Urinary incontinence

  • Definition
    • Urinary (or bladder) incontinence happens when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries urine out of your body from your bladder. You may leak urine from time to time. Or, you may not be able to hold any urine.

      The three main types of urinary incontinence are:

      • Stress incontinence -- occurs during activities like coughing, sneezing, laughing, or exercise.
      • Urge incontinence -- involves a strong, sudden need to urinate. Then the bladder squeezes and you lose urine. You don't have enough time after you feel the need to urinate to get to the bathroom before you do urinate.
      • Overflow incontinence -- occurs when the bladder cannot empty. This leads to dribbling.

      Mixed incontinence occurs when you have more than one type of urinary incontinence.

      Bowel incontinence is when you are unable to control the passage of stool. It is not covered in this article.

      How Much Do You Know About Urinary Incontinence?

      1. Women are more likely to have urinary incontinence than men.

        1. A. True
        2. B. False

        The correct answer is true. Urinary incontinence is more common in older women, though anyone can have it. It happens when you can't control your bladder and urine leaks out. See your doctor if you have any trouble controlling your urine.

      2. Which type of incontinence is caused by weak pelvic muscles?

        1. A. Stress incontinence
        2. B. Urge incontinence

        The correct answer is stress incontinence. When these muscles are weak, they can't prevent urine from flowing out when there's pressure on your abdomen. This is why stress incontinence happens during activities like sneezing, laughing, coughing, and exercise.

      3. Urge incontinence is the sudden, strong need to urinate.

        1. A. True
        2. B. False

        The correct answer is true. Urge incontinence happens because the bladder muscles squeeze at the wrong time. You may not have enough time to get to the bathroom before you urinate. If this ever happens to you, see your doctor.

      4. Incontinence never gets better without treatment.

        1. A. True
        2. B. False

        The correct answer is false. Sometimes incontinence clears up on its own. Sometimes this happens when it's caused by weight gain, urinary tract infection, medicines, pregnancy, or prostate infection. Ask your doctor for help if your incontinence doesn't go away.

      5. Losing weight can help reduce stress incontinence.

        1. A. True
        2. B. False

        The correct answer is true. Other changes can also help. These may include drinking less fluid, quitting smoking, avoiding alcohol and caffeine, and avoiding jumping and running. Work with your doctor to find changes that help you.

      6. Drinking less water helps relieve urge incontinence.

        1. A. True
        2. B. False

        The correct answer is false. When you have urge incontinence, drinking more water can help reduce leakage and may lessen odor. It helps to drink small amounts of water during the day, no more than eight ounces at one time. Stop drinking two hours before bedtime.

      7. Spicy foods can cause incontinence.

        1. A. True
        2. B. False

        The correct answer is true. Spicy foods can irritate your bladder and cause incontinence. Other foods you may want to avoid include carbonated drinks, caffeine, alcohol, and citrus fruits and juices.

      8. Incontinence can irritate your skin.

        1. A. True
        2. B. False

        The correct answer is true. The skin around your urethra may get irritated if it's often exposed to urine. To prevent skin irritation, clean the area right after you urinate. Ask your doctor about special skin cleansers that will not dry out your skin or other ways to protect your skin.

      9. Medicine is the best treatment for urge incontinence.

        1. A. True
        2. B. False

        The correct answer is false. There are many treatments for urge incontinence, including bladder retraining and surgery. Which one works best for you depends on your symptoms and how much they affect your daily life. Talk to your doctor to find the best treatment for you.

      10. Training the pelvic floor muscles can help stress incontinence.

        1. A. True
        2. B. False

        The correct answer is true. Stress incontinence happens when the pelvic muscles are weak. This can happen from childbirth, injury, or surgery. Exercising these muscles can help control urine leakage. Ask your doctor about exercises to try.

      11. Overflow incontinence is most common in men.

        1. A. True
        2. B. False

        The correct answer is true. Overflow incontinence occurs when the bladder can't empty fully. It's often caused by an enlarged prostate. The most common symptoms are urine dribbling, frequent urination, and a sensation that your bladder does not empty fully. Talk to your doctor if you have these symptoms.

