What is urinary incontinence?
Urinary incontinence is the loss of bladder control, often resulting in urine leakage. Healthy bladder control involves smooth muscles around the bladder, sphincter muscles, pelvic floor muscles, and nerve signals between the brain and bladder. A problem with any of these components can lead to urinary incontinence.
Normally, the bladder’s smooth muscles remain relaxed while the bladder is filling. The sphincter muscles stay contracted around the urethra to keep urine in the bladder while it fills. And the pelvic floor muscles support the bladder and keep it in place.
Once the bladder is full and you are ready to urinate, the brain sends signals to the muscles. The smooth muscles contract to squeeze urine out of the bladder. The sphincter muscles relax to allow urine to flow. There are different types of urinary incontinence, depending on the affected part of the process. Stress incontinence and urge incontinence (overactive bladder) are the main types.
Since the underlying causes of it vary, urinary incontinence treatment differs for each type. It often starts with lifestyle changes and exercises to improve urinary control. Urinary incontinence medication is an option for some forms. Surgery may also be an option if other treatments fail to improve urinary control.
Urinary incontinence can start out as a small problem, but it usually gets worse. If you’re one of the millions of Americans who leak urine, make an appointment to see your doctor. Persistent urine leakage can lead to other problems, such as skin problems in the area and recurring UTIs (urinary tract infections). It can also adversely affect your emotional, psychological and social well-being.
What are the different types of urinary incontinence?
The types of urinary incontinence include:
- Stress incontinence, which is due to weak pelvic floor muscles. Urine leakage occurs when there is stress—or pressure—on the bladder
- Urge incontinence or overactive bladder (OAB), which occurs when the brain signals to urinate or the bladder muscles squeeze out urine when the bladder isn’t full
- Mixed incontinence, which is a combination of stress and urge incontinence
- Overflow incontinence, which can occur when the body makes too much urine, the bladder muscles can’t squeeze out urine, or something is blocking the outflow of urine
Some people have incontinence even though they have normal bladder control. This can happen when another condition prevents them from accessing a toilet in time. For example, arthritis may hamper a person’s ability to move to the bathroom or undo garments. The name for this is functional incontinence.
In general, urinary incontinence is more common in females than males. The types and causes of urinary incontinence can vary between the sexes. Stress and urge incontinence tends to be more of a problem for females. Urinary incontinence in women often results from hormonal changes with menopause or physical changes from pregnancy and childbirth. Males more often have problems with overflow or urge incontinence, usually due to BPH (benign prostatic hyperplasia). While these causes are related to age, urinary incontinence is not just a normal consequence of aging.
What are the symptoms of urinary incontinence?
Urinary incontinence is a symptom itself—the leakage of urine. However, the way people experience leaks can vary with the type of incontinence. The amount and frequency of the leakages can also vary. In addition, urinary incontinence can be temporary or chronic.
Common ways urine leakages occur:
- Stress incontinence: Urine leaks when you are active, which puts pressure on the bladder. Examples include bending, coughing, exercising, laughing, lifting or sneezing.
- Urge incontinence: Urine leaks after a sudden, intense urge to go that you can’t control. You may also need to urinate more than normal throughout the day or night. Not all people with these uncontrollable urges leak urine. This is why it is also known as overactive bladder.
- Mixed incontinence: Urine leakage has characteristics of both stress and urge incontinence.
- Overflow incontinence: Urine leakage occurs as constant dribbling or people urinate small amounts very frequently.
If you notice urine leakage or other urinary problems, see your doctor promptly. It’s important to see your doctor soon after the onset of symptoms. Urinary incontinence usually continues to get worse over time. Early intervention may help prevent it from worsening. Urinary incontinence can also be a sign of a more serious condition.
What causes urinary incontinence?
There are various causes of urinary incontinence, which can be temporary or chronic.
Temporary urinary incontinence
Temporary urinary incontinence tends to resolve once the underlying cause is gone. These causes may include:
- Foods and beverages, such as alcohol, carbonated drinks, and caffeine
- Medications, such as diuretics, muscle relaxants, antidepressants, and sedatives
- UTI, vaginal infections, or prostate infections
Chronic urinary incontinence
Chronic or persistent incontinence is usually due to physical changes from an underlying condition or disease. These causes may include:
- Bladder problems, such as bladder cancer and bladder spasms
- Nerve, muscle, or pelvic floor damage from pregnancy, childbirth, surgery or radiation
- Neurological disorders, such as brain tumor, spinal cord injuries, stroke, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease
- Obstruction, including tumors and urinary stones
- Prostate problems, including BPH and prostate cancer
A number of things can make incontinence worse, including obesity, menopause and aging.
What are the risk factors for urinary incontinence?
Several factors increase the risk of developing urinary incontinence including:
- Age: Urinary incontinence is not a normal part of aging. But it becomes more common as people age. This is likely due to changes in the bladder and urethra.
- Family history: The risk is higher for people with a family history of urinary incontinence, especially urge incontinence.
- Gender: Urinary incontinence is about twice as common in women compared to men. Women are more likely to have stress or urge incontinence.
- Smoking: Smoking can irritate the bladder and increases the risk of bladder cancer. Coughing due to smoking can worsen incontinence.
- Weight: Being overweight or obese puts stress on the bladder. Over time, this can weaken the bladder and its supporting muscles.
Reducing your risk of urinary incontinence
Preventing a disease or condition relies on changing risk factors that are under your control. It’s not always possible to prevent all types of urinary incontinence. However, you may be able to lower your risk by:
- Avoiding bladder irritants, such as caffeine and alcohol
- Controlling medical conditions, such as diabetes and BPH
- Eating fiber-rich foods and drinking plenty of fluids to avoid constipation
- Maintaining a healthy body weight
- Practicing pelvic floor exercises (Kegels)
- Stopping smoking
If you are concerned about urinary incontinence, talk with your doctor. Find out about your risk factors and learn what you can do to lower your personal risk.
How is the cause of urinary incontinence diagnosed?
The first step in diagnosing urinary incontinence is a physical exam. Doctors look for problems, such as bladder prolapse, vaginal prolapse, and enlarged prostate. Your doctor may also ask you to keep a bladder diary. You note when and how often incontinence occurs and your activity when it happens. You’ll also note when and how often you urinate and whether it’s a lot or a little. Your doctor will want to know what you drink and when. These details can reveal patterns that can guide diagnosis and what tests your doctor needs to order.
Tests doctors may order to diagnose the cause of urinary incontinence include:
- Urinalysis, which can reveal infection, urinary stones, and other health problems
- Cystoscopy, which involves inserting a thin tube through the urethra. Using a tiny camera, your doctor can examine the inside of the bladder. The test can reveal tumors, blockages, and other problems with the bladder lining.
- Urodynamics, which is a group of tests. They can measure the speed and volume of urination, the amount of urine the bladder can hold, how much pressure builds up in the bladder, how full the bladder is when you feel the urge, and how much urine is left in the bladder after urinating. They can also tell if the bladder contracts without your control. All of this gives doctors information about muscle and nerve activity.
- Pelvic ultrasound, which is an imaging exam. It can show how much urine is in the bladder and how well it empties. It can also show bladder stones, tumors, and problems with the bladder lining or prostate.
How is urinary incontinence treated?
The goal of treating urinary incontinence is to correct the underlying problem, if possible, and improve symptoms. Treatment often starts with the same lifestyle changes that can help lower your risk of incontinence. Other treatment options include:
- Behavior modification: This may include decreasing your fluid intake, not drinking close to bedtime, and limiting caffeine and alcohol.
- Bladder training: This involves scheduling bathroom trips instead of waiting to go and gradually increasing the time between trips. Your doctor may also recommend double voiding—urinating and waiting a few minutes before trying again. Bladder training aims to give you more control over urges.
- Pelvic floor training: Kegel exercises are the core of this approach. It involves tightening the muscles that stop urination and holding them briefly. You gradually increase the time you can hold them tight. A physical therapist may need to help you identify the right muscles to use. Electrical stimulation may be an effective alternative for pelvic floor strengthening.
- Medical devices: Women may be able to use either pessaries or urethral inserts for incontinence. Pessaries are useful for prolapse and urethral inserts are like tiny tampons for stress incontinence.
- Medications: Some types of incontinence respond to medicines. This includes BPH medicines, estrogen, and drugs for overactive bladder or urge incontinence.
- Interventions: This includes bladder nerve stimulation, onabotulinum A toxin (Botox) injections, and bulking injections that thicken the area around the urethra to keep it closed.
- Surgery: This includes many different procedures that depend on whether you are male or female and the type and cause of the incontinence.
If none of these treatments are able to restore bladder control, you can manage leaks with other strategies. This includes absorbent pads and undergarments and various forms of catheters.
What are the potential complications of urinary incontinence?
Urinary incontinence can be embarrassing. This can put stress on your personal, social and work relationships. The impact on your emotional, psychological and social health can decrease your quality of life. Other potential complications from urinary incontinence include:
- Recurrent UTIs
- Skin problems due to constant moisture in the area. This includes rashes, itchiness and infections.