Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. 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.
Though it occurs more often as people get older, urinary incontinence isn’t an inevitable consequence of aging. If urinary incontinence affects your daily activities, don’t hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.
Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.
Types of urinary incontinence include:
- Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
- Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
- Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.
- Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
- Mixed incontinence. You experience more than one type of urinary incontinence.
Female urinary system
Female urinary system
Male urinary system
Urinary incontinence isn’t a disease, it’s a symptom. It can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what’s behind your incontinence.
Temporary urinary incontinence
Certain drinks, foods and medications may act as diuretics — stimulating your bladder and increasing your volume of urine. They include:
- Carbonated drinks and sparkling water
- Artificial sweeteners
- Chili peppers
- Foods that are high in spice, sugar or acid, especially citrus fruits
- Heart and blood pressure medications, sedatives, and muscle relaxants
- Large doses of vitamin C
Urinary incontinence may also be caused by an easily treatable medical condition, such as:
- Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate, and sometimes incontinence.
- Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.
Persistent urinary incontinence
Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:
- Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
- Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions can be associated with incontinence.
- Changes with age. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
- Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
- Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman’s reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
- Enlarged prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
- Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of treatments for prostate cancer.
- Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stone-like masses that form in the bladder — sometimes cause urine leakage.
- Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
Factors that increase your risk of developing urinary incontinence include:
- Gender. Women are more likely to have stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy account for this difference. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.
- Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release.
- Being overweight. Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
- Smoking. Tobacco use may increase your risk of urinary incontinence.
- Family history. If a close family member has urinary incontinence, especially urge incontinence, your risk of developing the condition is higher.
- Other diseases. Neurological disease or diabetes may increase your risk of incontinence.
Complications of chronic urinary incontinence include:
- Skin problems. Rashes, skin infections and sores can develop from constantly wet skin.
- Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.
- Impacts on your personal life. Urinary incontinence can affect your social, work and personal relationships.
Urinary incontinence isn’t always preventable. However, to help decrease your risk:
- Maintain a healthy weight
- Practice pelvic floor exercises
- Avoid bladder irritants, such as caffeine, alcohol and acidic foods
- Eat more fiber, which can prevent constipation, a cause of urinary incontinence
- Don’t smoke, or seek help to quit smoking
It’s important to determine the type of urinary incontinence that you have, and your symptoms often tell your doctor which type you have. That information will guide treatment decisions.
Your doctor is likely to start with a thorough history and physical exam. You may then be asked to do a simple maneuver that can demonstrate incontinence, such as coughing.
After that, your doctor will likely recommend:
- Urinalysis. A sample of your urine is checked for signs of infection, traces of blood or other abnormalities.
- Bladder diary. For several days you record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.
- Post-void residual measurement. You’re asked to urinate (void) 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 in your bladder may mean that you have an obstruction in your urinary tract 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 and pelvic ultrasound. These tests are usually done if you’re considering surgery.
Bladder neck suspension
If other treatments aren’t working, several surgical procedures can treat the problems that cause urinary incontinence:
- Sling procedures. Strips of your body’s tissue, synthetic material or mesh are used to create a pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress incontinence.
- Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it’s done during general or spinal anesthesia.
- Prolapse surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may include a combination of a sling procedure and prolapse surgery.
- Artificial urinary sphincter. In men, a small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter shut until you’re ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to flow.