If you have bladder issues, you're not alone. Bladder issues are common, affecting millions of people every year.
Urinary incontinence is described as the inability to hold urine in the bladder voluntarily. Incontinence may be a minor issue for some people. But for others, it's a major problem affecting every aspect of their daily lives.
Often, embarrassment and shame prevent people from seeking care for urinary incontinence. But you don’t have to deal with incontinence or “just live with it.” Bladder issues, like many other health concerns, are easier to treat the earlier you detect the problem.
On this page:
What Is Urinary Incontinence?
Urinary incontinence (UI) is the inability to hold urine inside the bladder voluntarily or to prevent leakage or dribbling.
Urine is stored in the bladder until it is eliminated from the body through a tube called the urethra. Urine flow and leakage are normally controlled by sphincter muscles, which tighten and close around the neck of the bladder and urethra.
When urination begins, bladder muscles contract to squeeze urine out of the bladder, and sphincter muscles relax to allow the urine to pass. When urination is completed, the bladder relaxes and the sphincter contracts.
Embarrassment prevents many people from seeking treatment. However, incontinence is a common medical condition, and effective treatment is available in most cases.
What are the types of urinary incontinence?
There are a few different types of urinary incontinence, depending on their symptoms:
Bedwetting
This type of incontinence, also called nocturnal enuresis, can happen to people of any age. Drinking caffeine or alcohol before bed can cause nocturnal enuresis to worsen. Certain medications may also contribute to bedwetting. This type of incontinence is almost always treated with lifestyle habit changes.
Functional incontinence
Functional incontinence is when a physical limitation prevents someone from reaching the toilet in time. This could include someone in a wheelchair who needs physical help getting to the toilet, someone with arthritis or a dexterity disability who needs more time taking their pants off in time, or someone with a neurological condition like dementia who doesn’t realize they have to go to the toilet.
Mixed incontinence
Some people experience both stress incontinence and urgency incontinence symptoms.
Overflow incontinence
Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. When bladder nerves are damaged due to illness or injury, they may not recognize when the bladder is full.
Blockage or narrowing of the bladder outlet by cancer or scar tissue may prevent normal emptying of the bladder. Benign prostatic hyperplasia (an enlarged prostate) can also cause blockage. For this reason, overflow incontinence is more common in men than in women.
Reflex incontinence
Reflex incontinence happens when urine leaks without warning. Often called unaware or unconscious incontinence, it often happens when bladder nerves are injured and communication to the brain is cut off. The bladder contracts at the wrong time, which causes urine leaks.
Multiple sclerosis and trauma, such as spinal cord injury, can cause reflex incontinence.
Stress incontinence
Stress incontinence is the most common form of incontinence. It occurs when the internal sphincter muscles do not close completely around the bladder neck. Activities such as coughing, sneezing, laughing, or lifting heavy objects apply pressure to a full bladder and cause urine to leak.
Women are more prone to stress incontinence during pregnancy, childbirth, and menopause. Prostate surgery and radiation treatment are the primary causes of stress incontinence in men.
Temporary incontinence
This type of incontinence only lasts for a short period, either due to taking a certain medication or an illness, such as a urinary tract infection (UTI).
Urge incontinence
Urge incontinence occurs when an overactive bladder contracts involuntarily and causes urine to leak, sometimes in large amounts. Bladder or prostate infection, bladder cancer, or kidney stone disease can irritate the bladder lining and trigger overactivity.
Neurological conditions such as spinal cord injury, stroke, Parkinson's disease, or multiple sclerosis affect communication between the brain and bladder and cause the bladder to contract inappropriately.
How common is urinary incontinence?
UI affects an estimated 17 million Americans of all ages, although it is more common in women and older adults.
What causes urinary incontinence?
Bladder control is a complex process that involves the brain, spinal cord, and muscles of the bladder and pelvis. Loss of bladder control can be caused by many problems with any of these components.
Some causes of urinary incontinence include changes in muscles because of:
- Aging.
- Birth defects.
- Degenerative changes associated with aging such as difficulty walking and memory loss.
- Dementia.
- Injuries to the pelvic region or the spinal cord.
- Neurological diseases, such as multiple sclerosis and Parkinson’s disease.
- Pelvic surgery.
- Pregnancy and childbirth.
Urinary incontinence risk factors
Risk factors for having an uncontrollable bladder include:
- Bladder infection.
- Damage to pelvic floor muscles from childbirth.
- Diabetes.
- Menopause.
- Previous pregnancy or childbirth.
