Treatment, causes, types, and symptoms

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Urinary incontinence is the involuntary leakage of urine. It means a person urinates when they do not want to. Control over the urinary sphincter is either lost or weakened.

Urinary incontinence is a common problem that affects many people.

According to the American Urological Association, one-quarter to one-third of men and women in the United States experience urinary incontinence.

Urinary incontinence is more common among women than men. An estimated 30 percent of females aged 30-60 are thought to suffer from it, compared to 1.5-5 percent of men.

Fast facts on urinary incontinence

• Urinary incontinence is more common in females than in males.
• There are a number of reasons why urinary incontinence can occur.
• Obesity and smoking are both risk factors for urinary incontinence.

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Urinary incontinence is when a person cannot prevent urine from leaking out.

It can be due to stress factors, such as coughing, it can happen during and after pregnancy, and it is more common with conditions such as obesity.

The chances of it happening increase with age.

Bladder control and pelvic floor, or Kegel, exercises can help prevent or reduce it.

Treatment will depend on several factors, such as the type of incontinence, the patient’s age, general health, and their mental state.

Stress incontinence

Pelvic floor exercises, also known as Kegel exercises, help strengthen the urinary sphincter and pelvic floor muscles – the muscles that help control urination.

Bladder training

• Delaying the event: The aim is to control urge. The patient learns how to delay urination whenever there is an urge to do so.
• Double voiding: This involves urinating, then waiting for a couple of minutes, then urinating again.
• Toilet timetable: The person schedules bathroom at set times during the day, for example, every 2 hours.

Bladder training helps the patient gradually regain control over their bladder.

Medications for urinary incontinence

If medications are used, this is usually in combination with other techniques or exercises.

The following medications are prescribed to treat urinary incontinence:

• Anticholinergics calm overactive bladders and may help patients with urge incontinence.
• Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
• Imipramine (Tofranil) is a tricyclic antidepressant.

Medical devices

The following medical devices are designed for females.

• Urethral inserts: A woman inserts the device before activity and takes it out when she wants to urinate.
• Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder up and prevent leakage.
• Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is usually firmer, often resulting in better urinary control.
• Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those with an overactive bladder.
• Bulking agents: Injected into tissue around the urethra, these help keep the urethra closed.
• Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control.

Surgery

Surgery is an option if other therapies do not work. Women who plan to have children should discuss surgical options with a doctor before making the decision.

• Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.
• Colposuspension: Lifting the bladder neck can help relieve stress incontinence.
• Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra.

Other options

Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body into a bag which collects urine.

Absorbent pads: A wide range of absorbent pads is available to purchase at pharmacies and supermarkets, as well as online.

The causes and the type of incontinence are closely linked.

Stress incontinence

Factors include:

• pregnancy and childbirth
• menopause, as falling estrogen can make the muscles weaker
• hysterectomy and some other surgical procedures
• age
• obesity

Urge incontinence

The following causes of urge incontinence have been identified:

• cystitis, an inflammation of the lining of the bladder
• neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease
• enlarged prostate, which can cause the bladder to drop, and the urethra to become irritated

Overflow incontinence

This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:

• an enlarged prostate gland
• a tumor pressing against the bladder
• urinary stones
• constipation
• urinary incontinence surgery which went too far

Total incontinence

This can result from:

• an anatomical defect present from birth
• a spinal cord injury that impairs the nerve signals between the brain and the bladder
• a fistula, when a tube or channel develops between the bladder and a nearby area, usually the vagina

Other causes:

These include:

• some medications, especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants
• alcohol
• urinary tract infections (UTIs)

The type of urinary incontinence is normally linked to the cause.

They include:

• Stress incontinence: Urine leaks out while coughing, laughing, or doing some activity, such as running or jumping
• Urge incontinence: There is a sudden and intense urge to urinate, and urine leaks at the same time or just after.
• Overflow incontinence: The inability to empty the bladder completely can result in leaking
• Total incontinence: The bladder cannot store urine
• Functional incontinence: Urine escapes because a person cannot reach the bathroom in time, possibly due to a mobility issue.
• Mixed incontinence: A combination of types

The main symptom is the unintentional release (leakage) of urine. When and how this occurs will depend on the type of urinary incontinence.

Stress incontinence

This is the most common kind of urinary incontinence, especially among women who have given birth or gone through the menopause.

In this case “stress” refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure, the person may urinate involuntarily.

The following actions may trigger stress incontinence:

• coughing, sneezing, or laughing
• heavy lifting
• exercise

Urge incontinence

Also known as reflex incontinence or “overactive bladder,” this is the second most common type of urinary incontinence. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be stopped.

When the urge to urinate comes, the person has a very short time before the urine is released, regardless of what they try to do.

The urge to urinate may be caused by:

• a sudden change in position
• the sound of running water
• sex, especially during orgasm

Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.

Overflow incontinence

This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. An enlarged prostate gland can obstruct the bladder.

