential treatment of your leakage.Examination — A physical examination is a common requirement to fully evaluate you for urinary incontinence. This may include a brief neurologic assessment and abdominal and lower extremity examination to assess for strength, sensation, and swelling in the legs. A pelvic examination is often necessary to fully evaluate incontinence and may include evaluation including a speculum examination (like a pap smear), a pelvic organ prolapse examination and evaluation for pelvic masses; palpation of the urethra, bladder and muscles of the pelvis; and a rectal examination. Assessment of pelvic muscle strength is also commonly performed. Tests — Simple tests may be done during an office visit to determine the type of leakage you are experiencing. This may include a cough test, when you are asked to cough with a full bladder while your doctor or nurse watches for urine leakage.A urine test (urinalysis and sometimes a urine culture to test for bacteria) is usually done to look for signs of infection or blood in the urine. In some cases, this may be collected by catheterization of the bladder.A test to see how well you empty your bladder when urinating may be done. This can involve inserting a small temporary catheter into the bladder or by a bladder ultrasound.Urodynamic testing — For a urodynamic test, small catheters are placed inside the bladder and vagina (or rectum) to measure how much urine your bladder can hold, what makes you leak urine, and whether there are problems emptying the bladder. This test can be done in the office and may be recommended if you have had or are planning surgery for urine leakage, or if the cause of your leakage is not clear.