Urinary incontinence in women: what people don't always dare to say

Many women live with urinary incontinence for years without discussing it with their doctor. Shame, the belief that it's inevitable after childbirth or with age, or simply the conviction that nothing can be done about it lead to resignation rather than seeking medical advice. This is unfortunate because urinary incontinence is treatable. Not always completely curable, but often significantly improved, with options ranging from pelvic floor rehabilitation to surgery, depending on the case.

In Canada, approximately 30 % of women experience urinary incontinence at some point in their adult lives (Society of Obstetricians and Gynecologists of Canada, 2023). It is one of the most common and most undertreated conditions in medicine.

Types of urinary incontinence

Stress urinary incontinence is the most common form in women. It occurs when intra-abdominal pressure increases, such as during coughing, sneezing, physical exertion, or laughter. It is linked to weakness of the pelvic floor or urethral sphincter, often resulting from vaginal childbirth, pelvic surgery, or menopause.

Overactive bladder incontinence, or urinary urgency, is characterized by an urgent and difficult-to-control need to urinate, often accompanied by leakage before reaching the toilet. It can occur without any apparent triggering reason or in response to stimuli such as the sound of water or contact with cold.

Mixed incontinence combines both mechanisms and is common in older women. Other less common forms include overflow incontinence, linked to incomplete bladder emptying, and functional incontinence, linked to a physical or cognitive limitation that prevents timely access to the toilet.

Risk factors

Vaginal births, particularly instrumental deliveries or large babies, increase the risk of pelvic floor injuries. Menopause, with its decline in estrogen leading to atrophy of the urethral and vaginal tissues, is a significant contributing factor. Being overweight increases pressure on the pelvic floor and sphincter. Chronic constipation and repeated straining during bowel movements also contribute to the weakening of the pelvic floor over time.

Treatment options

Perineal rehabilitation, performed by a specialized physiotherapist, is the first-line treatment for stress incontinence. Pelvic floor strengthening exercises, known as Kegel exercises, improve urinary control in a majority of women when practised correctly and regularly. A physiotherapist can teach the proper technique and monitor progress.

For overactive bladder, bladder retraining, which involves reprogramming voiding frequency, and behavioral modifications are the initial interventions. Anticholinergic medications or beta-3 agonists can be added if retraining alone is insufficient. For severe, refractory cases, injections of botulinum toxin into the bladder wall or sacral neuromodulation are specialized options available in Quebec.

Frequently Asked Questions about Urinary Incontinence

Is urinary incontinence inevitable with age?
No. It is common but not inevitable. Modifiable risk factors, such as being overweight, constipation, and a sedentary lifestyle, can be improved. Preventive strengthening of the pelvic floor, even in the absence of symptoms, is beneficial.

Are Kegel exercises enough?
For mild to moderate forms of stress incontinence, they can be sufficient if performed correctly. Many women contract the wrong muscles without realizing it. Follow-up with a pelvic physiotherapist is recommended to ensure proper technique.

Is it necessary to wait until incontinence is severe before seeking medical attention?
No. The earlier the support, the better the results. Waiting often worsens underlying anatomical conditions and reduces conservative treatment options.

When to consult a healthcare professional

If you experience urinary leakage, even occasionally, if it affects your activities or quality of life, or if you want to prevent incontinence after childbirth, medical consultation is necessary.

A doctor or a specialized nurse practitioner can assess the nature of incontinence, prescribe pelvic floor rehabilitation, and refer you to a urogynecologist if needed. An in-person or remote consultation teleconsultation at one of our Omicron Clinic in Quebec gives you quick access.

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