What causes urinary incontinence?

Female urinary incontinence is due to a number of causes. STRESS Incontinence, the loss of urine with coughing, sneezing, laughing, running etc is due to pelvic floor weakness or loss of support to the tissues around the urethra, the tube from the bladder to the outside. As such it is managed with Pelvic Floor exercises with some success, or surgery with a 95% success rate.

Urinary Urgency, the need to rush to the toilet, and URGE Incontinence, not making it to the toilet in time, is due to an overactivity of the muscle of the bladder known as the detrusor, and is managed with physiotherapy and then often medication to relax the muscle.

These problems can often be present simultaneously which makes management more difficult, and there may be also other rarer types of incontinence that are too detailed to discuss in this forum. All types of incontinence may present after pregnancy and childbirth, after the menopause or due to chronic increase in intra-abndominal pressure such as obesity, bad coughing periods etc.

To elaborate on Dr Rosen's answer, the pelvic floor is a sling of muscles in the Pelvic basin.
In women this sling has 3 openings (men having 2). From front to back they are:
1. Urethera (to pass water),
2. Vaginal opening (menstrual flow and deliver baby )
3. Anus ( to pass faeces)
Sometimes childbirth causes damage to this sling of muscles resulting in loss of urinary control.
You can prevent this damage by strengthening the muscles and performing daily Perineal Massage (the area between Vaginal opening and Anus) 4-6 weeks before delivery.
Even women who have not delivered vaginallly can suffer from this distressing condition.
Physiotherapists with experience in this area can support women suffering from Stress or Urge Incontinence to regain strength in Pelvic Floor muscles and may avoid the need for surgical repair.  With Urge Incontinence and the unstabile detrusor muscle there are ways to restore control and bring about relief from this condition e.g. reducing intake of tea, coffee and other diuretic substances.

Just because I'm just a little peeved at the “Australian Professionals”, 3 GPs, a urinary physiotherapist, 1 specialist - with his wonderful reputation- and his nurse  for not mentioning that Urge Incontinence can be affected by perimenopause/ menopause and some foods………….
before you head off to the professionals on your quest to discover dryness again- check out what foods are in your diet that could be aggravating the problem and try eliminating them to see if that makes a difference-
eg: fruits: citrus, peaches, apples, cantaloupe, grapes, cranberries, pineapple, plums, tomatoes, but low acid fruits like pears, apricots,  water melon and papaya should be ok.
Also taking out artificial sweeteners, Tea, coffee, chocolate, vinegar and mayonnaise would probably be worth a try.
Then gradually add them back to see which ones affect you.
It's interesting that the professionals answering questions about incontinence here on this site have not mentioned dietary considerations, and I wonder if anyone of them mentions it to their patients.
In Sept 2012 I bought a new pack of 28 Enablex tablets at $50/pack. I've still got 2 left. Prior to that I was taking one tablet /day.

Thanks Suzen.

I would like to add that Perineal Massage and Pelvic Floor strengthening can help prevent incontinence, but are not a guaranteed prevention. The reason is that there are so many factors that can affect your pelvic floor, such as hormonal changes, constipation, heavy lifting, difficult birth presentation (eg breech delivery), birthing a heavy baby with a large head and multiple births (the more children you deliver the higher the risk). Some of these may need to be carefully managed.

My understanding is that a pelvic floor exercise programme can help at least 70% of women with Stress Incontinence (see Dr Rosen's post above). This may be sufficient to alleviate the need for surgery in women, but it may also be necessary to keep the exercises going once the result is achieved. We usually refer women to a Physiotherapist with post-graduate training in women's health, as these Physios have special machines for testing and strengthening the relevant muscles as well as a lot of experience working in this area.

For those with Urge Incontinence (see Dr Rosen's post) a bladder training programme may be needed as well as pelvic floor exercises. Diet, stress, psychological factors can also contribute, for example some people experience urgency with or without leakage of urine when they hear water running, or when they get home and are trying to open the front door! Medication can also help this form of incontinence in some cases, but it is less responsive to surgery.

Clinical Pilates is often a great follow up programme for women with incontinence. The reason is that the sling of muscles which makes up your pelvic floor does not normally work in complete isolation. It is also important in postural stability and is actually considered to be one of your ‘core’ muscles. Weakness of the pelvic floor is often (but not always) associated with poor tone of the lower abdominal muscles and sometimes with a ‘sway back’ and lower back pain. Learning to activate these muscles as part of daily activities such as walking, going up stairs or getting up and down from a chair makes the exercises more interesting and functional.

On difficult circumstances (patients who cannot do Physio), it is worth trying laser or radiofrequency therapy (Thermiva).

However this is not medicare rebatable.