Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. Bladder control problems are very common, especially among older adults. They usually don't cause major health problems, but they can be embarrassing.
Incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation. It gets better when you treat the problem that is causing it. But this topic focuses on ongoing urinary incontinence.
There are two main kinds of urinary incontinence. Some women—especially older women—have both.
Bladder control problems may be caused by:
Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles can't support your bladder properly, the bladder drops down and pushes against the vagina. You can't tighten the muscles that close off the urethra. So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.
Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or stroke. Many times doctors don't know what causes it.
The main symptom is the accidental release of urine.
Your doctor will ask about what and how much you drink. He or she will also ask how often and how much you urinate and leak. It may help to keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.
Your doctor will examine you and may do some simple tests to look for the cause of your bladder control problem. If your doctor thinks it may be caused by more than one problem, you will likely have more tests.
Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. After your doctor knows what has caused the incontinence, your treatment may include exercises, bladder training, medicines, a pessary, or a combination of these. Some women may need surgery.
There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.
If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people can be helped or cured.
Strengthening your pelvic muscles with Kegel exercises may lower your risk for incontinence.
If you smoke, try to quit. Quitting may make you cough less, which may help with incontinence.
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When these muscles can't support your bladder well, the bladder drops down and pushes against the vagina. Then you can't tighten the muscles that usually close off the urethra. So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.
This is the most common type of urinary incontinence in women.
A chronic cough from smoking can make stress incontinence worse.
Urge incontinence is caused when the bladder muscle involuntarily contracts and pushes urine out of the bladder. Many times doctors don't know what causes this. But sometimes the cause is:
Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.
Less common types of urinary incontinence have other causes. These types include:
The main symptom of urinary incontinence is a problem controlling urination.
It is common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.
Urinary incontinence usually starts gradually and slowly becomes worse. As it gets worse, a woman may:
Treating the cause of incontinence often gets rid of or controls these problems.
Some bladder problems are temporary. For example, you may have a urinary tract infection that causes incontinence, but the problem goes away after the infection is cured.
Sometimes several things combine to cause urinary incontinence. For example, a woman may have had multiple childbirths, be older, and have a severe cough because of chronic bronchitis or smoking. All of these might contribute to her incontinence problem.
Physical conditions that make urinary incontinence more likely include:
Diseases and conditions that may cause urinary incontinence include:
Medicines and foods that may make urinary incontinence worse include:
Call your doctor if:
Don't be embarrassed to discuss the problem with your doctor. Urinary incontinence isn't an inevitable result of aging. In most cases, it can be helped or cured.
If you have urinary incontinence that develops slowly, you may be able to control the problem yourself. If home treatment doesn't help, or if incontinence interferes with your lifestyle, ask your doctor about other treatments.
To diagnose the cause of your urinary incontinence, your doctor will ask about your medical history and do a physical exam. It may be easier for you to answer questions if you keep a bladder diary for 3 or 4 days before you see your doctor.
To check for stress incontinence, your doctor may ask you to cough while you are standing.
Your doctor may also order these tests:
Urodynamic testing is expensive. It is typically done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function.
The actual tests done in urodynamic testing often vary. They may include:
If the cause of incontinence is not identified by the above tests, more extensive tests may be needed.
Urinary incontinence isn't an inevitable result of aging. Most women who have it can be helped or cured.
The best treatment depends on the cause of your incontinence and your personal preferences. Treatments include:
Behavioral training, exercises and lifestyle changes, and medicines are usually tried first. If the problem does not get better, your doctor may try another treatment or do more tests.
When there is more than one cause for incontinence, the most significant cause is treated first, followed by treatment for the secondary cause, if needed.
You may reduce your chances for urinary incontinence by:
If you have urinary incontinence, you can take some steps on your own that may stop or reduce the problem.
Pelvic floor (Kegel) exercises can help women who have any type of urinary incontinence.footnote 1 These exercises are especially useful for stress incontinence. But they may also help urge incontinence.
Losing weight often helps stress incontinence. Remember that effective weight-loss programs depend on a combination of diet and exercise.
Sometimes making lifestyle changes can help with urge incontinence. Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, dairy products, aspartame, and spicy foods—and cut back on them. Also, avoid alcohol and caffeine.
If you smoke, try to quit. This may reduce coughing, which may reduce your problem with incontinence. For more information, see the topic Quitting Smoking.
Take steps to avoid constipation:
Not all forms of urinary incontinence are treated with medicines. In many cases, treatment with behavioral methods (bladder training, timed urination) and Kegel exercises are tried before medicines. These treatments, when combined with medicine, may help some women more than either treatment alone.
Medicines used to treat urge incontinence in women may include:
There are several different kinds of surgeries to correct stress incontinence, which occurs when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra, the bladder, or both into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.
If other treatments (like pelvic floor muscle exercises) haven't worked to control your incontinence, surgery may be your best option. What kind of surgery you have depends on your preference, your health, and your doctor's experience.
Mixed incontinence means you have both stress incontinence and urge incontinence. Surgery may help women who have mixed incontinence. If surgery works to reduce the stress symptoms, often the urge symptoms cause less bother.
Other types of treatment for urinary incontinence include:
Before trying behavioral methods or exercise for urinary incontinence, ask your doctor the following questions:
- Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).
- Emmons SL, Otto L (2005). Acupuncture for overactive bladder. Obstetrics and Gynecology, 106(1): 138–143.
Other Works Consulted
- Barber MD, et al. (2008). Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence. Obstetrics and Gynecology, 111(3): 611–621.
- Garley AD, Noor N (2014). Diagnosis and surgical treatment of stress urinary incontinence. Obstetrics and Gynecology, 124(5): 1011–1027. DOI: 10.1097/AOG.0000000000000514. Accessed August 17, 2015.
- Hartmann KE, et al. (2009). Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187 (AHRQ Publication No. 09-E017). Available online: http://www.ahrq.gov/clinic/tp/bladdertp.htm.
- Kirchin V, et al. (2012). Urethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews (2).
- Naumann M, et al. (2008). Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1707–1714.
- Shamliyan TA, et al. (2008). Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine, 148(6): 1–15.
- Sung VW, et al. (2007). Comparison of retropubic vs transobturator approach to midurethral slings: A systematic review. American Journal of Obstetrics and Gynecology, 197(1): 3–11.
- Tanagho EA, et al. (2008). Urinary incontinence. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 473–489. New York: McGraw-Hill Medical.
- Waetjen LE, et al. (2008). Factors associated with worsening and improving urinary incontinence across the menopausal transition. Obstetrics and Gynecology, 111(3): 667–677.
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