Definition

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.

Causes

Incontinence has several different causes. The cause could also be unclear. Temporary incontinence can be caused by:

• Medication
• Constipation
• Infection
• Muscle weakness
• Restricted mobility
• Obesity
• Endocrinological disorders such as diabetes

Muscles Involved in Incontinence in Women

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Stress incontinence may be caused by:

• Weakening of muscles that suspend the bladder
• Weakening of muscles that control urine flow
• Obesity

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
• Caffeine
• Alcohol
• Nerve damage due to:
  • Spinal cord injury
  • Stroke
  • Multiple sclerosis
  • Parkinson disease
• Constipation
• 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:
  • Surgery
  • Diabetes
  • 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.

Risk Factors

Urinary incontinence is more common in women age 65 years or older. Things that may increase your chances of urinary incontinence are:

• Childbirth—History of multiple pregnancies or vaginal deliveries
• Urinary tract infection
• Obesity
• Chronic lung disease
• Urethritis
• Previous hysterectomy or urethral surgery
• Pelvic organ prolapse
• Depression
• Dementia, including Alzheimer disease
• Menopause
• Diabetes
• Stroke
• 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

Symptoms

Any loss of bladder control can be considered incontinence.

Diagnosis

The doctor will ask about symptoms and past health. They will ask how often you empty your bladder and patterns of urine leakage. A physical exam will be done to look for any physical causes. A urologist may be recommended.

The flow of urine can be tested with:

• Stress test
• Urodynamic tests

Images of the urinary tract may be taken with:

• Ultrasound
• Cystoscopy

Treatment

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 lower episodes of stress or urge incontinence in those who are overweight or obese.

Prevention

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.