Urinary Incontinence

Overview

What is urinary incontinence?

Urinary incontinence is the loss of bladder control. This means that you can’t always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control. This can be embarrassing, but talk to your doctor about it. It can be treated.

Millions of adults in the United States have urinary incontinence. It’s most common in people older than 50 years of age, especially women. But it can also affect younger people, especially women who have just given birth.

Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.

Symptoms

Are there different types of incontinence?

Yes. There are 5 types of urinary incontinence. A brief explanation of each follows.

Stress incontinence

Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women.

Urge incontinence

This occurs when the need to urinate comes on very suddenly, often before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of a urinary tract infection or an overactive bladder.

Overflow incontinence

This type of incontinence is the uncontrollable leakage of small amounts of urine. It’s caused by an overfilled bladder. You may feel like you can’t empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause the problem.

Functional incontinence

This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.

Mixed incontinence

This type involves more than one of the types of incontinence listed above.

Causes & Risk Factors

Is urinary incontinence just part of growing older?

No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesn’t mean you’ll have urinary incontinence just because you’re aging. With treatment, it can be controlled or cured.

What causes incontinence?

Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. See the box below for a list of common causes.

Treatment

How can it be treated?

Treatment depends on what’s causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence through strengthening the pelvic muscles. Medicine and surgery are other options.

What are Kegel exercises?

Stress incontinence can be treated with special exercises, called Kegel exercises (see the box below). These exercises help strengthen the muscles that control the bladder. They can be done anywhere, any time. Although designed for women, the Kegel exercises can also help men. It may take 3 to 6 months to see an improvement.

What is bladder training?

Bladder training is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence or a combination of the 2 types (mixed incontinence). Some bladder training techniques are explained in “Bladder Training for Urinary Incontinence”.

Will medicine or surgery help?

Medicine helps some types of urinary incontinence. For example, estrogen cream to put in the vagina can be helpful for some women who have mild stress incontinence. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine through the prostate. Talk to your doctor about possible medicine options for your type of incontinence.

Surgery can sometimes be helpful, especially in stress incontinence in women and in overflow incontinence in men due to an enlarged prostate. It is usually only performed if other treatments haven’t worked or if the incontinence is severe.

Causes of urinary incontinence

  • For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
  • For men, enlarged prostate gland or prostate surgery
  • Weakened and stretched pelvic muscles after childbirth
  • Certain medicines
  • Build-up of stool in the bowels
  • Overweight and obesity, which increase pressure on the bladder and muscles that control the bladder
  • Urinary tract infections
  • Vascular disease
  • Diseases such as diabetes, Alzheimer’s disease and multiple sclerosis

Kegel exercises

  • To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you’re able to slow or stop the stream of urine, you’ve located the right muscles.
  • Squeeze your muscles. Hold for a count of 10. Relax for a count of 10.
  • Repeat this 10 to 20 times, 3 times a day.
  • You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day. Work your way up from there.

Bladder Training for Urinary Incontinence

What is bladder training?

Bladder training is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence or a combination of the 2 types (mixed incontinence). Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Urge incontinence is when the need to urinate comes on so fast that you can’t get to a toilet in time. Some bladder training techniques are explained below.

How can bladder training help?

Bladder training can help in the following ways:

  • Lengthen the amount of time between bathroom trips.
  • Increase the amount of urine your bladder can hold.
  • Improve your control over the urge to urinate.

Where do I start?

Ask your doctor about starting a bladder training program. He or she may ask you to keep a diary to record how much and how often you urinate. This information will help your doctor create a plan that’s right for you.

Three bladder training methods are listed below. Your doctor may recommend 1 or more of these methods to help control your incontinence.

Keep in mind that bladder training can take 3 to 12 weeks. During your training program, your doctor may have you keep track of the number of urine leaks you have each day. This will help you and your doctor see if bladder training is helping. Don’t be discouraged if you don’t have immediate results or if you still experience some incontinence.

  • Kegel exercises: These are exercises that help strengthen the muscles you use to stop the flow of urine. For more information, see “Kegel Exercises for Your Pelvic Muscles.”
  • Delay urination: Some people who have urge incontinence can learn to put off urination when they feel the urge. You start by trying to hold your urine for 5 minutes every time you feel an urge to urinate. When it’s easy to wait 5 minutes, you try to increase the time to 10 minutes until you’re urinating every 3 to 4 hours. When you feel the urge to urinate before your time is up, you can try relaxation techniques. Breathe slowly and deeply. Concentrate on your breathing until the urge goes away. Kegel exercises may also help control urges.
  • Scheduled bathroom trips: Some people control their incontinence by going to the bathroom on a schedule. This means that you go to the bathroom at set times, whether you feel the urge or not. For example, you might start by going to the bathroom every hour. Then gradually you increase the time until you find a schedule that works for you.

What else can I do?

You may find it helpful to make some changes in your diet. Alcohol, caffeine, foods high in acid (such as tomato or grapefruit) and spicy foods can irritate your bladder. Talk to your doctor if you think your diet may contribute to your incontinence.

Some people find that limiting how much they drink before bedtime helps reduce nighttime incontinence.

Losing weight if you are overweight can also help reduce incontinence.

Are there other ways to treat incontinence?

Yes. Medicines or medical devices can treat some types of urinary incontinence. In some cases, surgery may be an option. Treatment depends on what type of urinary incontinence you have and what is causing it.

Questions to Ask Your Doctor

  • What type of urinary incontinence do I have?
  • What is the likely cause of my urinary incontinence? Can this condition be treated?
  • If so, will treating the condition cure my urinary incontinence? When can I expect relief from my symptoms?
  • Should I start doing Kegel exercises? How often?
  • Would a bladder training program help manage my urinary incontinence?
  • Will any lifestyle changes help manage my urinary incontinence?
  • I’m embarrassed by my urinary incontinence. Until my symptoms improve, what else can I do to help manage my condition?