Female Incontinence

Urinary Incontinence

Urinary incontinence (UI) is the involuntary loss of urine.  The two main causes in UI are bladder-related and urethral-related, although both causes may occur in the same patient.Bladder-related UI is termed “overactive bladder” (OAB) or urgency UI.  Urethral-related UI is termed stress urinary incontinence.  Other symptoms that frequently occur with UI include: feeling of having to urinate frequently (frequency), getting up frequently to urinate (nocturia), having sudden strong urges to urinate, and having frequent urinary tract infections.  The causes of bladder-related incontinence is not well understood but probably involve alterations of how the nerves and bladder muscle interact which result in a propensity of abnormal sensations of fullness and/or uncontrolled contractions of the bladder muscle which can overcome normal urethral continence mechanisms, thus resulting in UI.The causes of urethral-based incontinence are secondary to loss of mechanical support of the urethra resulting in the urethra not able to maintain urinary continence during increased abdominal pressure situations such as coughing, laughing, sneezing, or straining.Rare causes of urinary incontinence include fistulae (holes) in the urinary tract which are usually iatrogenic (caused by other surgical treatments for other conditions). Neurologic diseases can cause UI (see section on Neurogenic Bladder).Urodynamics is a test that is done on patients to assess both the bladder and urethral sphincter function. It involves placing a catheter into the bladder.  The bladder is filled with saline or water while measuring the pressure in the bladder.  The goal of urodynamics is recreate the UI during the test.  Since there are different causes of UI, urodynamics may help determine which one is causing the UI and potentially help guide treatment.

Fecal Incontinence

Fecal incontinence (FI) can occur for different reasons.  Having an inconsistent quality of stool may create a condition for FI.  Certain medical conditions can increase the risk of FI. The anal sphincter may not work properly to prevent stool from leaking and a test called anal manometry assesses the function of the anal sphincter. Sometimes, a radiologic test (MRI defecogram) to determine if there is an anatomical cause for the FI.