- Urinary tract infection, kidney infection, or kidney stone.
- Weak bladder muscles.
- Weight gain.
Complications of urinary incontinence
A leaky bladder may lead to:
- Decreased physical activity.
- Depression.
- Kidney issues.
- Sexual dysfunction.
- Social isolation.
- Urinary tract infections (UTIs).
How can I prevent urinary incontinence?
While you may not be able to completely prevent urinary incontinence, there are some lifestyle changes you can make today to avoid it, including:
Eat healthy
Eating a healthy diet while avoiding foods that are known to contribute to inflammation and bladder irritation can help prevent diabetes and obesity, which raise your risk of bladder incontinence.
If you can, try to avoid drinks and food that may contribute to UIs, including:
- Alcohol
- Artificial sweeteners.
- Chocolate.
- Carbonated beverages.
- Citrus-flavored beverages.
- High-acid foods like tomatoes and raw citrus fruits.
- Spicy foods
Eating foods that are high in fiber, such as vegetables, fruits, and whole grains, also helps avoid constipation, which can lead to UIs.
Maintain a healthy weight
Obesity can raise your risk of UI or worsen symptoms. It’s important to talk with your doctor about how to maintain a healthy weight through diet, exercise, mental health stability, and lifestyle habit changes.
Quit smoking
Smoking is destructive to your overall health, including your bladder. Smoking increases your chances of stress incontinence from coughing. Smoking can also make symptoms worse and cause bladder cancer. For many reasons, quitting smoking is a great way to decrease your chances of UIs and other health concerns.
Stay hydrated
Talk with your doctor about the appropriate amount of liquids you should be drinking daily based on your size, environment, and activity level. You should be drinking enough water to urinate a pale-yellow color every few hours. Know the signs of dehydration.
Urinate when you feel the urge
Some people hold their urine when they feel the urge to go. This can weaken bladder muscles and cause a bladder infection. Instead, find a bathroom once you feel the urge and try to relax your sphincter muscles, so it is easier to go. Make sure you completely empty your bladder before you finish.
What Are the Signs and Symptoms of Urinary Incontinence?
Urinary incontinence affects everyone differently.
You may have urinary incontinence if you leak pee:
- Climbing stairs.
- Coughing and sneezing.
- During intercourse.
- Getting up from a chair.
- Jumping or exercising.
- Laughing.
- Lifting, bending, or stretching.
Other signs of urinary incontinence are:
- Feeling like your bladder is never completely empty.
- Getting up more than once at night to pee.
- Going to the bathroom more than seven times per day.
- Having frequent leaking episodes.
- Having frequent uncontrollable urges to urinate that may result in incontinence.
- Leaking urine due to triggers, such as putting your key in the door or hearing running water.
- Leaking urine as soon as you need to go to the bathroom.
- Leaking urine even when you drink small amounts of liquid.
When should I see a doctor about my urinary incontinence symptoms?
If you find yourself leaking urine in daily life or experiencing any of the above symptoms, make an appointment with your doctor to talk about incontinence. The quicker you address the symptoms, the easier the condition is to treat.
How Do You Diagnose Urinary Incontinence?
Because urinary incontinence can be caused by different issues and there's more than one type, your doctor will need to run tests to make a diagnosis.
Tests to diagnose urinary incontinence
Tests your doctor might order include:
- Blood work — These tests can show how your body is functioning and if there is a chemical imbalance contributing to the symptoms.
- Cystoscopy — If your doctor wants a deeper look inside the bladder or urethra, they may order this procedure that uses a long, thin instrument with a camera attached to one end to survey the inside of the body.
- Urinalysis — This test checks the urine for other health conditions, such as kidney problems, diabetes, and UTIs.
- Urodynamic evaluation — Your doctor may order these tests to evaluate how well your bladder is working. Urodynamic tests can be simple or complex and can provide a range of measurements, such as:
- How much urine your body produces.
- How much urine your bladder can hold before an involuntary loss of urine occurs.
- The rate at which your bladder empties.
- The volume of urine remaining in your bladder after you pee.
- The amount of urine in your bladder when you feel the need to pee.
- Voiding diary — Your urologist may ask you to keep a diary of your bathroom habits. This voiding diary, or bladder diary, keeps track of how much you drink and pee. Together, urodynamic tests and a voiding diary can provide valuable details about your bladder. An accurate diary gives your urologist a clear picture of:
- How often you go.
- How often you leak.
- What you drink.
- How often you drink.
