Urinary Incontinence

Urinary incontinence, the involuntary loss of bladder control, affects millions of people worldwide, yet many suffer in silence due to embarrassment. While it becomes more common with age, it is not an inevitable part of getting older, and effective treatments are available to help you regain control and improve your quality of life.

Table of contents

• What is urinary incontinence?
• Types of urinary incontinence
• Signs and symptoms
• What causes urinary incontinence?
• Who is at risk?
• How is it diagnosed?
• Treatment options
• Lifestyle changes and self-care
• Preventing urinary incontinence
• Living with urinary incontinence

What is urinary incontinence?

Urinary incontinence is the unintentional passing of urine, meaning you leak pee before you can make it to a bathroom or during certain activities^[1][3]. It’s a common condition thought to affect millions of people, with about 62% of females age 20 and older and a little less than 14% of males experiencing some type of urinary incontinence^[2].

Your urinary system (the organs that filter, store, and remove waste from your body as urine) consists of many different parts working together. When this system works as expected, you usually have time to get to a bathroom, and you don’t leak pee. Urinary incontinence occurs when these parts don’t operate as they should^[2].

Many people think incontinence is a normal part of getting older and that nothing can be done about it. While your risk does increase with age, urinary incontinence can happen to anyone, regardless of age^[2]. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time^[1].

Types of urinary incontinence

There are several different types of urinary incontinence. Each type has different causes, characteristics, and triggers. Knowing which type you have is an important part of your diagnosis and treatment plan^[2].

Stress incontinence

Stress incontinence happens when you leak urine during activities that put pressure on your bladder, such as coughing, sneezing, laughing, exercising, or lifting something heavy^[1][2]. This is usually the result of weakening or damage to the muscles used to prevent urination, such as the pelvic floor muscles (muscles that support the bladder and bowels in the pelvic area) and the urethral sphincter (muscles that control the tube through which urine exits your body)^[3]. This type is most common in younger women and can be caused by pregnancy, childbirth, and menopause^[4][6].

Urge incontinence

Urge incontinence, also known as overactive bladder, causes a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night^[1][2]. This happens when the bladder muscle contracts or squeezes before it is full, or when the nerve signals between your brain and bladder don’t work properly^[6]. Urge incontinence is usually the result of overactivity of the detrusor muscles (muscles that control the bladder)^[3]. This type is most common in older adults and has a strong association with stroke^[12].

Mixed incontinence

Mixed incontinence is when you have a combination of several conditions that all lead to bladder leakage problems. For example, you may have both stress incontinence and an overactive bladder^[2][6]. This is the overall most common type^[12].

Overflow incontinence

Overflow incontinence happens when your bladder doesn’t completely empty each time you urinate. Your bladder gets too full, and you leak urine. You may experience frequent or constant dribbling^[1][2]. This form is most common in men and can be caused by an enlarged prostate, tumors, kidney stones, diabetes, stroke, and certain medicines^[4][5].

Functional incontinence

Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time^[1][5]. For example, someone with severe arthritis may have trouble unbuttoning their pants, or a person with Alzheimer’s disease may not realize they need to plan to use the toilet^[5].

Other types

Additional types include total incontinence, when your bladder cannot store any urine at all, causing constant urination or frequent leaking^[3], and transient incontinence, which is temporary urine leakage caused by a situation such as an infection or new medicine that goes away once the cause is removed^[5].

Signs and symptoms

Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently^[1]. The primary symptom of incontinence is leaking pee before you can make it to the bathroom or during certain activities. The amount of leakage can range from a lot of pee to a small amount, and it could be a constant drip or an occasional leak^[2].

Your symptoms usually depend on the type of incontinence you have, but they may include^[2]:

• Peeing more than eight times a day (frequent urination)
• Needing to use the bathroom but only a little amount comes out each time
• Waking up to pee more than twice at night (nocturia)
• Wetting the bed (enuresis)
• Leaking pee during activities like exercise, laughing, coughing, sneezing, bending over, or having sexual intercourse

If you have any of these symptoms, or if you have any concerns about your toilet habits, you should see your doctor^[3]. You should not feel embarrassed talking to them about your symptoms^[3].

What causes urinary incontinence?

Urinary incontinence can have many different causes depending on the type^[4].

Stress incontinence is usually caused by weakening of or damage to the pelvic floor muscles and the urethral sphincter. In women, this can result from pregnancy and vaginal birth, weight gain, or menopause^[3][4]. These conditions strain the pelvic floor muscles, which support the bladder and help stop the flow of urine^[6].

Urge incontinence is usually caused by overactivity of the detrusor muscles, which control the bladder^[3]. It may be caused by a minor condition, such as infection, or a more severe condition such as a neurological disorder or diabetes^[1]. The bladder muscle spasms or contracts, forcing urine past the sphincter muscles^[11].

Overflow incontinence is often caused by an obstruction or blockage in your bladder, which prevents it from emptying fully^[3]. In men, this is frequently related to an enlarged prostate^[2]. It can also result from nerve damage from conditions like diabetes, stroke, or spinal cord injury^[4][11].

Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a small, tunnel-like hole that can form between the bladder and a nearby area (called a fistula)^[3].

Who is at risk?

Certain things can increase the chances of developing urinary incontinence^[3][5]:

• Being female, especially after going through pregnancy, childbirth, and menopause
• Being older (although incontinence is not an inevitable part of aging)
• Being a man with prostate problems
• Having certain health problems, such as diabetes, obesity, or long-lasting constipation
• Being a smoker
• Having a family history of incontinence
• Having a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children^[5].

How is it diagnosed?

It’s important to determine the type of urinary incontinence you have, and your symptoms often tell your doctor which type you have. That information will guide treatment decisions^[8].

Your health care provider may use many tools to make a diagnosis^[5][8]:

• A medical history, which includes asking about your symptoms
• A physical exam, such as a pelvic examination (if you have a vagina) or a rectal examination (if you have a penis)
• A bladder diary, where you note how much fluid you drink and how often you have to urinate for several days
• Urinalysis: A sample of your urine is checked for signs of infection, traces of blood, or other abnormalities
• Postvoid residual measurement: You’re asked to urinate into a container that measures urine output. Then your doctor checks the amount of leftover urine in your bladder using a catheter or ultrasound test. A large amount of leftover urine may mean you have an obstruction or a problem with your bladder nerves or muscles

If further information is needed, your doctor may recommend more involved tests, such as urodynamic testing (which measures how well your bladder stores and releases urine) and pelvic ultrasound. These tests are usually done if you’re considering surgery^[8].

Treatment options

Treatment for urinary incontinence depends on the type of incontinence, its severity, and the underlying cause. A combination of treatments may be needed^[8][11].

Behavioral and physical therapies

Pelvic floor muscle exercises, also known as Kegel exercises, are considered first-line treatment for both stress and urge incontinence^[10][12]. These exercises strengthen the muscles that support the bladder and help control urination. To do Kegel exercises, you squeeze the muscles you would use to stop the flow of urine, hold for several seconds, then release. You should include both short squeezes and long squeezes, practicing several times a day^[10][11].

Bladder training involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. This can help if you have urge incontinence^[10].

Biofeedback is a way to monitor how well you do pelvic floor exercises by giving you feedback as you do them. This can involve sensors or electrodes that detect when muscles are squeezed^[10].

Electrical stimulation may be recommended if you’re unable to contract your pelvic floor muscles. A small probe inserted into the vagina or anus runs an electrical current that helps strengthen your pelvic floor muscles while you exercise them^[10].

Medications

Medicine may be recommended if you’re unable to manage your symptoms with behavioral therapies^[8][13]. For urge incontinence, anticholinergic medications help stabilize overactive bladder problems by relaxing bladder muscles. Examples include Ditropan XL®, Detrol®, and Enablex®^[19]. However, because of adverse effects, these agents are not recommended in older adults^[12].

Other medication options include mirabegron (Myrbetriq®), which helps relax bladder muscles, and onabotulinumtoxinA (botulinum toxin injections) for urge incontinence^[4][12]. For overflow issues, alpha blockers like Flomax®, Uroxatral®, Rapaflo®, and Cardura® can help^[19].

Medical devices

Several devices are available to help manage incontinence^[19]:

• Pessary: A silicone device for women that rests against the back of the pubic bone and supports the walls of the vagina to hold up the bladder and urethra
• Urine seal: Adhesive pads for women to prevent urine leakage
• Vaginal cones: Small weights inserted into the vagina that you hold in place using your pelvic floor muscles
• Artificial sphincters: A device for men that inflates around the urethra

Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy^[12]. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence^[4][12].

