Urinary Incontinence in Women: Causes, Types & Treatment Options

In short: Urinary incontinence is loss of control of urine, more common after several or difficult births and after the menopause. The two main types are stress incontinence, on laughing or coughing, and urge incontinence, after a sudden need to pass urine. More than 50% of affected women benefit from pelvic floor exercises, and there are also medicines and surgery (TVT). Most cases can be helped, so do not hesitate to see the doctor.

Many women hesitate to bring up urinary incontinence (the inability to control urination) when they visit a gynecology clinic. Some may even feel embarrassed or think it’s an unusual complaint. In reality, this is one of the most common problems women face, especially after vaginal deliveries — particularly frequent or difficult ones — or after menopause.

Women dealing with this issue generally fall into three groups:

• A- Those who notice the problem and actively look for a solution.

B- Those who notice the problem but feel too embarrassed to mention it.

C- Those who assume urinary incontinence is just a normal part of being a woman, rather than a medical condition that can be treated.

Research shows that for 60% of women who experience urinary incontinence, it affects their daily life, and for 40%, it impacts their sexual life as well. In 75% of cases, it affects mental well-being, and 20% of affected women describe their quality of life as significantly reduced. If any of this sounds familiar, please know that you’re not alone — and that effective help is available.

Types of Urinary Incontinence

• A- Stress incontinence: an unconscious loss of bladder control triggered by sudden physical stress, such as laughing, coughing, moving, or sneezing.

B- Urge incontinence: an unconscious loss of bladder control that follows a sudden, strong urge to urinate.

C- As mentioned, urinary incontinence can also develop after repeated pregnancies and deliveries, which place extra strain on the bladder and pelvic muscles. This can affect the sphincter that controls urine flow and may weaken the detrusor muscle. Other contributing factors include recurrent bladder infections, chronic cough, or hormonal changes such as those occurring after menopause.

Treatment of Urinary Incontinence

• The right treatment approach depends on the type of incontinence a woman has.

Natural Treatment for Urinary Incontinence

This approach involves teaching the patient specific physical exercises designed to strengthen the pelvic floor muscles that support the bladder. Studies suggest that when these exercises are performed correctly, more than 50% of women experience lasting improvement, while many others notice a meaningful reduction in symptoms.

The exercises work best when supervised by a trained physiotherapist for at least 3 months. For urge incontinence, bladder training (gradually increasing the time between visits to the toilet) for at least 6 weeks is recommended. Losing excess weight, stopping smoking and reducing caffeine and fizzy drinks also help. These steps should be tried before surgery is considered.

• Medical treatment for urinary incontinence: for urge incontinence (overactive bladder), tablets that relax the bladder (such as solifenacin or mirabegron) are used, and vaginal estrogen can help after menopause. If these do not work, botulinum toxin (Botox) injections into the bladder may be offered. Medicines do not usually help stress incontinence.

Surgical Treatment for Urinary Incontinence

In more difficult or persistent cases, several surgical approaches have been developed over the years. These have traditionally been performed under general anesthesia, some through open (laparotomy) surgery and others vaginally using more complex techniques that require a longer recovery period and carry a lower success rate. Over time, these methods evolved into what is now known as TVT (tension-free vaginal tape), which has produced very good results for stress incontinence (it does not treat urge incontinence). Because the tape is made of synthetic mesh, the benefits, risks and alternatives (such as colposuspension, a sling made from the patient’s own tissue, or bulking injections) should be discussed carefully before choosing surgery.

What Is TVT?

TVT is a specialized tape used to support the urinary passage and prevent urine leakage when the bladder is put under pressure, such as during coughing or laughing.

The tape is inserted through a minor procedure performed under spinal anesthesia, since the patient needs to be awake and able to cough on request so the surgeon can confirm that no leakage occurs and that the procedure has been successful.

During the procedure, a small opening is made in the front wall of the vagina, under the middle of the urethra, to place the tape. It typically takes around 30 minutes, and most patients can go home the same day or the following day. Mild discomfort for 24 to 48 hours after surgery is common and usually manageable with simple pain relief, along with some temporary difficulty urinating that typically resolves quickly. Working women are generally advised to take two weeks off work and avoid lifting heavy objects. Most patients return to their normal daily activities around eight weeks after the operation, with a follow-up visit recommended six weeks post-surgery.

Possible Complications of the TVT Procedure

1- Bleeding.

2- Injury to the bladder or urethra during surgery, difficulty emptying the bladder, or new urgency symptoms. 3- Mesh-related problems (uncommon): the tape can become exposed in the vagina or erode into the bladder or urethra, or cause long-term pain in the groin, pelvis or during sex; these may need further surgery and are not always fully reversible.

3- Urinary tract infection.

4- The possibility that the procedure does not fully resolve symptoms.

Reported Success Rate: 92%

This procedure is performed by Dr. Najeeb Layyous. If you’re experiencing symptoms of urinary incontinence, we warmly invite you to book a consultation to discuss which option may be right for you.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist