Urinary Incontinence: Types, Causes, Symptoms & Treatment 

Urinary incontinence (involuntary urination) is any uncontrolled leakage of urine or loss of bladder control. It is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

Urinary incontinence affects women more often than men in a 2-to-1 ratio, according to National Center for Biotechnology Information. However, this condition can affect anyone and has many different causes.

Normal urinary continence and bladder control requires a complex interaction between the brain, nervous system and organs in the pelvis. The pelvic organs include the bladder, urethra, the prostate in men and the muscles of the pelvic floor called the levator ani. Controlling the outflow of urine are two valves, or sphincters, located in the bladder neck and earliest portion of the urethra.

The bladder neck sphincter is under involuntary (autonomic) control while the urethral sphincter has both voluntary and involuntary components. The levator ani muscles act as a supporting hammock for this system and also have reflex as well as voluntary activity.

The urinary system

The urinary system is made up of the kidneys, ureters, bladder and urethra. These parts do several jobs. They filter, store and remove waste from your body. Your kidneys are the filters of your body. Waste products are removed from your blood by the kidneys, creating urine. The urine then moves down through two thin tubes called the ureters. The ureters connect to the bladder, where the urine will collect until it’s time to leave the body.

The bladder

The bladder has two essential functions: to store urine and to empty urine. While this concept is simple, the interplay necessary between the brain, bladder, sphincters and pelvic floor muscles is very complex. Perceptions of bladder filling and fullness, and subsequent initiation of emptying requires synchronization of the nervous system, the bladder muscle, sphincters and pelvic floor. Similarly, controlling a full bladder in the face of daily activity relies on precise neural orchestration and healthy pelvic organs.

When any component of the system loses normal function, urinary control can be affected. Neural injury, damage to the bladder, sphincters, supporting structures and even the pelvic floor can all lead to incontinence.

Though it occurs more often as people get older, urinary incontinence isn’t an inevitable consequence of aging. If urinary incontinence affects your daily activities, don’t hesitate to see your doctor. For most people, simple lifestyle and dietary changes or medical care can treat symptoms of urinary incontinence.

Many different health problems can also cause the condition. Symptoms can range from mild to severe and can be a sign of cancer, kidney stones, infection, or an enlarged prostate, among other causes.

Key points about urinary incontinence

• Urinary incontinence or bladder incontinence occurs when you lose control of your bladder. This may mean a minor leak or emptying your bladder or somewhere in between.

• This can be a temporary issue, such as one caused by an infection, or a more persistent one that may be caused by another health condition, such as an enlarged prostate or pelvic floor weakness.

• A doctor may be able to help treat your urinary incontinence by resolving the health issue that’s causing it. Or, they may be able to help you manage the condition through behavioral therapy, bladder training, medication, or other treatments. 

• Even if the cause is not serious, urinary incontinence can affect your quality of life. It is important to talk with a doctor to discover the cause and find a treatment option that works for you.

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Types of urinary incontinence

There are several different types of incontinence. These types have different causes, characteristics and triggers for urine leakage. Knowing the type of incontinence is often an important part of the diagnosis and treatment plan for incontinence. The types of incontinence include:

• Urge incontinence: This type of incontinence is characterized by an intense need to urinate right away. Often, this happens too quickly for you to make it to a toilet and you end up leaking urine. Urge incontinence can be caused by a condition called overactive bladder (OAB). You could have OAB for a variety of reasons like having weak pelvic muscles, nerve damage, an infection, low levels of estrogen after menopause or a heavier body weight. Some medications and beverages like alcohol and caffeine can also cause OAB.
• Stress incontinence: When you leak urine during activities, this is often stress incontinence. In this type of incontinence, your pelvic floor muscles are weak and no longer support your pelvic organs as they should. This muscle weakness means that you’re more likely to accidently leak urine when you move around. For many people, leakage issues happen when they laugh, cough, sneeze, run, jump or lift things. These actions all place pressure on your bladder. Without the support of strong pelvic muscles, you’re more likely to leak urine. Women who have given birth are at a higher risk of having stress incontinence. Men who have had prostate surgery may develop stress incontinence.
• Overflow incontinence: If your bladder doesn’t empty completely each time you urinate, you could have overflow incontinence. Think of the bladder as a juice jug. If you only pour some of the juice out of the jug, but not all of it, there’s still a risk that you could spill when you move around. People with overflow incontinence never completely empty the bladder, placing them at risk for a spill. Usually, this results in small amounts of urine dripping out over time instead of one big gush of urine. This type of incontinence is more common in people with chronic conditions like multiple sclerosis (MS), stroke or diabetes. This may also occur in men with a large prostate.
• Mixed incontinence: This type of incontinence is a combination of several problems that all lead to leakage issues. When you have mixed incontinence, you might be dealing with stress incontinence and an overactive bladder. It’s often important to pay attention to what you’re doing when you have leakage issues with this type of incontinence. Identifying what triggers mixed incontinence is usually the best way to manage it.
• Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

Symptoms of urinary incontinence

The main symptom of incontinence is a leakage of urine. This could be a constant dripping of urine or an occasional experience of leakage. If you have incontinence, you might have large amounts or small amounts of leaked urine. You might experience leakage for a wide variety of reasons, often depending on the type of incontinence you have.