The bladder cannot hold as much urine as the body is making, or the bladder cannot empty completely, causing small amounts of urinary leakage.

Often, patients will need to urinate frequently, and they may experience “dribbling” or a constant dripping of urine from the urethra.

Mixed incontinence

There will be symptoms of both stress and urge incontinence.

Functional incontinence

With functional incontinence, the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem.

Common causes of functional incontinence include:

• confusion
• dementia
• poor eyesight or mobility
• poor dexterity, making it hard to cannot unbutton the pants
• depression, anxiety, or anger can lead to an unwillingness to use the bathroom

Functional incontinence is more prevalent among elderly people and is common in nursing homes.

Total incontinence

This either means that the person leaks urine continuously, or has periodic uncontrollable leaking of large amounts of urine.

The patient may have a congenital problem (born with a defect), there may be an injury to the spinal cord or urinary system, or there may be a hole (fistula) between the bladder and, for example, the vagina.

The following are risk factors linked to urinary incontinence:

• Obesity: This puts extra pressure on the bladder and surrounding muscles. It weakens the muscles, making leakage more likely when the person sneezes or coughs.
• Smoking: This can lead to a chronic cough, which may result in episodes of incontinence.
• Gender: Women have a higher chance of experiencing stress incontinence than men, especially if they have had children.
• Old age: The muscles in the bladder and urethra weaken with age.
• Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke, increase the risk.
• Prostate disease: Incontinence may present after prostate surgery or radiation therapy.

Ways to diagnose urinary incontinence include:

• A bladder diary: The person records how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
• Physical exam: The doctor may examine the vagina and check the strength of the pelvic floor muscles. They may examine the rectum of a male patient, to determine whether the prostate gland is enlarged.
• Urinalysis: Tests are carried out for signs of infection and abnormalities.
• Blood test: This can assess kidney function.
• Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.
• Pelvic ultrasound: Provides an image and may help detect any abnormalities.
• Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
• Urodynamic testing: This determines how much pressure the bladder and urinary sphincter muscle can withstand.
• Cystogram: An X-ray procedure provide an image of the bladder.
• Cystoscopy: A thin tube with a lens at the end is inserted into the urethra. The doctor can view any abnormalities in the urinary tract.

The inability to retain urine can sometimes lead to discomfort, embarrassment, and sometimes other physical problems.

These include:

• Skin problems – a person with urinary incontinence is more likely to have skin sores, rashes, and infections because the skin is wet or damp most of the time. This is bad for wound healing and also promotes fungal infections.
• Urinary tract infections – long-term use of a urinary catheter significantly increases the risk of infection.
• Prolapse – part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic floor muscles.

Embarrassment can cause people to withdraw socially, and this can lead to depression. Anyone who is concerned about urinary incontinence should see a doctor, as help may be available.

Urinary incontinence | Office on Women’s Health

Urinary incontinence is the loss of bladder control. The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence, also called overactive bladder. Incontinence affects twice as many women as men. This may be because pregnancy, childbirth, and menopause may make urinary incontinence more likely. Urinary incontinence is not a normal part of aging, and it can be treated.

What is urinary incontinence?

Urinary incontinence is the loss of bladder control, or leaking urine.

Urine is made by the kidneys and stored in the bladder. The bladder has muscles that tighten when you need to urinate. When the bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body.

Incontinence can happen when the bladder muscles suddenly tighten and the sphincter muscles are not strong enough to pinch the urethra shut. This causes a sudden, strong urge to urinate that you may not be able to control. Pressure caused by laughing, sneezing, or exercising can cause you to leak urine. Urinary incontinence may also happen if there is a problem with the nerves that control the bladder muscles and urethra. Urinary incontinence can mean you leak a small amount of urine or release a lot of urine all at once.

Who gets urinary incontinence?

Urinary incontinence affects twice as many women as men. This is because reproductive health events unique to women, like pregnancy, childbirth, and menopause, affect the bladder, urethra, and other muscles that support these organs.

Urinary incontinence can happen to women at any age, but it is more common in older women. This is probably because of hormonal changes during menopause. More than 4 in 10 women 65 and older have urinary incontinence.¹

Why does urinary incontinence affect more women than men?

Women have unique health events, such as pregnancy, childbirth, and menopause, that may affect the urinary tract and the surrounding muscles. The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker or damaged. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate. This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.

Also, the female urethra is shorter than the male urethra. Any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in until you are ready to urinate.

What are the types of urinary incontinence that affect women?

