Female Urinary Incontinence – What Causes It?

by Marcelle Pick, OB/GYN NP

Don’t just live with urinary incontinence — learn about the causes of incontinence so you can move forward

The other night I was at a charity event and a friend introduced me to a group of eight women whose ages ranged from 35 to 50. One of them asked me what I was working on and I decided to be frank and say I was putting the finishing touches on an article about urinary incontinence in women.

You should have heard the outcry! Each woman had a different story to tell. One had to leave her aerobics class after her shorts got soaked. Another abandoned a grocery cart full of food in the check-out line to sprint for the public bathroom. Another organized her day around easy access to the toilet.

Every woman in that group (some were mothers, others were not) had some experience of losing bladder control. Most seemed to think it was an inevitable part of aging — complete with the requisite adult diapers or incontinence surgery.

Stress incontinence and overactive bladder (OAB), or a mixture of both, are extraordinarily common — but nobody wants to talk about them. In the past, traditional medicine viewed incontinence as primarily a men’s issue. But in my experience almost all women will suffer at some point in their lives from some form of urinary incontinence. What’s more, our bladder control issues can leap from moderate (or non-existent) to severe with the onset of menopause, especially for women who never experienced childbirth.

It’s high time we bring urinary incontinence out into the light and talk about it. Women are so conditioned to suffer in silence, but it’s not good for our health. In fact, women rarely mention urinary incontinence in their annual visits with me. So I ask. Incontinence may not be entirely avoidable as we get older, but it is certainly treatable, and there are very effective alternative methods.

What is female urinary incontinence?

A sudden urge to go, leaking urine and frequent urination are all forms of urinary incontinence, which is generally defined as a lack of bladder control. While there are many causes, the most basic is a gradual weakening of the pelvic nerves, organs and smooth muscles that are meant to work together to control urination.

The bladder itself is a sac that stores urine from your kidneys. When it’s full, pelvic nerves send a signal to the brain that you have “to go”. Your pelvic muscles, especially the sphincter of the urethra, clench and “hold it” until you get to the bathroom. Once you’re there and safe, your brain tells the sphincter muscles to relax and your bladder empties.

Believe it or not, the muscle anatomy “down there” is still not completely understood by modern medicine. We do know it’s an intricate and amazing arrangement of dozens of muscles which keeps things in and lets them out as necessary. Of course the female pelvic floor is much more complex because women have babies.

But a lot can change in the course of a lifetime. Inner pelvic muscles stretch and atrophy with age, pregnancy, gravity and trauma. Muscles lose their elasticity from lack of use and loss of estrogen. Organs actually move around, often pressing on the bladder itself. In some cases the bladder or urethra become damaged or chronically inflamed and malfunction. Scarring from surgery, injury or infection may disrupt the natural alignment of the organs inside the pelvic area.

And when you think about it, which of us doesn’t experience several of those factors over time?