UI is the loss of bladder control, or being unable to control urination.

UI can affect men, women, and children, but women are twice as likely as men to experience UI. This is due to the structure of the female urinary tract as well as the effects of pregnancy, childbirth, and menopause. UI is also more common among older women, although it is not a normal part of the aging process.

Adults may experience one of several types of UI

• Stress incontinence is usually related to a structural issue, such as when the bladder is out of its normal position. Urine leaks can occur during physical movement such as laughing, coughing, exercising, or lifting, or when no movement is occurring.
• Urge incontinence or overactive bladder is usually related to the muscles around the bladder. It occurs when urine leaks at unexpected times, including during sleep. Urge incontinence is most common in older people and may or may not be a sign of a UTI. It is also associated with certain neurological conditions, such as multiple sclerosis.
• Overflow incontinence happens when an overfilled bladder causes uncontrollable leaking of urine. A person with overflow incontinence may feel unable to completely empty the bladder. Causes include tumors, kidney stones, diabetes, and medications. Overflow incontinence is most common in men.
• Functional incontinence is the inability to get to the bathroom in time because of a physical or other type of disability.
• Mixed incontinence occurs when a person experiences more than one type of incontinence. Generally, mixed incontinence refers to a combination of stress and urge incontinence.
• Transient incontinence occurs when urine leakage is caused by a temporary situation such as an infection or new medication. Once the cause is removed, the incontinence goes away.

Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women.

SUI can happen when pelvic tissues and muscles, which support the bladder and urethra, become weak and allow the bladder "neck" (where the bladder and urethra intersect) to descend during bursts of physical activity. This descent can prevent the urethra from working properly to control the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra weakens. The weakened sphincter muscle is not able to stop the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may occur from pregnancy, childbirth, aging, or prior pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity and smoking.

It is important for you to consult with your health care provider for proper diagnosis of SUI.

UI is caused by problems with the muscles and nerves that hold or release urine. These muscles include bladder muscles, which contract to force urine into the urethra, and sphincter muscles that surround the urethra, which relax to allow urine to pass from the body. Incontinence occurs if bladder muscles suddenly contract or sphincter muscles are not strong enough to hold back urine.

These muscles also help to hold the urinary tract in place, so if the muscles are weakened, they may not be able to keep the bladder or other structures in the right position in the body. These types of structural problems, such as when the bladder is out of position, can also cause UI.

UTIs, vaginal infections or irritation, and medications can temporarily cause or aggravate UI. Constipation and being overweight or obese put pressure on the bladder and its controlling muscles and can also cause or aggravate UI.

Other problems that can contribute to UI in women include:

• Weakened and stretched pelvic muscles after childbirth, with aging, or from genetic causes
• Thinning and drying of the skin in the vagina or urethra after menopause
• Weak bladder muscles or muscle spasms
• Damage to nerves that control the bladder because of Parkinson's disease, multiple sclerosis, or physical injury
• Age-related or behavioral changes
• Diabetes
• Obesity
• Any injury, disability, or disease that makes it difficult to get to the bathroom promptly

The following are some signs of UI:

• Leaking urine because of sudden pressure on the lower stomach from physical activity such as laughing, coughing, running, or lifting
• Sudden, strong, and frequent urges to urinate
• Unexpected and uncontrollable leaking of urine

To diagnose UI, healthcare providers begin by taking a medical history and asking about symptoms. They often ask patients to keep a bladder diary to track patterns of voiding (urinating) and leaking episodes. The diary can help a healthcare provider understand the cause of the problem and how best to treat it.

Information collected in a bladder diary typically includes times and amounts a patient urinates, straining or discomfort, fluid intake, and when and about how much urine leaks. Healthcare providers may give patients a special pan that fits over the toilet rim to measure how much they urinate. If the diary, symptoms, and medical history are not enough to diagnose UI, healthcare providers may recommend other tests. In addition to urodynamics and cystoscopy tests and an ultrasound of the urinary tract, the tests may include:

• A bladder stress test. This test requires a patient to cough vigorously while the healthcare provider watches for leakage from the urethra opening.
• Urinalysis and urine culture. A laboratory test of urine is conducted to detect infection, urinary stones, and other possible UI causes.