The two most common types of urinary incontinence in women are:

• Stress incontinence. This is the most common type of incontinence. It is also the most common type of incontinence that affects younger women.² Stress incontinence happens when there is stress or pressure on the bladder. Stress incontinence can happen when weak pelvic floor muscles put pressure on the bladder and urethra by making them work harder. With stress incontinence, everyday actions that use the pelvic floor muscles, such as coughing, sneezing, or laughing, can cause you to leak urine. Sudden movements and physical activity can also cause you to leak urine.
• Urge incontinence. With urge incontinence, urine leakage usually happens after a strong, sudden urge to urinate and before you can get to a bathroom. Some women with urge incontinence are able to get to a bathroom in time but feel the urge to urinate more than eight times a day. They also do not urinate much once they get to the bathroom. Urge incontinence is sometimes called “overactive bladder.” Urge incontinence is more common in older women. ³ It can happen when you don’t expect it, such as during sleep, after drinking water, or when you hear or touch running water.

Many women with urinary incontinence have both stress and urge incontinence. This is called “mixed” incontinence.

What are the symptoms of urinary incontinence?

Urinary incontinence is not a disease by itself. Urinary incontinence is a symptom of another health problem, usually weak pelvic floor muscles. In addition to urinary incontinence, some women have other urinary symptoms:⁴

• Pressure or spasms in the pelvic area that causes a strong urge to urinate
• Going to the bathroom more than usual (more than eight times a day or more than twice at night)
• Urinating while sleeping (bedwetting)

What causes urinary incontinence?

Urinary incontinence is usually caused by problems with the muscles and nerves that help the bladder hold or pass urine. Certain health events unique to women, such as pregnancy, childbirth, and menopause, can cause problems with these muscles and nerves.

Other causes of urinary incontinence include:

• Overweight. Having overweight puts pressure on the bladder, which can weaken the muscles over time. A weak bladder cannot hold as much urine.
• Constipation. Problems with bladder control can happen to people with long-term (chronic) constipation. Constipation, or straining to have a bowel movement, can put stress or pressure on the bladder and pelvic floor muscles. This weakens the muscles and can cause urinary incontinence or leaking.
• Nerve damage. Damaged nerves may send signals to the bladder at the wrong time or not at all. Childbirth and health problems such as diabetes and multiple sclerosis can cause nerve damage in the bladder, urethra, or pelvic floor muscles.
• Surgery. Any surgery that involves a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed. ⁵ If the pelvic floor muscles are damaged, a woman’s bladder muscles may not work like they should. This can cause urinary incontinence.

Sometimes urinary incontinence lasts only for a short time and happens because of other reasons, including:

• Certain medicines. Urinary incontinence may be a side effect of medicines such as diuretics (“water pills” used to treat heart failure, liver cirrhosis, hypertension, and certain kidney diseases). The incontinence often goes away when you stop taking the medicine.
• Caffeine. Drinks with caffeine can cause the bladder to fill quickly, which can cause you to leak urine. Studies suggest that women who drink more than two cups of drinks with caffeine per day may be more likely to have problems with incontinence.⁶ Limiting caffeine may help with incontinence because there is less strain on your bladder.
• Infection. Infections of the urinary tract and bladder may cause incontinence for a short time. Bladder control often returns when the infection goes away.

How does pregnancy cause urinary incontinence?

As many as 4 in 10 women get urinary incontinence during pregnancy.⁷ During pregnancy, as your unborn baby grows, he or she pushes down on your bladder, urethra, and pelvic floor muscles. Over time, this pressure may weaken the pelvic floor muscles and lead to leaks or problems passing urine.

Most problems with bladder control during pregnancy go away after childbirth when the muscles have had some time to heal. If you’re still having bladder problems 6 weeks after childbirth, talk to your doctor, nurse, or midwife.

How does childbirth cause urinary incontinence?

Problems during labor and childbirth, especially vaginal birth, can weaken pelvic floor muscles and damage the nerves that control the bladder. Most problems with bladder control that happen as a result of labor and delivery go away after the muscles have had some time to heal. If you’re still having bladder problems 6 weeks after childbirth, talk to your doctor, nurse, or midwife.

How does menopause cause urinary incontinence?

Some women have bladder control problems after they stop having periods. Researchers think having low levels of the hormone estrogen after menopause may weaken the urethra.⁸ The urethra helps keep urine in the bladder until you are ready to urinate.

Also, like all muscles, the bladder and urethra muscles lose some of their strength as you get older. This means you may not be able to hold as much urine as you get older.

What type of doctor or nurse should I go to for help with urinary incontinence?

If you have urinary incontinence, you can make an appointment with your primary care provider, your OB/GYN, or a nurse practitioner. Your doctor or nurse will work with you to treat your urinary incontinence or refer you to a specialist if you need different treatment.

The specialist may be a urologist, who treats urinary problems in both men and women, or a urogynecologist, who has special training in the female urinary system. You might also need to see a pelvic floor specialist, a type of physical therapist, who will work with you to strengthen your pelvic floor muscles that support the urinary tract.

How is urinary incontinence diagnosed?

Your doctor or nurse will ask you about your symptoms and your medical history, including:

• How often you empty your bladder
• How and when you leak urine
• How much urine you leak
• When your symptoms started
• What medicines you take
• If you have ever been pregnant and what your labor and delivery experience was like

Your doctor or nurse will do a physical exam to look for signs of health problems that can cause incontinence.