You might leak urine when you:

• Exercise.
• Cough.
• Laugh.
• Sneeze.
• Have an urge to urinate, but can’t make it to the toilet on time.
• Have to get up in the middle of night to urinate (nocturia).

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Causes of urinary incontinence

Urinary incontinence can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what’s behind your incontinence.

Temporary urinary incontinence

Certain drinks, foods and medications may act as diuretics, stimulating your bladder and increasing your volume of urine. They include:

• Alcohol
• Caffeine
• Carbonated drinks and sparkling water
• Artificial sweeteners
• Chocolate
• Chili peppers
• Foods that are high in spice, sugar or acid, especially citrus fruits
• Heart and blood pressure medications, sedatives, and muscle relaxants
• Large doses of vitamin C

Urinary incontinence may also be caused by an easily treatable medical condition, such as:

• Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate and, sometimes, incontinence.
• Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.

Persistent urinary incontinence

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

• Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
• Childbirth. Vaginal delivery can weaken muscles needed for bladder control and damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions may be associated with incontinence.
• Changes with age. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
• Menopause. After menopause, women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
• Enlarged prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
• Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of treatments for prostate cancer.
• Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones, hard, stonelike masses that form in the bladder, sometimes cause urine leakage.
• Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Risk factors of urinary incontinence

There are many potential risk factors for urinary incontinence. Some risk factors can include:

• having weakened bladder muscles, which can result from aging
• having physical damage to your pelvic floor muscles, such as from childbirth
• having an enlarged prostate
• having prostate or bladder cancer, which can put pressure on your bladder
• having a neurological condition such as dementia, Alzheimer’s, or a physical condition that may prevent you from making it to the bathroom on time
• having an infection, such as a urinary tract infection, bladder infection, kidney infection, or kidney stone
• being pregnant
• being overweight
• having diabetes
• going through menopause

Some of the conditions that cause urinary incontinence are easily treatable and only cause temporary urinary problems. Others are more serious and persistent.

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Complications of urinary incontinence

Urinary incontinence and treatment for urinary incontinence may result in complications, depending on the cause. These complications may include:

• Urinary tract infections. UTIs can be caused by wet undergarments against the skin. This may create an environment where bacteria can grow.
• Kidney damage. In some cases where the flow of urine is obstructed, you may experience kidney trouble or kidney failure.
• Cellulitis. This skin infection is caused by bacteria and may cause swelling and pain.
• Medication side effects. Medications used to control urinary incontinence may cause side effects, depending on the medication. Side effects may include dry mouth, nausea, hypertension, or others.
• Catheter side effects. If you have a catheter placed, you may experience side effects such as infection and trauma.
• Mental health side effects. Urinary incontinence may cause feelings of anxiety, depression, or social isolation.
• Impacts on your personal life. Urinary incontinence can affect your social, work and personal relationships.

Prevention of urinary incontinence

Urinary incontinence isn’t always preventable. However, to help decrease your risk:

• Maintain a healthy weight
• Practice pelvic floor exercises
• Avoid bladder irritants, such as caffeine, alcohol and acidic foods
• Eat more fiber, which can prevent constipation, a cause of urinary incontinence
• Don’t smoke, or seek help to quit if you’re a smoker
• seek prompt treatment for urinary tract or bladder infections

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Diagnosis of urinary incontinence

The diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:

• How often do you urinate?
• Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
• How long have you been experiencing incontinence?

These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, it’s important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.

There are also several specific tests that your provider might do to diagnose incontinence, including:

• Physical exam: Your healthcare provider will typically do a physical exam early in the diagnosis process. During this exam, your provider will look for any physical reason that could be causing your incontinence. This could include doing a pelvic exam if you’re a woman or checking the size of a man’s prostate.
• Urine samples/Urinalysis: Your provider may take samples of your urine to test for infections or blood. Testing your urine is also called urinalysis.
• An ultrasound of your bladder: An ultrasound is a painless test that uses sound waves to create an image of your internal organs. This imaging test will allow your provider to look at the contents of your bladder and assess the emptying ability of your bladder in a non-invasive way.
• Stress test: During this test, your provider will ask you to cough to see if any urine leaks from this action. If you’ve noticed leakage during other activities, like running or jumping, your provider may ask you to repeat those actions to see if you have a leakage issue.
• Cystoscopy: A cystoscope is a thin flexible tube with a camera on the end that can be inserted into your urethra and bladder to get a close look at the inside of your urinary tract. This tool allows your provider to see a lot of detail inside your body.
• Bladder diary. For several days you record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.
• Postvoid residual measurement. You’re asked to urinate (void) into a container that measures urine output. Then your doctor checks the amount of leftover urine in your bladder using a catheter or ultrasound test. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.
• Urodynamic testing: This testing involves several tests that check how much your bladder can hold and how well your urethral sphincter muscle (the muscle that holds your urethra shut) is working. One part of this testing may involve inserting a tube into your bladder that will fill the bladder up with fluid. This checks how much your bladder can actually hold.
• Pad test: Your provider may give you a pad to wear, which will catch any leaked urine. At the end of the test, this pad will be checked to see how much urine you lost.

While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. You’ll then bring this journal with you to your appointment and talk about it with your provider.

Treatment of urinary incontinence

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. If an underlying condition is causing your symptoms, your doctor will first treat that condition.

Your doctor may recommend less invasive treatments to start with and move on to other options if these techniques fail to help you.

Behavioral techniques

Your doctor may recommend:

• Bladder training, to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you’re urinating only every 2.5 to 3.5 hours.
• Double voiding, to help you learn to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.
• Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.
• Fluid and diet management, to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Pelvic floor muscle exercises

Your doctor may recommend that you do these exercises frequently to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence.

To do pelvic floor muscle exercises, imagine that you’re trying to stop your urine flow. Then:

• Tighten (contract) the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
• Work up to holding the contractions for 10 seconds at a time.
• Aim for at least three sets of 10 repetitions each day.

To help you identify and contract the right muscles, your doctor may suggest that you work with a pelvic floor physical therapist or try biofeedback techniques.

Medications

Medications commonly used to treat incontinence include:

• Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride.
• Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.
• Alpha blockers. In men who have urge incontinence or overflow incontinence, these medications relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
• Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas.

Electrical stimulation

Electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months.

Medical devices

Devices designed to treat women with incontinence include:

• Urethral insert, a small, tampon-like disposable device inserted into the urethra before a specific activity, such as tennis, that can trigger incontinence. The insert acts as a plug to prevent leakage and is removed before urination.
• Pessary, a flexible silicone ring that you insert into your vagina and wear all day. The device is also used in women with vaginal prolapse. The pessary helps support the urethra, to prevent urine leakage.

Interventional therapies

Interventional therapies that may help with incontinence include:

• Bulking material injections. A synthetic material is injected into tissue surrounding the urethra. The bulking material helps keep the urethra closed and reduce urine leakage. This procedure is for the treatment of stress incontinence and is generally less effective than more-invasive treatments such as surgery. It may need to be repeated more than once.
• OnabotulinumtoxinA (Botox).Injections of Botox into the bladder muscle may benefit people who have an overactive bladder and urge incontinence. Botox is generally prescribed to people only if other treatments haven’t been successful.
• Nerve stimulators. There are two types of devices that use painless electrical pulses to stimulate the nerves involved in bladder control (sacral nerves). One type is implanted under your skin in your buttock and connected to wires on the lower back. The other type is a removable plug that is inserted into the vagina. Stimulating the sacral nerves can control overactive bladder and urge incontinence if other therapies haven’t worked.

Surgery/Procedures

If other treatments aren’t working, several surgical procedures can treat the problems that cause urinary incontinence:

• Sling procedures. Synthetic material (mesh) or strips of your body’s tissue are used to create a pelvic sling underneath your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress incontinence.
• Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck, an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it’s done during general or spinal anesthesia.
• Prolapse surgery. In women who have pelvic organ prolapse and mixed incontinence, surgery may include a combination of a sling procedure and prolapse surgery. Repair of pelvic organ prolapse alone does not routinely improve urinary incontinence symptoms.
• Artificial urinary sphincter. A small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter shut until there’s a need to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to flow.

Absorbent pads and catheters

If medical treatments can’t eliminate your incontinence, you can try products that help ease the discomfort and inconvenience of leaking urine:

• Pads and protective garments. Most products are no more bulky than normal underwear and can be easily worn under everyday clothing. Men who have problems with dribbles of urine can use a drip collector, a small pocket of absorbent padding that’s worn over the penis and held in place by close-fitting underwear.
• Catheter. If you’re incontinent because your bladder doesn’t empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder. You’ll be instructed on how to clean these catheters for safe reuse.

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It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldn’t stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You don’t need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.

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