  • Alternative Names
    • Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

  • Causes
    • Causes of urinary incontinence include:

      • Blockage in the urinary system
      • Brain or nerve problems
      • Dementia or other mental health problems that make it hard to feel and respond to the urge to urinate
      • Problems with the urinary system
      • Nerve and muscle problems

      Incontinence may be sudden and go away after a short period of time. Or, it may continue long-term. Causes of sudden or temporary incontinence include:

      • Bedrest -- for example, when recovering from surgery
      • Certain medications (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines)
      • Mental confusion
      • Pregnancy
      • Prostate infection or inflammation
      • Stool impaction from severe constipation, which causes pressure on the bladder
      • Urinary tract infection or inflammation
      • Weight gain

      Causes that may be more long-term:

      • Alzheimer's disease
      • Bladder cancer
      • Bladder spasms
      • Depression
      • Large prostate in men
      • Nervous system conditions, such as multiple sclerosis or stroke
      • Nerve or muscle damage after radiation treatment to the pelvis
      • Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vagina. This may be caused by pregnancy and delivery.
      • Problems with the urinary tract
      • Spinal cord injuries
      • Weakness of the sphincter, the circle-shaped muscles that open and close the bladder. This can be caused by prostate surgery in men, or surgery to the vagina in women.
  • Home Care
    • If you have symptoms of incontinence, see your health care provider for tests and a treatment plan. Which treatment you get depends on what caused your incontinence and what type you have.

      There are four main treatment approaches for urinary incontinence:

      Lifestyle changes. These changes may help improve incontinence. You may need to make these changes along with other treatments.

      • Keep your bowel movements regular to avoid constipation. Try increasing the fiber in your diet.
      • Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
      • Avoid alcohol and caffeinated drinks such as coffee, which can stimulate your bladder.
      • Lose weight if you need to.
      • Avoid foods and drinks that may irritate your bladder. These include spicy foods, carbonated drinks, and citrus fruits and juices.
      • If you have diabetes, keep your blood sugar under good control.

      For urine leaks, wear absorbent pads or undergarments. There are many well-designed products no one else will notice.

      Bladder training and pelvic floor exercises. Bladder retraining helps you gain better control over your bladder. Kegel exercises can help strengthen the muscles of your pelvic floor. Your provider can show you how to do them. Many women do not do these exercises correctly, even if they believe they are doing them correctly. Often, people benefit from formal bladder strengthening and retraining with a pelvic floor specialist.

      Medicines. Depending on the type of incontinence you have, your health care provider may prescribe one or more medicines. These drugs help prevent muscle spasms, relax the bladder, and improve bladder function. Your provider can help you learn how to take these medicines and manage their side effects.

      Surgery. If other treatments do not work, or you have severe incontinence, your provider may recommend surgery. The type of surgery you have will depend on:

      • The type of incontinence you have (such as urge, stress, or overflow)
      • How severe your symptoms are
      • The cause (such as pelvic prolapse, enlarged prostate, enlarged uterus, or other causes)

      If you have overflow incontinence or you cannot fully empty your bladder, you may need to use a catheter. You may use a catheter that stays in long term, or one that you are taught to put in and take out yourself.

  • When to Contact a Medical Professional
    • Talk to your health care provider about incontinence. Health care providers who treat incontinence are called gynecologists and urologists. They can find the cause and recommend treatments.

      Call your local emergency number (such as 911) or go to an emergency room if you suddenly lose control over urine and you have:

      • Difficulty talking, walking, or speaking
      • Sudden weakness, numbness, or tingling in an arm or leg
      • Loss of vision
      • Loss of consciousness or confusion
      • Loss of bowel control

      Call your health care provider if you have:

      • Cloudy or bloody urine
      • Dribbling
      • Frequent or urgent need to urinate
      • Pain or burning when you urinate
      • Trouble starting your urine flow
      • Fever
  • References
    • Deng DY. Urinary incontinence in women. Med Clin North Am. 2011;95:101-9. PMID: 21095414

      Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 3.

      Resnick NM. Incontinence. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 25.