Your doctor or nurse also may do other tests such as:

• Urine test. After you urinate into a cup, the doctor or nurse will send your urine to a lab. At the lab, your urine will be checked for infection or other causes of incontinence.
• Ultrasound. Your doctor will use an ultrasound wand on the outside of your abdomen to take pictures of the kidneys, bladder, and urethra. Your doctor will look for anything unusual that may be causing urinary incontinence.
• Bladder stress test. During this test, you will cough or bear down as if pushing during childbirth as your doctor watches for loss of urine.
• Cystoscopy. Your doctor inserts a thin tube with a tiny camera into your urethra and bladder to look for damaged tissue. Depending on the type of cystoscopy you need, your doctor may use medicine to numb your skin and urinary organs while you are still awake, or you may be fully sedated.
• Urodynamics. Your doctor inserts a thin tube into your bladder and fills your bladder with water. This allows your doctor to measure the pressure in your bladder to see how much fluid your bladder can hold.

Your doctor or nurse may ask you to keep a diary for 2 to 3 days to track when you empty your bladder or leak urine. The diary may help your doctor or nurse see patterns in the incontinence that give clues about the possible cause and treatments that might work for you.

How is urinary incontinence treated?

You and your doctor or nurse will work together to create a treatment plan. You may start with steps you can take at home. If these steps do not improve your symptoms, your doctor or nurse may recommend other treatments depending on whether you have stress incontinence or urge incontinence or both.

Be patient as you work with your doctor or nurse on a treatment plan. It may take a month or longer for different treatments to begin working.

What steps can I take at home to treat urinary incontinence?

Your doctor or nurse may suggest some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:

• Doing Kegel exercises. If you have stress incontinence, Kegel exercises to strengthen your pelvic floor muscles may help. Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
• Training your bladder. You can help control overactive bladder or urge incontinence by going to the bathroom at set times. Start by tracking how often you go to the bathroom each day in a bladder diary (PDF, 499 KB). Then slowly add about 15 minutes between bathroom visits. Urinate each time, even if you do not feel the urge to go. By gradually increasing the amount of time between visits, your bladder learns to hold more urine before it signals the need to go again.
• Losing weight. Extra weight puts more pressure on your bladder and nearby muscles, which can lead to problems with bladder control. If you have overweight, your doctor or nurse can help you create a plan to lose weight by choosing healthy foods and getting regular physical activity. Your doctor or nurse may refer you to a dietitian or physical therapist to create a healthy eating and exercise plan.
• Changing your eating habits. Drinks with caffeine, carbonation (such as sodas), or alcohol may make bladder leakage or urinary incontinence worse. Your doctor might suggest that you stop drinking these drinks for a while to see if that helps.
• Quitting smoking. Smoking can make many health problems, including urinary incontinence, worse.
• Treating constipation. Your doctor might recommend that you eat more fiber, since constipation can make urinary incontinence worse. Eating foods with a lot of fiber (PDF, 166 KB) can make you less constipated.

You can also buy pads or protective underwear while you take other steps to treat urinary incontinence. These are sold in many stores that also sell feminine hygiene products like tampons and pads.

What are Kegel exercises?

Kegel exercises, also called Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles to help prevent or reduce stress urinary incontinence. Your pelvic floor muscles support your uterus, bladder, small intestine, and rectum.

Four in 10 women improved their symptoms after trying Kegels.⁹ Kegels can be done daily and may be especially helpful during pregnancy. They can help prevent the weakening of pelvic floor muscles, which often happens during pregnancy and childbirth. Your pelvic floor muscles may also weaken with age and less physical activity.

Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.

How do I do Kegel exercises?

To do Kegels:

1. Lie down. It may be easier to learn how to do Kegels correctly while lying down. You don’t have to lie down once you learn to do Kegels correctly. 
2. Squeeze the muscles in your genital area as if you were trying to stop the flow of urine or passing gas. Try not to squeeze the muscles in your belly or legs at the same time. Try to squeeze only the pelvic muscles. Be extra careful not to tighten your stomach, legs, or buttocks (because then you will not be using your pelvic floor muscles).
3. Relax. Squeeze the muscles again and hold for 3 seconds. Then relax for 3 seconds. Work up to 3 sets of 10 each day.
4. Practice Kegels anywhere. When your muscles get stronger, try doing Kegels while sitting or standing. You can do these exercises at any time, such as while sitting at your desk or in the car, waiting in line, or doing the dishes. Don’t do Kegel exercises at the same time you are urinating. This can weaken your pelvic floor muscles over time.¹⁰

If you are uncomfortable or uncertain about doing Kegel exercises on your own, a doctor or nurse can also teach you how to do Kegels. A pelvic floor physical therapist or other specialist may also be available in your area to help teach you how to strengthen these muscles.

How soon after starting Kegel exercises will urinary incontinence get better?

