Which Department and Doctor Treat Urinary Incontinence in Women?

What is Urinary Incontinence in Women?

Urinary incontinence in women is a common but often overlooked symptom characterized by the involuntary loss of urine, which significantly impacts quality of life. It typically arises due to pelvic floor muscle weakness, bladder dysfunction, or neurological causes. According to the International Continence Society (ICS),it is defined as objectively demonstrable involuntary urine loss that presents a social and hygienic problem. The prevalence of incontinence in women increases with age but can also occur during the reproductive years due to various reasons.

What Causes Urinary Incontinence in Women?

Urinary incontinence has a multifactorial etiology and is clinically classified into several subtypes: stress incontinence, urge incontinence, mixed incontinence, and overflow incontinence. The most common form, especially in women who have given birth, is stress urinary incontinence. This usually results from the weakening of pelvic floor support or the intrapelvic ligament structures.

Childbirth trauma, particularly vaginal deliveries; decreased estrogen after menopause; obesity; chronic coughing; connective tissue disorders; and heavy physical activity can compromise the integrity of pelvic support tissues. On the other hand, urge incontinence is more related to detrusor instability or neurogenic bladder dysfunction. Neurological diseases such as diabetes, multiple sclerosis, and Parkinson’s disease can also contribute to this condition. Mixed incontinence refers to the presence of both pathophysiologies simultaneously.

How is Urinary Incontinence Treated in Women?

The treatment approach should be individualized based on the underlying cause, severity of symptoms, and the patient’s lifestyle.

Initially, lifestyle modifications such as weight loss, regulating fluid intake, and bladder training are recommended, along with pelvic floor muscle exercises (Kegel exercises). Especially in the early stages, regular pelvic floor rehabilitation is sufficient to control symptoms for many patients.

Medications are particularly effective for urge incontinence. Antimuscarinic agents (such as tolterodine, oxybutynin) and beta-3 agonists (like mirabegron) help by suppressing bladder overactivity. Local vaginal estrogen therapy can also be beneficial in postmenopausal women by improving mucosal trophism.

Among invasive treatments, the most commonly used method is mid-urethral sling (MUS) surgery. It is a highly effective and reliable surgical option, especially for stress urinary incontinence. Botulinum toxin injections and sacral nerve stimulation are other options to consider, particularly in refractory urge incontinence cases.

Which Department and Doctor Should Women with Urinary Incontinence See?

Women experiencing urinary incontinence should initially consult a urologist or a gynecologist (obstetrics and gynecology specialist). However, since most underlying causes are related to pelvic floor anatomy and bladder function, a urology specialist experienced in this field is best suited to provide accurate diagnosis and treatment guidance.

Urodynamic evaluation plays a critical role in thoroughly analyzing symptoms and shaping the treatment plan. In some cases, a multidisciplinary approach involving urogynecology, physiotherapy, and psychiatry may be necessary. Therefore, in advanced or treatment-resistant cases, management by a specialized urologist ensures the best clinical outcomes.