Unpredictable, uncontrollable, undesirable loss of urine is called incontinence. This can happen suddenly with the onset of a bladder infection or it may be a chronic problem. The shorter length of the female urethra (the tube that drains the urine from the bladder) makes this a much more frequent problem in women than in men. The urethra comes out of the female bladder at about a 90- degree angle, like the horizontal base of the capital letter "L". Normally, with a cough or a sneeze, the bladder (represented by the vertical aspect of the letter "L") is pushed down and the urethra remains stationary. This has a valve-like effect turning the "L" to a "<". This crimps the urethra and prevents urine loss.

There are several causes of urine loss. These problems can be distinguished from one another by certain tests. "Overflow" can occur in people with bladder nerve-injuring diseases such as diabetes or hypothyroidism. The bladder doesn't sense that it is completely full and urine leaks because the bladder cannot stretch to hold any more urine. This problem can be treated sometimes with medications or by drainage of the bladder on a regular basis with a catheter. An "irritable" bladder is another cause of urine loss. This is a bladder that as two speeds: stop and warp drive. The bladder fills up to a point then suddenly empties itself. A cough or sneeze or sudden jolt can get this response. This can be caused by neurologic injury to the spine or local inflammation of the bladder caused by infections, tumors or stones. This is treated with medications that relax the bladder.

The most common cause of urine loss is "stress urinary incontinence" (SUI) and this is related to a weakening of the forces that hold the urine in. SUI is caused by a decrease in effectiveness of the urethra vesical valve. This is more common in older women. Childbirth injures the support structures that align the bladder and the urethra. Menopause with its loss of estrogen also weakens these structures. The treatment of this problem revolves around increasing the effectiveness of the valve. Estrogen can sometimes help. There are surgeries that "suspend" the bladder and seek to restore the proper anatomical alignment.

Who should have a surgery? That's hard to say. I have had patients with what would appear to be an intolerable amount of urine loss who just wanted to go on using protective devices (e.g. Depends). I have had other patients that had mush less of a urine loss problem request surgery so as not to prevent them from country western dancing. It depends on the individual's level of tolerance. Your physician will give you the risks and benefits and any other options to allow you to make your own decision.