It may take 4 to 6 weeks before you notice any improvement in your symptoms.¹⁰

Kegel exercises work differently for each person. Your symptoms may go away totally, you may notice an improvement in your symptoms but still have some leakage, or you may not see any improvement at all. But even if your symptoms don’t get better, Kegel exercises can help prevent your incontinence from getting worse.

You may need to continue doing Kegel exercises for the rest of your life. Even if your symptoms improve, urinary incontinence can come back if you stop doing the exercises.

Should I drink less water or other fluids if I have urinary incontinence?

No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health. (But alcohol and caffeine can irritate or stress the bladder and make urinary incontinence worse.)

Women need 91 ounces (about 11 cups) of fluids a day from food and drinks.¹¹ Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.

After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.¹²

What are some medical treatments for stress incontinence?

If steps you can take at home do not work to improve your stress incontinence, your doctor may talk to you about other options:

• Medicine. After menopause, applying vaginal creams, rings, or patches with estrogen (called topical estrogen) can help strengthen the muscles and tissues in the urethra and vaginal areas. A stronger urethra will help with bladder control. Learn more about menopause treatments.
• Vaginal pessary. A reusable pessary is a small plastic or silicone device (shaped like a ring or small donut) that you put into your vagina. The pessary pushes up against the wall of the vagina and the urethra to support the pelvic floor muscles and help reduce stress incontinence. Pessaries come in different sizes, so your doctor or nurse must write a prescription for the size that will fit you. Another type of pessary looks like a tampon and is used once and then thrown away. You can get this type of pessary at a store that also sells feminine hygiene products.
• Bulking agents. Your doctor can inject a bulking agent, such as collagen, into tissues around the bladder and urethra to cause them to thicken. This helps keep the bladder opening closed and reduces the amount of urine that can leak out.
• Surgery. Surgery for urinary incontinence is not recommended if you plan to get pregnant in the future. Pregnancy and childbirth can cause leakage to happen again. The two most common types of surgery for urinary incontinence are:¹³
  • Sling procedures. The mid-urethral sling is the most common type of surgery to treat stress incontinence. The sling is either a narrow piece of synthetic (man-made) mesh or a piece of tissue from your own body that your doctor places under your urethra. The sling acts like a hammock to support the urethra and hold the bladder in place. Serious complications from the sling procedure include pain, infection, pain during sex, and damage to nearby organs, such as the bladder. The Food and Drug Administration (FDA) reports that in 1 out of every 50 patients who have synthetic mesh for urinary incontinence, the mesh moves after surgery and stick outs, into the vagina, causing pain. ¹⁴ The FDA recommends discussing treatment options with your doctor before surgery, and asking specific questions about side effects.
  • Colposuspension. This surgery also helps hold the bladder in place with stitches on either side of the urethra. This is often referred to as a Burch procedure.

What are some nonsurgical treatments for urge incontinence?

If steps you can take at home do not work to improve your urge incontinence, your doctor may suggest one or more of the following treatments:

• Medicines. Medicines to treat urge incontinence help relax the bladder muscle and increase the amount of urine your bladder can hold. Common side effects of these medicines include constipation and dry eyes and mouth.
• Botox. Botox injections in the bladder can help if other treatments don’t work. Botox helps relax the bladder and increases the amount of urine your bladder can hold. You may need to get Botox treatments about once every 3 months.
• Nerve stimulation. This treatment uses mild electric pulses to stimulate nerves in the bladder. The pulses may increase blood flow to the bladder and strengthen the muscles that help control the bladder. Talk to your doctor about the different types of nerve stimulation.
• Biofeedback. Biofeedback helps you see how your bladder responds on a screen. A therapist puts an electrical patch on the skin over your bladder and urethral muscles. A wire connected to the patch is linked to a screen. You and your therapist watch the screen to see when these muscles contract so you can learn to control them.
• Surgery. If you have severe urge incontinence, your doctor may recommend surgery to help increase the amount of urine your bladder can hold or to remove your bladder. Removing your bladder is a serious surgery and is an option only when no other treatments work and the quality of your life is seriously affected.

How can I prevent urinary incontinence?

Although you can’t always prevent urinary incontinence, you can take steps to lower your risk:

• Practice Kegels daily, especially during pregnancy and after talking to your doctor, nurse, or midwife.
• Reach or stay at a healthy weight.
• Eat foods with fiber to help prevent constipation.

Did we answer your questions about urinary incontinence?