Women have both non-surgical and surgical options to treat SUI.

Not every woman with SUI will need surgery. Some factors you should consider before deciding whether to undergo surgery include:

• the severity of your SUI symptoms and their effect on your daily activities;
• your desire for future pregnancy as vaginal delivery can cause recurrence of SUI symptoms, which could require future surgery

NONSURGICAL TREATMENT OPTIONS

Examples of nonsurgical treatment options for SUI include:

• Pelvic Floor Exercises: A type of exercise to strengthen the pelvic floor by contracting and relaxing the muscles that surround the opening of the urethra, vagina, and rectum. These exercises, commonly referred to as Kegel exercises, improve the muscles’ strength and function and may help to hold urine in the bladder longer.
• Pessary: A removable device that is inserted into the vagina against the vaginal wall and urethra to support the bladder neck. This helps reposition the urethra to reduce SUI.
• Transurethral Bulking Agents: Collagen injections around the urethra that make the space around the urethra thicker, thus helping to control urine leakage. The effects may not be permanent.
• Behavioral Modification: This includes avoiding activities that trigger episodes of leaking.

SURGICAL TREATMENT OPTIONS

Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling).

Surgical mesh in the form of a "sling" (sometimes called "tape") is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a "sling procedure."

The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator. There is also a "mini-sling" procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

Ask your surgeon about all SUI treatment options, including non-surgical options and surgical options that do and do not use mesh slings. It is important for you to understand why your surgeon may be recommending a particular treatment option to treat your SUI.

Any surgery for SUI may put you at risk for complications, including additional surgery. One complication that may occur when mesh slings are used is vaginal mesh erosion, which could require additional surgery to resolve.

If mesh erosion occurs through the vaginal tissue, it is possible that men may experience penile irritation and/or pain during sexual intercourse.

Ask your surgeon the following questions before you decide to have SUI surgery:

• What surgical or non-surgical treatment options are available and what do you recommend to treat my SUI?
• Have you had specialized training in the surgical treatment of SUI, and if so, what type of training have you had with this particular product and/or procedure?
• What can I expect after surgery and what is the recovery time?
• If I also have pelvic organ prolapse, will that change how you treat my SUI?
• What if the surgery doesn’t correct my problem?
• Which side effects should I report to you after the surgery?
• Are you planning to use a mesh sling in my surgery? If so:
  • How often have you performed this surgery using this particular product? What results have your other patients had with this product?
  • What are the pros and cons of using a mesh sling in my particular case? How likely is it that my repair could be successfully performed without using a mesh sling?
  • Are recovery times different for mesh sling surgery compared to non-mesh surgery?
  • Will my partner be able to feel the mesh sling during sexual intercourse?
  • If I have a complication related to the mesh sling, how likely is it that the complication can be resolved? Will you treat it or will I be referred to a specialist experienced with mesh sling complications?
  • Is there patient information that comes with the product, and can I have a copy?

• Continue with annual check-ups and follow-up care, notifying your health care provider if complications develop, such as persistent vaginal bleeding or discharge, pelvic or groin pain, or pain during sexual intercourse. There is no need to take additional action if you are satisfied with your surgery and are not having complications or symptoms.
• If you have complications or other symptoms:
  • Discuss complications and treatment options with your health care provider. Only your health care provider can give you personalized medical advice.
  • Consider getting a second opinion from a surgeon who specializes in female pelvic reconstruction if you are not satisfied with your discussion with your health care provider.
• Let your health care provider know you have a mesh sling, especially if you plan to have another surgery, plan to become pregnant or have other medical procedures.
• If you have had SUI surgery but do not know whether your surgeon used a mesh sling, ask your health care provider.
• Talk to your health care provider about any additional questions you may have.
• Submit a voluntary report about any problems experienced with surgical mesh slings through Medwatch, the FDA Safety Information and Adverse Event Reporting program.

Kegel exercises strengthen the muscles that support the pelvic floor and tighten the urethra, which can help reduce UI in women. They can benefit women with stress or urge incontinence. Like any type of exercise, Kegel exercises only work as long as a woman does them. Once a woman stops the exercises, the muscles will become weak again and UI might return to its previous level.