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Urinary incontinence

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary; Overactive bladder

Urinary (or bladder) incontinence occurs 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 -- occurs as a result of a strong, sudden need to urinate immediately. 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 does not empty and the volume of urine exceeds its capacity. This leads to dribbling.

Mixed incontinence occurs when you have both stress and urge 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?

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

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Which type of incontinence is caused by weak pelvic muscles?

     

    A. Stress incontinence

     

    B. Urge incontinence

    Correct Answer
    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.
  • Urge incontinence is the sudden, strong need to urinate.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Incontinence never gets better without treatment.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Losing weight can help reduce stress incontinence.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Drinking less water helps relieve urge incontinence.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Spicy foods can cause incontinence.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Incontinence can irritate your skin.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Medicine is the best treatment for urge incontinence.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Training the pelvic floor muscles can help stress incontinence.

     

    A. True

     

    B. False

    Correct Answer
    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.
  • Overflow incontinence is most common in men.

     

    A. True

     

    B. False

    Correct Answer
    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.

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
  • Weakness of the pelvic or urethral muscles
  • Enlarged prostate
  • Diabetes
  • Use of certain medicines

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 -- such as when you are recovering from surgery
  • Certain medicines (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 disease.
  • Bladder cancer.
  • Bladder spasms.
  • 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 several 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 that 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 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)
  • The severity of your symptoms
  • 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.

Bladder nerve stimulation. Urge incontinence and urinary frequency can sometimes be treated by electrical nerve stimulation. Pulses of electricity are used to reprogram bladder reflexes. In one technique, the provider inserts a stimulator through the skin near a nerve in the leg. This is done weekly in the provider's office. Another method uses battery-operated implanted device similar to a pacemaker that is placed under the skin in the lower back.

Botox injections. Urge incontinence can sometimes be treated with an injection of onabotulinum A toxin (also known as Botox). The injection relaxes the bladder muscle and increases the storage capacity of the bladder. The injection is delivered through a thin tube with a camera on the end (cystoscope). In most cases, the procedure can be done in the provider's office.

When to Contact a Medical Professional

Talk to your provider about incontinence. Providers who treat incontinence are gynecologists and urologists that specialize in this problem. 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 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

Kirby AC, Lentz GM. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 21.

Newman DK, Burgio KL. Conservative management of urinary incontinence: behavioral and pelvic floor therapy and urethral and pelvic devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 80.

Resnick NM. Incontinence. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 26.

Reynolds WS, Dmochowski R, Karram MM. Surgical management of detrusor compliance abnormalities. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2016:chap 93.

Vasavada SP, Rackley RR. Electrical stimulation and neuromodulation in storage and emptying failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 81.

  • Benign prostate hyperplasia (BPH) cause and symptoms

    Benign prostate hyperplasia (BPH) cause and symptoms

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    Benign prostate hyperplasia (BPH) cause and symptoms - Animation

    Learn about the cause, symptoms and treatment of benign prostatic hyperplasia (BPH).

  • Bladder function - neurological control

    Animation

  •  

    Bladder function - neurological control - Animation

    This animation shows the neurological control of normal bladder function.

  • Urinary incontinence

    Animation

  •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Female urinary tract

    Female urinary tract - illustration

    The female and male urinary tracts are relatively the same except for the length of the urethra.

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract - illustration

    The male and female urinary tracts are relatively the same except for the length of the urethra.

    Male urinary tract

    illustration

  • Benign prostate hyperplasia (BPH) cause and symptoms

    Animation

  •  

    Benign prostate hyperplasia (BPH) cause and symptoms - Animation

    Learn about the cause, symptoms and treatment of benign prostatic hyperplasia (BPH).

  • Bladder function - neurological control

    Animation

  •  

    Bladder function - neurological control - Animation

    This animation shows the neurological control of normal bladder function.

  • Urinary incontinence

    Animation

  •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Female urinary tract

    Female urinary tract - illustration

    The female and male urinary tracts are relatively the same except for the length of the urethra.

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract - illustration

    The male and female urinary tracts are relatively the same except for the length of the urethra.

    Male urinary tract

    illustration

A Closer Look

 

Talking to your MD

 

Self Care

 

 

Review Date: 10/10/2018

Reviewed By: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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