For more information about urinary incontinence, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

• National Institute on Aging (NIA), NIH, HHS
  Phone Number: 1-800-222-2225
• National Kidney and Urologic Diseases Information Clearinghouse, NIDDK, NIH, HHS
  Phone Number: 301-496-3583
• American Urogynecologic Society
  Phone Number: 202-367-1167
• National Association for Continence
  Phone Number: 1-800-BLADDER
• Urology Care Foundation
  Phone Number: 410-689-3998

Sources

1. Centers for Disease Control and Prevention. (2014). Prevalence of Incontinence Among Older Americans (PDF, 1.3 MB). National Center for Health Statistics. Vital Health Statistics; 3(36). 
2. Reddy, J., & Paraiso, M.F.R. (2010). Primary Stress Urinary Incontinence: What to Do and Why. Reviews in Obstetrics & Gynecology; 3(4): 150–155.
3. Stewart, W.F., et al. (2003). Prevalence and Burden of Overactive Bladder in the United States. World Journal of Urology; 20(6): 327–336.
4. American College of Obstetricians and Gynecologists. (2016). Urinary Incontinence (PDF, 84 KB).
5. Altman, D., Granath, F., Cnattingius, S., & Falconer, C. (2007). Hysterectomy and Risk of Stress-Urinary-Incontinence Surgery: Nationwide Cohort Study. Lancet; 370(9597): 1494–1499.
6. Gleason, J.L., Richter, H.E., Redden, D.T., Goode, P.S., Burgio, K.L., & Markland, A.D. (2013). Caffeine and Urinary Incontinence in Women. International Urogynecology Journal; 24(2): 295–302.
7. Sangsawang, B., & Sangsawang, N. (2013). Stress Urinary Incontinence in Pregnant Women: A Review of Prevalence, Pathophysiology, and Treatment. International Urogynecology Journal; 24(6): 901–912.
8. Kim, D.K., & Chancellor, M.B. (2006). Is Estrogen for Urinary Incontinence Good or Bad? Reviews in Urology; 8(2): 91–92.
9. Health Resources and Services Administration, Agency for Healthcare Research and Quality. (2012). Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (PDF, 12.9 MB). Comparative Effectiveness Review; 36.
10. U.S. National Library of Medicine. (2017). Kegel exercises – self-care.
11. Institute of Medicine. (2004). Dietary References Intakes: Water, Potassium, Sodium, Chloride, and Sulfate.
12. Rosinger, A. and Herrick, K. (2016). Daily water intake among U.S. men and women, 2009–2012. National Center for Health Statistics Data Brief; 242.
13. American College of Obstetricians and Gynecologists. (2017). Surgery for Stress Urinary Incontinence (PDF, 85 KB).
14. Food and Drug Administration. (2018). Considerations about surgical mesh for SUI.

The Office on Women’s Health is grateful for the medical review by:

• Tamara G. Bavendam, M.D., M.S., Senior Scientific Officer and Program Director, Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases
• Douglas M. Van Drie, M.D., Director of Female Pelvic Medicine & Urogynecology Institute, Grand Rapids Women’s Health

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

Page last updated:
February 22, 2021

Urinary incontinence: causes, how to treat it

Today we will talk about a pathology that is often ashamed: urinary incontinence. Its development should be stopped as early as possible – and then you can get by with muscle-strengthening exercises instead of surgery. Our interlocutor is Stepan Petrovich Sidorov, a urologist and surgeon at Expert Clinic Irkutsk.

– Stepan Petrovich, please tell me, urinary incontinence – what is it? Why is it happening?

– This is a disease, the main symptom of which is the involuntary release of urine.

It is often accompanied by a decrease in bladder volume and can be due to sneezing, physical activity, infections, stress. Stress (or stress) urinary incontinence should be distinguished from overactive bladder, which is caused by other disorders.

— Are there specific causes of urinary incontinence in women and men?

– Everyone has the same reason – weakness of the sphincter. However, incontinence is more common in women than in men. This is due to differences in the structure of the genitourinary system: for example, men have three urethral sphincters (according to new data – four), and women have two. The urethra in men is longer and narrower.

Most often, urinary incontinence in young and elderly men occurs after operations on the pelvic organs, with radical interventions – for example, to remove the prostate gland.

In women, the risk of pathology increases after pregnancy: sometimes there are postpartum changes in the genitourinary system.

But obesity can cause pathology in both sexes, so you should watch your weight.

— Does the risk of disease increase with age?

— Yes, age-related urinary incontinence is common. For example, in women, the elasticity of tissues decreases due to a decrease in the amount of estrogen. That is why we try to transfer women who have begun menopause to hormone replacement therapy if there are no contraindications.

– Does the frequency of incontinence depend on the time of day?

– First of all, it depends on the fullness of the bladder, especially if it is not able to accumulate the full volume of fluid. However, at night, the brain has less control over the work of the sphincter, and in the presence of pathologies, urine leaks.

— How severe is involuntary urination?

— Depends on the complexity of the disease. There can be slight leakage, and abundant, when you need to change several urological pads in a short time. In severe cases, urges occur regularly. Sometimes repeated urination occurs 10 minutes after the previous one.

– You mentioned urological pads. What are they and how do they differ from ordinary women’s?

– These are larger spacers. They also absorb moisture better.

— Which doctors should be contacted if involuntary urination occurs?

– To the urologist, gynecologist and neurologist. As a rule, the consultation begins with a visit to the urologist, who can prescribe various types of treatment, ranging from medication to surgery.

