Urinary incontinence in women
Introduction
Urinary incontinence in women is characterized by involuntary leakage of urine in a variety of situations (stress, emergency, or both). These problems can be a real nuisance in everyday life, affecting quality of life, psychological well-being and social relationships.
⚠️ Fortunately, accurate diagnosis and appropriate treatment are possible. It is essential to consult a urologist as soon as these symptoms appear, in order to limit progression and choose the best treatment strategy.
What is female urinary incontinence?
Urinary incontinence is the involuntary loss of urine, uncontrollable by the individual, outside of normal voluntary micturition. In women, there are three main forms:
- Stress incontinence – leakage on coughing, exertion, sport
- Urgent incontinence – urges that are difficult to contain
- Mixed incontinence – combination of stress and urge incontinence
These forms can vary in severity, frequency and impact on daily life.
📌Some key figures :
- Urinary incontinence affects a significant percentage of women, particularly after pregnancy, menopause or in association with pelvic risk factors.
- Many women don’t dare talk about it, delaying treatment.
Types of incontinence and their mechanisms
1️⃣ Stress incontinence (sports, coughing, sneezing)
This form occurs when intra-abdominal pressure rises (e.g. during exertion, coughing, sneezing, sport) and the urethral sphincter cannot resist this surge.
This reflects a weakness in the perineal support system, a pelvic floor deficiency, or a weakening of the urethral sphincter itself.
Favouring factors :
- Childbirth (particularly with episiotomy or tearing)
- Pelvic floor prematurity
- Menopause (hormonal decline, tissue atrophy)
- Obesity, chronic constipation
- Previous pelvic surgeries
2️⃣ Urinary emergencies and urges
In this form, the bladder contracts involuntarily (bladder instability) during the filling phase, triggering a sudden, urgent need to urinate. If the person cannot reach the toilet in time, leakage occurs.
Typical mechanisms: bladder overactivity, bladder irritability, neurological abnormality or bladder emptying disorders.
3️⃣ Mixed incontinence (stress + emergency)
Mixed incontinence combines the mechanisms of stress and urgency. A woman may experience both stress leakage and urge incontinence. In many cases, this is the form most frequently encountered when two mechanisms coexist.
Symptoms and effects
The most frequent signs:
- Urinary leakage during exertion (jumping, carrying a load, running)
- Spontaneous leakage with a sudden urge to urinate
- frequent need to go to the bathroom (pollakiuria), sometimes at night
- Inability to hold urine until you reach the toilet
- Delayed drops after micturition
- Use of protection (pads, urinary protection)
- Washing frequency, stained garments
- Psychosocial impacts: embarrassment, guilt, avoidance of social or sporting activities
📌Incontinence can alter quality of life, intimate relationships, sleep, and lead to a loss of self-confidence.
Diagnosis
A complete workup is necessary to determine the nature of the incontinence, assess its severity and guide treatment:
1️⃣ Precise questioning
- Date of onset of leaks
- Conditions in which they occur (exertion, emergency, mixed)
- Frequency and quantity (pad test, urine diary)
- Aggravating factors: constipation, weight gain, chronic coughing
- Gynecological, obstetrical and surgical history
- Medications, co-morbidities
2️⃣ Clinical examination
- Examination of the perineum and pelvic floor
- Standing cough test (observation of a coughing leak)
- Gynecological examination, assessment of urethral mobility
- Checking neurological sensitivity
3️⃣ Supplementary balance sheet
- Pad test (weighing of protections) to quantify leaks
- Voiding diary to record volumes and frequencies
- Pelvic ultrasound / post-micturition residue
- Urodynamics: study of bladder pressures, sphincter function
- Cystoscopy if concomitant bladder or urethral lesion suspected
📌 These examinations help differentiate the origin (sphincter, bladder, mixed) and decide on the therapeutic strategy.
Possible treatments
Treatments must be individualized, depending on the form of incontinence, its severity, age, comorbidities and the patient’s expectations.
1️⃣ Non-surgical approach
- Perineal rehabilitation / pelvic physiotherapy (targeted exercises, biofeedback)
- Electrical stimulation / perineal neuromodulation
- Hygienic dietary measures: weight control, avoid constipation, limit irritating drinks
- Modification of bladder habits : programmed micturition, 2nd intention
- For the emergency component: anticholinergic drugs, beta-3 agonists
2️⃣ Medical devices
- Urethral pessaries (in certain cases)
- Female slings
- Urethral injections (volumizing agents) in mild cases
3️⃣ Surgical options
- Taping (tension-free vaginal tape, TVT, TVT-O, TOT): for stress incontinence
- Colovesical suspension techniques(Burch cure, colposuspension)
- Sacral neuromodulation (sacral nerve stimulation) for the emergency component
- Botulinum toxin bladder injection for resistant overactive bladder
The choice of surgery will depend on the assessment, the predominant mechanisms and the patient’s profile.
Why consult Pr Haab?
- Expertise in women's urology and functional urological pathologies
- Personalized, step-by-step approach, starting with the least invasive solutions
- Expertise in modern surgical techniques (slings, neuromodulation, injectables)
- Comprehensive care (precise diagnosis, post-treatment follow-up, support)
Do you suffer from incontinence?
Requirements
Expertise
Patient pathway
Each patient benefits from personalized support, from the first consultation to post-treatment follow-up. This includes a precise assessment, a clear presentation of the different treatment options and a progressive approach to treatment, tailored to each patient’s individual situation.
Do you suffer from urinary incontinence?
Don’t let urinary incontinence affect your well-being and your intimate life.
Professor François Haab consults in Paris and supports you every step of the way, with scientific rigor and human kindness.
📍 Cabinet Urologie Paris Opéra – Paris 17th
📅 Face-to-face consultation or teleconsultation
📞 Book an appointment today
Patient pathway
Each patient benefits from individualized support, from diagnosis to post-treatment follow-up. This includes a full assessment, presentation of the various options available, and progressive management to ensure the best possible outcome.
Make an appointment
Do you suffer from bladder weakness? Would you like specialist advice and appropriate treatment?
Professor François Haab consults in Paris and supports you with scientific rigor and kindness.