- X-ray — These imaging scans will be ordered if your doctor wants to get a better look inside your body, such as at your urinary tract and nervous system.
Urinary incontinence prognosis
While the prognosis for UI is varied because of the different types and myriad treatment options, outcomes are generally positive for treating the condition. A mix of different treatment methods, including emotional therapy, can help men and women live full, confident lives with manageable urinary incontinence.
How Do You Treat Urinary Incontinence?
Many people are embarrassed or ashamed by a loss of bladder control and mistakenly believe nothing can be done to correct it. But that's not the case — there's a range of treatment options for UI.
Different types of urinary incontinence are treated differently. Not every treatment will work for every person, and some people will need a mixture of treatments for the best outcome.
Drinking less water isn't a good way to solve any kind of urinary incontinence because it may cause dehydration. Concentrated urine caused by dehydration can irritate the lining of the bladder and urethra and make your incontinence worse. It may also cause bladder stones. Drinking two to three quarts of water a day actually may help incontinence.
But some fluids, like alcohol and caffeinated drinks, may make your incontinence worse. Stop drinking any fluids two to three hours before bedtime.
Urgency incontinence treatments
Behavioral treatments for urgency incontinence
Urgency incontinence is usually treated through behavioral modification and medicine to control bladder spasms.
Behavioral approaches to urgency incontinence include:
- Scheduled toileting — When you're prompted to empty your bladder at a predetermined timed interval, rather than waiting until you have the urge to go.
- Bladder retraining — A form of scheduled toileting in which the length of time between bathroom trips is gradually increased to enable your bladder to hold larger volumes of urine. This therapy trains the bladder to wait for longer time periods and has proved effective in treating urgency and mixed incontinence.
- Pelvic muscle rehabilitation — This technique involves training the pelvic floor muscles. You'll do exercises alone or in conjunction with biofeedback therapy, vaginal weight training, and pelvic floor stimulation to stimulate pelvic nerves.
Medicine for urgency incontinence
Your doctor may prescribe medications to relax the bladder and reduce spasms or instability. These drugs help prevent your bladder from contracting spontaneously.
Other treatment options for urinary incontinence
If other treatments provide only some or no relief, other treatments may be recommended.
They include:
- BOTOX® — Works by relaxing the overactive bladder muscles, increasing to bladder’s ability to store urine and reducing urinary incontinence. The Botox injection goes directly into the bladder muscle in a procedure done under local anesthesia in a doctor’s office. A small camera enables the urogynecologist or urologist to visualize the bladder for placement of the injection.
- InterStim® — A small, surgically implanted device that's programmed to provide mild electrical stimulation to your sacral nerves at the base of your tailbone. The sacral nerves are responsible for sending messages to your brain related to bladder and urinary function. Electrical stimulation helps improve communication between the brain and the sacral nerves so your bladder and pelvic floor muscles can function properly.
Stress incontinence
Physical therapy for stress incontinence
Stress incontinence is commonly treated with the help of physical therapy and pelvic floor therapy. These exercises help relieve the pain and symptoms associated with pelvic floor dysfunction and can be done on an outpatient basis.
Medicine for stress incontinence
The most common medication for stress incontinence is called Imprezza™, which stabilizes the urethra during increased abdominal pressure.
Surgery for stress incontinence
Surgical procedures to treat stress incontinence include:
- Midurethral sling — Uses a piece of synthetic material to stabilize the urethra and help it to close. The procedure helps prevent bladder leaking when coughing, sneezing, laughing, or exercising, and can provide cure rates up to 90%. The midurethral sling procedure usually is performed as an outpatient surgery. It has been used in the U.S. for 20 years with significant clinical data that support its treatment outcomes and safety profile with minimal risk.
- Bladder neck sling — The bladder neck sling uses your own native tissue to stabilize the urethra. Bladder neck slings can be performed for people who don't want synthetic material placed or who've had complications from midurethral slings.
- Periurethral bulking — Often a procedure that can be done in addition to the sling. For stress incontinence caused by weakened muscles that close the urethra, a substance can be injected around the urethral muscles to create bulking. The bulking improves the ability to close the urethra and prevent incontinence. Periurethral bulking can be done in the office or the operating room.
Why Choose UPMC for Urinary Incontinence Care?
Bladder issues don’t have to stop you from enjoying life. UPMC has effective treatments for urinary incontinence.
Our providers have many years of experience treating women with these conditions. Treatments vary from behavioral modification and physical therapy to advanced surgical techniques that can maximize your quality of life with minimal-to-no downtime.