— How is urinary incontinence diagnosed?

– To begin with – collecting complaints and anamnesis, examination on a chair, cough test, in which the patient is asked to cough. He is also asked to push, to reproduce other actions that provoke involuntary urination. This will help assess the severity of the pathology.

If necessary, urethrocystography, bladder ultrasound with residual urine, pelvic ultrasound are performed. When we doubt whether there is bladder hyperactivity, we prescribe an MRI of the lumbosacral spine.

Among the invasive diagnostic methods, we make ureteroscopy – an endoscopic examination method, with the help of which the bladder is examined from the inside.

Ideally, of course, it is worth conducting a comprehensive urodynamic study – an instrumental method in which sensors are placed on the abdominal wall, rectum and bladder. This is necessary for the differential diagnosis of stress incontinence and overactive bladder.

— How to treat urinary incontinence?

– There are various correction options. For example, gymnastic exercises that help keep the muscles of the bladder in good shape. In more severe cases, we inject hyaluronic acid into the urethra. When non-invasive and minimally invasive techniques do not help, we perform bladder plastic surgery: we put a mesh that strengthens the sphincter. In some cases, the operation is carried out in conjunction with a gynecologist or other doctors: for example, they treat uterine prolapse, and the urologist puts the mesh.

— What measures should be taken to cure the pathology as soon as possible?

— First of all, see a doctor as soon as possible. Incontinence symptoms build up gradually. It doesn’t happen that a person goes to bed healthy in the evening and wakes up sick in the morning. Another thing is whether a person will pay attention to the symptoms or wait for complications.

In practice, there are cases when incontinence was detected by chance during the diagnosis of completely different diseases. For example, a patient came in because of kidney stones, and it turned out that he had been wearing diapers for a long time. Of course, gymnastics alone will not do here.

It is also important that sometimes an early visit to the doctor can prevent more serious diseases – in particular, problems with the lower back.

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For information:

Sidorov Stepan Petrovich

In 2009 he graduated from the Irkutsk State Medical University

2009—2010 — internship in general surgery

2010-2012 — residency in Urology

Currently — head of the urological center, urologist, andrologist, surgeon, doctor of ultrasound diagnostics at the Expert Clinic Irkutsk

Delicate problem (urinary incontinence)

Some topics in our society are considered embarrassing to discuss even with a doctor. One such health problem that is quite common among women – especially older women – is urinary incontinence. Every fifth woman suffers from this pathology in reproductive age, every third in perimenopausal and early menopausal age, and every second in the elderly (after 70 years).

Urinary incontinence is not only a hygienic problem, it very seriously affects the quality of life of a woman, as it is accompanied by a forced decrease in physical activity, neurosis, depression, and sexual dysfunction.

We talked with Anna Sergeevna PROSHKINA, a urologist at the Euromed clinic, about the causes that lead to this condition, as well as about ways to treat the disease.

– Anna Sergeevna, please tell us in more detail what this condition is.

– Urinary incontinence is understood as involuntary and uncontrolled release of urine from the urethra, due to violations of various mechanisms of regulation of bladder emptying.

In women, the following types of urinary incontinence occur:

• Stress – involuntary excretion of urine associated with incompetence of the urethral sphincter or with weakness of the muscles of the pelvic floor. Prerequisites for stress urinary incontinence in women can be obesity, constipation, rapid weight loss, hard physical labor, radiation therapy. Women who give birth are more likely to suffer from the disease, while the number of births is not so important as their course. The birth of a large fetus, a narrow pelvis, ruptures of the soft tissues of the perineum and overstretching of the muscles of the pelvic floor.

• Imperative (urgent, overactive bladder) – unbearable, uncontrollable urges due to increased bladder reactivity. Most often this is due to age-related deficiency of estrogen and other sex steroids and atrophic changes in the organs of the genitourinary system that occur against this background. Operations on the pelvic organs (removal of cysts and tumors of the appendages, uterus), prolapse and prolapse of the uterus, chronic cystitis and urethritis make their contribution.

• Mixed – combining signs of stress and urge incontinence. A sudden, uncontrollable need to urinate occurs during physical exertion, followed by uncontrolled urination.

The immediate provoking factor of stress incontinence is any tension that leads to an increase in intra-abdominal pressure: coughing, sneezing, brisk walking, running, sudden movements, heavy lifting and other physical effort. The prerequisites for the occurrence of urgent urges are the same as with stress incontinence, and various external stimuli (sharp sound, bright light, water pouring from a tap) can act as provoking factors.

The mechanism of occurrence of stress urinary incontinence in women is associated with insufficiency of the urethral or vesical sphincters and / or weakness of the pelvic floor structures. An important role in the regulation of urination is given to the state of the sphincter apparatus – with changes in architectonics (the ratio of muscle and connective tissue components), the contractility and extensibility of the sphincters are disturbed, as a result of which the latter become unable to regulate urine output.