Surgical treatments

Surgery may be considered if incontinence has not responded to less invasive treatment modalities^[8][12]. For stress incontinence, procedures such as sling procedures are used to reduce pressure on the bladder or strengthen the muscles that control urination^[3]. Urethropexy procedures are another surgical option^[12].

Minimally invasive procedures include radiofrequency denaturation of the urethra and injection of periurethral bulking agents^[12]. Surgery to treat urge incontinence includes enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles^[3].

Lifestyle changes and self-care

Simple lifestyle changes may improve bladder control or help medicine work better. These changes are safe, easy, and cost little or nothing. Try them before trying other types of treatment, or use them along with other treatments^[13][15].

Managing fluids

Drink the right amount of liquid at the right time. You should drink six to eight glasses of fluid a day (but no more) unless your doctor advises otherwise^[13][16]. Many people with urinary incontinence avoid drinking fluids, but limiting fluid intake makes incontinence worse because it reduces your bladder’s capacity^[16].

To limit nighttime trips to the bathroom, you may want to stop drinking liquids a few hours before bedtime, but only if your health care professional suggests it^[13].

Certain foods and beverages can irritate the bladder and increase the need to urinate^[15][16]:

• Coffee, tea, and drinks with bubbles (even without caffeine)
• Alcohol
• Chocolate
• Spicy and acidic foods, such as curries and citrus fruits
• Artificial sweeteners
• Carbonated drinks

Limiting or avoiding these bladder irritants may help improve your symptoms^[15][16].

Weight management

Being overweight or having obesity can weaken your pelvic floor muscles and cause incontinence because of the pressure of fatty tissue on your bladder. Your symptoms may improve, and could go away completely, if you lose any excess weight^[3][16]. Studies suggest that as your body mass index increases, you’re more likely to leak^[13].

Physical activity

Regular physical activity is important for weight management and good overall health. Activities such as walking, swimming, biking, and dancing can improve your health^[13]. However, you may want to replace high-impact exercise, such as jogging and aerobics, with strengthening exercises, such as Pilates, which can strengthen your core muscles and benefit stress incontinence^[16].

Avoiding constipation

Constipation can make urinary tract health worse and can lead to incontinence. Straining to have a bowel movement weakens your pelvic floor muscles and makes urinary incontinence worse^[13][16]. Eating more fiber and drinking enough fluids can help avoid constipation^[16].

Other lifestyle tips

Smoking puts you at risk of incontinence because coughing puts strain on your pelvic floor muscles^[16]. Lifting also puts strain on these muscles, so avoid it whenever you can. When you do need to lift something, tighten your pelvic floor muscles before and during the lift^[16].

Preventing urinary incontinence

It’s not always possible to prevent urinary incontinence, but there are some steps you can take that may help reduce the chance of it happening^[3][21]:

• Maintaining a healthy weight through regular exercise and healthy eating
• Changing your drinking habits, including cutting down on alcohol and caffeine
• Doing pelvic floor muscle exercises regularly
• Avoiding constipation by drinking enough fluids and eating enough fiber
• Not smoking
• Developing good toilet habits, such as not ignoring the urge to go

Living with urinary incontinence

Urinary incontinence can directly affect your ability to socialize and can cause you to avoid people for fear of embarrassment if an accident happens^[19]. However, many products and strategies can make urinary incontinence more manageable from day to day^[17].

Containment products

Adult incontinence pads and incontinence underwear are widely available at pharmacies, grocery stores, and general merchandise stores. They use a wetness-protection layer to draw urine away from skin. Some have elastic around the waist and legs and are pulled on like clothing, while others have tabs to make them easy to secure or remove quickly. They come in different absorbencies and are disposable^[17].

External urine collection devices draw urine away from the body and into a collection container via a flexible tube. For men, one option is a condom-like device worn over the penis. Women’s devices may be held around the opening to the urethra with adhesive or suction. These devices keep urine away from skin, which can reduce infections, and eliminate the need to get up at night to urinate^[17].

Managing odor

Drinking enough water helps dilute your urine and reduce odor. Changing incontinence products promptly and maintaining good personal hygiene can also help manage odor^[17].

If you’re dealing with issues from incontinence, don’t hesitate to see your doctor or talk to a continence professional. For most people, simple lifestyle and dietary changes or medical care can treat symptoms of urinary incontinence^[1]. Treatments are available to help you manage it, and incontinence doesn’t have to disrupt your life or keep you from being active^[2].