Incontinence: Types and Severity

Jumping as incontinence diagnosticWould you pass the trampoline test?

When asked if they have incontinence, many women say “No, I just leak when I [sneeze, laugh, exercise, have a full bladder, lift a heavy object].” In fact, these women DO have urinary incontinence, which is defined as the lack of control over urination (“peeing”). It is a very common condition, affecting one in three women over 30 years old, and one in two over the age of 50.  Symptoms often begin after childbirth.  Left untreated, incontinence can worsen, affecting many aspects of women’s well-being.

Understanding the types of incontinence

Stress Urinary Incontinence (SUI) is urine leakage with increased abdominal pressure, which pushes downward on pelvic floor muscles that are too weak to keep the opening of the bladder closed. The pelvic floor muscles are a band of muscles that act like a hammock to support your bladder, vagina, and rectum. That increased abdominal pressure often occurs suddenly when you sneeze, cough, exercise, etc.  85% of women with incontinence have some degree of stress incontinence. Conservative treatments focus on strengthening the pelvic floor muscles.

Urge Urinary Incontinence (UUI) is defined as a sudden and strong desire to urinate, accompanied by an accident. If the women can get to the toilet before leaking the condition is simply called “overactive bladder”.  The cause is complex and deals with how the nervous system controls the bladder.   Treatment often involves medication or stimulation to calm the bladder. 

Mixed Incontinence (MI) describes the condition where a woman has both stress and urge incontinence symptoms.

Overflow Incontinence occurs when the bladder literally overflows because it is full but no message is sent to the brain to tell the women to urinate. In some cases, the bladder also has difficultly fully emptying. The causes are varied and require a range of medical treatments.

Nocturia is incontinence at night and often requires waking up multiple times, interrupting sleep.  Learn more here.

Note: The most common type is Stress Urinary Incontinence (including Mixed). Stress Incontinence mainly deals with weak muscles and so treatment often is focused on strengthening those pelvic muscles. Urge Incontinence is an issue with the nerves and so treatment is focused on calming the nerves through medication or stimulation.

Understanding the severity or degree of symptoms

The severity of stress incontinence symptoms vary but is often defined as mild, moderate and severe.  Regardless of the severity, you should consider treatment and consult a healthcare professional.

Mild:  You experience occasional light leakage with vigorous exercise, coughing, laughing or sneezing. It’s usually a surprise when it happens, but you may wear an absorbent pad “just in case”.

Moderate:  You leak from as little as a few times a week to every day.  You likely wear an absorbent pad.

Severe:  You leak multiple times per day, sometimes from simple movements such as standing up, walking or bending over.  You likely use multiple pads per day. In addition to incontinence, you may have notable pelvic organ prolapse.

Incontinence Treatment Options

For Mild Stress Incontinence

  • Behavior Modification – This involves changes to your daily routine including increasing the frequency of your toilet visits and modifying when and how much fluid you drink. This method doesn’t solve any underlying problems so your condition may worsen.
  • Pelvic Floor Muscle Training – Also known as Kegel exercises, this training strengthens the pelvic floor muscles, which in turn improves continence.  These work well if performed correctly and often, but studies have shown that women struggle to do them correctly and consistently.
  • Biofeedback– This treatment is used to sense whether a woman is performing Kegels properly.  The treatment required insertion of a vaginal probe. Studies show that biofeedback increases success with muscle training.
  • Weighted Kegel Balls – These devices are placed in your vagina and provide additional resistance when performing muscle training.  These are less convenient than basic Kegel exercised and there is also a risk of infection.
  • Surface Stimulation ELITONE allows women to tone their pelvic floor with muscle stimulation.  Unlike many of the other treatment options, it doesn’t require insertion.  It can also be used while going about everyday activities. 

For Moderate Stress Incontinence

  • See Surface Stimulation above
  • See Weighted Kegel Balls above
  • Vaginal Stimulation – The pelvic floor is exercised with muscle stimulation applied through a vaginally inserted device.  Treatment occurs over multiple weeks.  Many women don’t tolerate the invasive nature of this treatment.
  • Pessaries– These removable devices are placed in the vagina and press against the urethra, squeezing it closed to prevent leakage. This can be a good alternative to surgery, but it doesn’t address the underlying cause and there are side effects including infection and odor.

For Severe Stress Incontinence

  • Surgery– Surgery is an invasive option that should be considered the last resort. The most common surgery is a sling procedure where the surgeon tacks the ends of a sling (mesh or tape) to other tissues and the sling physically lifts the bladder neck.  There is a recent history of severe complications with the products used in incontinence surgeries.

Ready for an effective, easy to use stress incontinence treatment? Try ELITONE