Normally, urinary retention is provided by a positive urethral pressure gradient (i.e., the pressure in the urethra is higher than in the bladder). Involuntary excretion of urine occurs if this gradient changes to negative.

The pathogenesis of urge urinary incontinence is associated with impaired neuromuscular transmission in the detrusor, leading to overactive bladder. In this case, with the accumulation of even a small amount of urine, there is a strong, unbearable urge to urinate.

— What symptoms should I look out for?

– Patients who have a stressful form of the disease begin to notice involuntary, without prior urge to urinate, urine leakage, which occurs with any physical exertion. As the pathology progresses, the amount of urine lost increases (from a few drops to almost the entire volume of the bladder), and exercise tolerance decreases.

Urge incontinence may be accompanied by a number of other symptoms: increased frequency of urination during the day more than 8 times, nighttime urination, difficult to hold urges. If the violation of urination is combined with the prolapse of the bladder, there may be discomfort or pain in the lower abdomen, a feeling of incomplete emptying, a feeling of a foreign body in the vagina, pain during intercourse.

— What are the consequences of this pathology?

– A woman experiences not only hygienic problems, but also serious psychological discomfort. The patient is forced to give up her usual way of life, limit her physical activity, avoid appearance in public places and in companies, refuse sex.

Constant leakage of urine is fraught with the development of dermatitis in the inguinal region, recurrent urogenital infections (vulvovaginitis, cystitis, pyelonephritis), as well as neuropsychiatric disorders – neurosis and depression. However, due to shame or a false idea of ​​urinary incontinence as an “inevitable companion of age”, women rarely seek medical help with this problem, preferring to put up with obvious inconveniences.

A patient facing the problem of urinary incontinence should be examined by a urologist and gynecologist. This will allow not only to establish the causes and form of urinary incontinence, but also to choose the best ways of correction. An important stage in the diagnosis is a urination diary, which notes the frequency of going to the toilet, the volume of each allocated portion of urine, the number of episodes of incontinence, the number of pads used, the amount of fluid consumed per day.

— What are the ways to treat this problem?

– First, we determine the causes of incontinence – it can be not only hormonal disruptions or complications after childbirth, but also banal urinary tract infections or tumor diseases. It is clear that in this case, charging for the pelvic floor muscles will not give a special effect.

Non-drug treatments for incontinence include:

– training of the bladder;

– exercises to strengthen the pelvic floor;

– physiotherapy;

– following a diet:

– a sharp restriction of foods and drinks that irritate the mucous membrane of the urethra and bladder;

– the fight against extra pounds and further weight control.

Training consists in creating a plan of urination and its implementation. The implementation of the plan must also be learned and trained better under the guidance of a doctor. The intervals between urination should gradually increase. The fact is that women suffering from incontinence develop a certain stereotype of going to the toilet over time: they tend to go there, even if the urge is weak, as if “for prevention” or “in reserve”, so that in no case will embarrassment . Fulfilling the plan, a woman must restrain her urges. The interval between urination should be increased by half an hour every week until its duration is 3-3.5 hours. Thus, a woman changes the old stereotype of behavior and develops a new one. Usually, training is supported by drug therapy, which is designed for 3 months, as is the training program.

No less attention should be paid to training the pelvic floor muscles. For most women, trained pelvic floor muscles are the key to success in the treatment and prevention of urinary incontinence. Unfortunately, only a few consciously work on the pelvic muscles. This is the best prevention of female incontinence. For example, “Kegel exercises” are included in the list of physical therapy exercises for incontinence.

In addition to these exercises and training, one should not forget about physiotherapy. It can strengthen the muscles and make the ligaments more elastic by improving the blood supply to the pelvis. For this purpose, such methods of physiotherapeutic influence as microcurrents, electromagnetic impulses are usually used.

Medications have proved to be especially effective in the urgent type of urinary incontinence. For treatment, m-anticholinergics are prescribed first of all (they have a relaxing effect on the muscles of the bladder; they extinguish impulses to urges from the nervous system) and antidepressants (drugs of central action).

Thus, under the influence of drug therapy, the bladder relaxes and increases in volume, the imperative urges that the woman could not cope with disappear, respectively, she begins to go to the toilet less often.

Surgery

Surgery is usually used for stress incontinence. The question of surgical intervention is decided when medical treatment is ineffective. At the present stage of the development of surgery, doctors use about 250 different methods of surgical interventions in order to eliminate stress urinary incontinence in women. Many of these methods are also used in our country, including minimally invasive methods, for example, throwing a loop of synthetic fabric. After such operations, a woman can go home the day after the intervention.

The method of treatment, the choice of medications and their dosages, as well as the duration are selected by the doctor individually, depending on the severity of the pathology, the severity of urinary incontinence, and the age of the patient.

Many women feel embarrassed about their problem and postpone the visit to the doctor, “quietly” using urological pads. Such an attitude towards one’s health is unreasonable, because modern medicine allows us to solve this delicate problem and enable patients to return to a full life.