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Urinary Incontinence

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

What are the types of urinary incontinence (UI)?

There are several different types of UI. Each type has different symptoms and causes:

  • Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
  • Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
  • Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
  • Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
  • Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
  • Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
  • Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
    • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
    • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.
Who is at risk for urinary incontinence (UI)?

In adults, you are at higher risk of developing UI if you

  • Are female, especially after going through pregnancy, childbirth, and/or menopause
  • Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
  • Are a man with prostate problems
  • Have certain health problems, such as diabetes, obesity, or long-lasting constipation
  • Are a smoker
  • Have 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.

How is urinary incontinence (UI) diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
  • A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
  • Urine and/or blood tests
  • Bladder function tests
  • Imaging tests
What are the treatments for urinary incontinence (UI)?

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including

  • Lifestyle changes to reduce leaks:
    • Drinking the right amount of liquid at the right time
    • Being physically active
    • Staying at a healthy weigh
    • Avoiding constipation
    • Not smoking
  • Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
  • Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as

  • Medicines, which can be used to
    • Relax the bladder muscles, to help prevent bladder spasms
    • Block nerve signals that cause urinary frequency and urgency
    • In men, shrink the prostate and improve urine flow
  • Medical devices, including
    • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
    • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
  • Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
  • Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
  • Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Pelvic Floor Disorders

The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. In women, it holds the uterus, bladder, bowel, and other pelvic organs in place so that they can work properly. The pelvic floor can become weak or be injured. The main causes are pregnancy and childbirth. Other causes include being overweight, radiation treatment, surgery, and getting older.

Common symptoms include

  • Feeling heaviness, fullness, pulling, or aching in the vagina. It gets worse by the end of the day or during a bowel movement.
  • Seeing or feeling a "bulge" or "something coming out" of the vagina
  • Having a hard time starting to urinate or emptying the bladder completely
  • Having frequent urinary tract infections
  • Leaking urine when you cough, laugh, or exercise
  • Feeling an urgent or frequent need to urinate
  • Feeling pain while urinating
  • Leaking stool or having a hard time controlling gas
  • Being constipated
  • Having a hard time making it to the bathroom in time

Your health care provider diagnoses the problem with a physical exam, a pelvic exam, or special tests. Treatments include special pelvic muscle exercises called Kegel exercises. A mechanical support device called a pessary helps some women. Surgery and medicines are other treatments.

NIH: National Institute of Child Health and Human Development

Bladder Diseases

The bladder is a hollow organ in your lower abdomen that stores urine. Many conditions can affect your bladder. Some common ones are

  • Cystitis - inflammation of the bladder, often from an infection
  • Urinary incontinence - loss of bladder control
  • Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time
  • Interstitial cystitis - a chronic problem that causes bladder pain and frequent, urgent urination
  • Bladder cancer

Doctors diagnose bladder diseases using different tests. These include urine tests, x-rays, and an examination of the bladder wall with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Overactive Bladder

Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:

  • You urinate eight or more times a day or two or more times at night
  • You have the sudden, strong need to urinate immediately
  • You leak urine after a sudden, strong urge to urinate

You also may have incontinence, a loss of bladder control. Nerve problems, too much fluid, or too much caffeine can cause it. Often the cause is unknown.

Your doctor may prescribe a medicine that can calm muscles and nerves. The medicine may come as a pill, a liquid, or a patch. The medicines can cause your eyes to become dry. They can also cause dry mouth and constipation. To deal with these effects, use eye drops to keep your eyes moist, chew sugarless gum or suck on sugarless hard candy if dry mouth bothers you, and take small sips of water throughout the day.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Urine and Urination

Your kidneys make urine by filtering wastes and extra water from your blood. The waste is called urea. Your blood carries it to the kidneys. From the kidneys, urine travels down two thin tubes called ureters to the bladder. The bladder stores urine until you are ready to urinate. It swells into a round shape when it is full and gets smaller when empty. If your urinary system is healthy, your bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours.

You may have problems with urination if you have

  • Kidney failure
  • Urinary tract infections
  • An enlarged prostate
  • Bladder control problems like incontinence, overactive bladder, or interstitial cystitis
  • A blockage that prevents you from emptying your bladder

Some conditions may also cause you to have blood or protein in your urine. If you have a urinary problem, see your health care provider. Urinalysis and other urine tests can help to diagnose the problem. Treatment depends on the cause.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases