(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)
Urinary incontinence is the loss of voluntary bladder control that can cause leakage of urine. It can be temporary or last for a long time.
There are four types of long-term or permanent incontinence:
- Stress incontinence—Most common type. Leakage occurs when there is extra pressure on the bladder. Triggers may include laughing, sneezing, lifting heavy objects, or exercise.
- Urge incontinence—Known as overactive bladder, a loss of bladder control following a strong urge to urinate. The bladder is unable to hold urine long enough to make it to a restroom.
- Overflow incontinence—The bladder will not empty, so urine builds up and the bladder overflows.
- Functional incontinence—There is normal bladder control, but the toilet cannot be reached in time.
People may have just one or a combination of these types.
Incontinence has several different causes. The cause could also be unclear.
Temporary incontinence can be caused by:
- Muscle weakness
- Restricted mobility
- Endocrinological disorders such as diabetes
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Stress incontinence may be caused by:
- Weakening of muscles that suspend the bladder
- Weakening of muscles that control urine flow
Urge incontinence is the accidental loss of urine when the bladder spasms for no reason. It may be caused or worsened by:
- Urinary tract infection
- Diabetes type 1 and type 2
- Bladder irritation such as a stone or a tumor
- Drugs such as hypnotics or diuretics
- Nerve damage due to:
- Excessive fluid intake
Overflow incontinence is caused by overfill and overflow of the bladder. It may be caused or worsened by:
- A bladder that is blocked, such as by a scar in the urethra
- Fecal impaction
- Drugs such as antidepressants, hypnotics, antipsychotics, antihistamines, or calcium channel blockers
- Vitamin B12 deficiency
- Weak bladder muscles
Nerve damage due to:
- Spinal cord injuries
- Other factors
Functional incontinence may be caused by:
- Medical conditions that make it difficult to move like severe arthritis
- Drugs that cause confusion or sedation
Some incontinence may be caused by a fistula. A fistula is an abnormal opening between the bladder and another nearby structure. The fistula can make it difficult for the bladder to act as it should.
Urinary incontinence is more common in women age 65 years or older.
Factors that may increase your chances of urinary incontinence:
- Childbirth—History of multiple pregnancies or vaginal deliveries
- Urinary tract infection
- Chronic lung disease
- Previous hysterectomy or urethral surgery
- Pelvic organ prolapse
- Dementia, including Alzheimer disease
- Multiple sclerosis
- Spinal cord injury or disease
- Use of certain substances such as caffeine or alcohol
- Use of certain medications, such as cholinergic agents or alpha-agonists
Any loss of bladder control can be considered incontinence.
When Should I Call My Doctor?
Call your doctor if you have a loss of urine control. Your doctor can help you determine the underlying cause.
You will be asked about your symptoms and medical history. You will be asked how often you empty your bladder and patterns of urine leakage. A physical exam will be done to look for any physical causes, such as blockages or nerve problems. You may be referred to a specialist.
Your bodily fluids will be tested. This can be done with:
- Blood tests
- Urine tests
The flow of your urine will be assessed. This can be done with:
- Stress test
- Urodynamic tests
Your bodily structures may need to be viewed. This can be done with:
Treatments are based on the cause of the urinary incontinence.
Temporary incontinence may be relieved by managing the conditions associated with the incontinence.
Weight loss may help reduce the number of episodes due to stress or urge incontinence in people who are overweight or obese. Talk to your doctor about a weight loss program that is right for you.
Initial treatment relies on behavior changes and strengthening pelvic floor muscles. Behavior changes include:
- Decreasing caffeine—caffeine has been linked to worsening of urinary incontinence
- Planning frequent bathroom trips throughout the day to prevent accidents
Methods to increase strength in the pelvic floor muscles include:
- Kegel exercises —focuses on muscles that hold the bladder in place and those that control urine flow
- Painless electrical stimulation—may strengthen the muscles more quickly; helpful for stress incontinence
- Pelvic floor exercises using cone-shaped weights that are placed in the vagina
- Biofeedback—a device signals how strong you are at contracting your muscles during exercise
Surgical procedures may be done for incontinence that is not responding to these treatments. Surgical options include:
- Placement of strips of material or sutures to support structures in the area and relieve pressure on the urethra. There are several different types of surgery, but a common option, called a urethral suspension, uses mesh to help support the urethra.
- Collagen injection into the wall of the urethra. This substance bulks up the wall of the urethra to help stop leaks.
Initial treatment depends on behavior changes and strengthening pelvic floor muscles. Behavior changes include:
- Drinking less fluid throughout the day
- Avoiding caffeine and alcohol
- Avoiding drinking at bedtime
- Keeping a log of your urination schedule and accidents.
Kegel exercises can help strengthen pelvic floor muscles and relieve some symptoms.
Medications may be recommended. Anticholinergics are the most common medication. They can relax the muscles of the bladder. Other medications may be used in combination to help manage symptoms, such as botulinum toxin injections.
Nerve stimulation may be used if urge incontinence does not respond to behavior modification or medication. A device will send pulses to the nerves that control the bladder. This has been shown to help stimulate bladder control. In some cases, the device is implanted in the back.
Treatment for overflow incontinence is to allow the bladder to completely empty. If a blockage is causing the problems, surgery may be needed to open the urine pathways.
Other causes of overflow incontinence may require the use of a tube called a catheter to allow urine to drain from the bladder. People can use certain catheters at home.
Other Management Steps
Absorbent pads or diapers can be used to manage urinary leakage. Plugs and patches can also be used to help hold urine in place.
A supportive device called a pessary may also be used. Pessaries are devices that raise the uterus or the prolapsed bladder. It can decrease pressure on the bladder.
Incontinence is a symptom of many other conditions. There are several ways to prevent incontinence:
- If advised by your doctor, do exercises to strengthen your pelvic floor muscles, such as Kegel exercises. This is especially important if you are pregnant.
- Reduce your intake of substances that lead to incontinence such as caffeine, alcohol, and certain drugs.
- Lose weight, if needed.
- Eat a healthy diet to avoid constipation.
National Institute of Diabetes and Digestive and Kidney Diseases
Urology Care Foundation
Women's Health Matters—Women's College Hospital
Bladder control problems in women (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women. Updated July 2016. Accessed December 19, 2017.
Overactive bladder (OAB). Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)?article=112. Updated March 2013. Accessed December 19, 2017.
Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence, and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dys Function. 2008;19(3):367-373.
Urinary incontinence. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/urinary-incontinence. Updated March 2013. Accessed December 19, 2017.
Urinary incontinence. Family Doctor—American Academy of Family Physicians. Available at: https://familydoctor.org/condition/urinary-incontinence. Updated April 2014. Accessed December 19, 2017.
Urinary incontinence in women. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women. Updated November 1, 2017. Accessed December 19, 2017.
Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175(3 pt 2):S5-S10.
2/5/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women: Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481-490.
3/5/2010 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women: Vardy MD, Mitcheson HD, Samuels TA, et al. Effects of solifenacin on overactive bladder symptoms, symptom bother and other patient-reported outcomes: results from VIBRANT—a double-blind, placebo-controlled trial. Int J Clin Pract. 2009;63(12):1702-1714.
12/3/2010 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women: Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK. Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.
3/5/2013 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women: Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471.
7/28/2014 DynaMed Plus Systematic Literature Surveillancehttps://www.dynamed.com/topics/dmp~AN~T116429/Interstitial-cystitis-Painful-bladder-syndrome: Mangera A, Apostolidis A, Andersson KE, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981-990.
4/25/2018 DynaMed Plus Systematic Literature Surveillancehttps://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women#anc-178706624: Wood LN, Markowitz MA, et al. Is it safe to reduce water intake in the overactive bladder population?: A systematic review. J Urol. 2018 Feb 27. pii: S0022-5347(18)42401-42409.
Last reviewed November 2018 by EBSCO Medical Review Board Adrienne Carmack, MD Last Updated: 4/25/2018