Incontinence

Urinary (or bladder) incontinence is the involuntary loss of bladder control and 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. 

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

Symptoms include:

  • Cloudy or bloody urine
  • Dribbling
  • Frequent or urgent need to urinate
  • Pain or burning when you urinate
  • Trouble starting your urine flow
  • Fever

Your doctor will give you a physical exam and take your medical history. He or she will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests.

These might include:

  • Urine and blood tests
  • Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to an urologist, a doctor who specializes in urinary tract problems.

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.