What to know about urinary incontinence

What is urinary incontinence?

Urinary incontinence is a person being unable to preventTrusted Source urine from leaking out.

It can be due to stress factors, such as sneezing, laughing, and 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.

Symptoms

The main symptomTrusted Source is the unintentional release or 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 in urinary control are 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. A sudden, involuntary contraction of the bladder’s muscular wall causes an urge to urinate that will not stop.

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 bladder’s nerves, nervous system, or muscles.

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 is unable to empty, 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
• issues with eyesight or mobility
• issues with 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 means the person leaks urine continuously or has periodic uncontrollable leaking of large amounts of urine.

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

Types

The type of urinary incontinence is usually 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 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.

Causes

The causes and the type of incontinence are closely linked.

Stress incontinence

Factors includeTrusted Source:

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

Urge incontinence

The following causes of urge incontinence include:

• cystitis, an inflammation of the lining of the bladder
• neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease

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

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)

Risk factors

The following are risk factors linking 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.

Diagnosis

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 incontinence episodes.
• 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 watches for urine loss.
• Urodynamic testing: This determines various factors, such as measuring the tone and contractions of the bladder muscle as it is filling and whether there are abnormal contractions, reduced bladder capacity, weak or hypotonic bladder, sphincter contractions, and pressure at various levels of filling.
• Cystogram: An X-ray procedure provides an image of the bladder.
• Cystoscopy: A cystoscopy is when a thin tube with a lens at the end is inserted into the urethra. The doctor can view any abnormalities in the urinary tract.

Treatment

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

Stress incontinence

Pelvic floor exercises, also known as Kegel exercises, help strengthenTrusted Source the urinary sphincter and pelvic floor muscles, which help control urination.

Bladder training

• Delaying the event: The aim is to control the 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 visits during the day, such as every two 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:

• Beta-3 agonists, such as Myrbetriq, may calm overactive bladders and 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 urinating.
• Pessary: A pessary is 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. It is usually firmer when it heals, often resulting in better urinary control.
• Botox (botulinum toxin type A): Botox is injected into the bladder muscle, which 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 urine flow from the bladder into the urethra.

Other options

• Urinary catheter: A urinary catheter is a tube from the bladder, through the urethra, out of the body into a bag that collects urine.
• Absorbent pads: A wide range of absorbent pads are available at pharmacies, supermarkets, and online.

Complications

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

These include:

• Skin problems: A person with urinary incontinence is likelier to have skin sores, rashes, and infections because the skin is often wet or damp. This is bad for wound healing and also promotes fungal infections.
• Urinary tract infections: A long-term use of a urinary catheter significantly increases the risk of infection.
• Prolapse: A part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. Weakened pelvic floor muscles usually cause this.

Embarrassment can cause people to withdraw socially, and this can lead to issues with mental health. Anyone concerned about urinary incontinence should see a doctor, as help may be available.

Frequently asked questions

What are some ways to manage urinary incontinence?

Some ways to manage urinary incontinence include pelvic floor exercises like Kegels to strengthen the pelvic floor and prevent urinary issues. Other ways can include avoiding smoking and eating a nutritious diet.

What are the signs that something is wrong with the bladder?

Symptoms of bladder issues can includeTrusted Source having issues with urinating, bladder control, waking up to use the bathroom, incontinence, and pelvic pain.

Summary

Urinary incontinence occurs when the bladder leaks urine. Causes can include abnormalities in the bladder muscle, bladder lining, pelvic anatomy, and central nervous system or as a side effect of various medications.

Treatment depends on what the initial reason for incontinence is but can include pelvic floor exercises, medications, and surgery.