Urinary Incontinence

Symptoms, causes and treatments of urinary incontinence.
Dec. 30, 2014
Elderly woman on wheelchair with a nurse
Many different treatments are available for urinary incontinence. You and your physician will determine the best plan for your lifestyle. Photo: Getty Images.

Urinary incontinence at a glance

  • Urinary incontinence is accidental leakage of urine from the bladder.
  • There are six main types of urinary incontinence, including stress, urge, mixed, overflow, functional, and total urinary incontinence. The amount of urine leaked depends on the type of incontinence.
  • Urinary incontinence can be caused by a variety of physical issues or medical conditions, and may be temporary or persistent.
  • Some types of medicine can worsen urinary incontinence, including antidepressants and blood pressure medications.
  • Treatment for urinary incontinence depends on individual circumstances, but can include strengthening exercises, medicines, bladder training, or a pessary. In some cases, surgical treatments may be an option.

Symptoms and causes of urinary incontinence

Stress incontinence

Stress incontinence is when a small amount of urine leaks out when pressure is put on the bladder from simple activities like laughing, coughing, sneezing, lifting, or exercising.

In women, stress incontinence is frequently caused by pregnancy, childbirth, weight gain, or menopause. These conditions strain the pelvic floor muscles, which support the bladder and help stop the flow of urine. When extra pressure is put on the bladder, a small to moderate amount of urine may leak out.

Urge incontinence and overactive bladder

Urge incontinence, sometimes known as overactive bladder, is a sudden, strong need to urinate that is often accompanied by accidental leakage of large amounts of urine. Frequent urination, both day and night, is also a sign of urge incontinence.

Women with an overactive bladder may not experience leakage, but have such frequent need to urinate that it interrupts their daily life.

With urge incontinence, the muscles of the bladder spasm or contract, forcing urine past the sphincter muscles around the tube that urine flows out of (the urethra). Pregnancy, childbirth, obesity, and urinary tract infections all increase a woman’s chance of developing urge incontinence. Urge incontinence is also common among the elderly.

Urge incontinence may have no known cause, or may occur due to nerve damage from other medical conditions like multiple sclerosis, Parkinson’s disease, diabetes, or stroke. Spinal cord damage or bladder irritation can also be causes of urge incontinence.

Mixed incontinence

If a woman is experiencing symptoms of both stress and urge incontinence, she may have mixed incontinence.

Treatments for urinary incontinence

Many different treatments are available for urinary incontinence. You and your physician will determine the best plan for your lifestyle. In many cases, a combination of behavioral changes, medicine, and/or medical interventions will be needed to treat urinary incontinence.

Dietary changes

One way to address mild incontinence is by making dietary changes. Paying close attention to the amount of fluids you drink throughout the day, as well as the type of beverages you consume, may help reduce urinary incontinence. Drinking moderate amounts of liquids throughout the day, and limiting the amount of liquids you consume before bedtime may help.

Certain types of foods and beverages may also irritate the bladder, causing you to urinate more often or feel an intense urge to urinate. Alcohol and caffeinated drinks like coffee and tea act as diuretics, making your body produce more urine.

Beverages that contain caffeine may also increase the likelihood of having bladder spasms.

The following foods or beverages can irritate your bladder:

  • Coffee
  • Tea
  • Citrus fruits
  • Tomatoes
  • Spicy foods
  • Carbonated drinks
  • Artificial sweeteners
  • Corn syrup
  • Sugar
  • Chocolate
  • Cutting back on or eliminating these foods and beverages may help improve urinary incontinence symptoms.

Kegel exercises and biofeedback

Special exercises, known as Kegels, can strengthen the muscles of the pelvic floor, which help control urination. To do Kegel exercises, squeeze the muscles you would use to stop the flow of urine. Hold for 10 seconds, then release. Try to practice three or four sets of 10 each day.

At first, it may be difficult to know if you’re contracting the correct muscles. Try to relax the large muscles of the abdomen, buttocks, and thighs, and direct your efforts at pulling the pelvic floor muscles up and in to the body.

Initially, it may be helpful to practice Kegel exercises when lying down, but over time, Kegels can be done in the car, at your desk, standing in line, or in countless other everyday situations.

For some women, it may be beneficial to have a physician use biofeedback methods that show activity in your bladder and pelvic floor muscles. Biofeedback involves placing a sensor near the pelvic floor muscles, which transmits the amount of force you’re exerting to a computer. The computer displays the results on a monitor so you can immediately see whether you are using the correct muscles. Once you get a sense of how to properly do the exercises, you can continue doing them without biofeedback.

Bladder training

Bladder training involves setting a schedule for urination, and then gradually increasing the amount of time in between visits to the restroom. It may be useful to begin keeping a bladder diary that details what you’ve had to drink, when you’ve urinated, any leaks that occurred, and the intensity of the urge you may have felt.

Using the diary observations, you can determine how much time usually passes between urinations, and then set a schedule to extend that time for an additional 15 minutes. With mindful relaxation, you may be able to reduce the feeling of urgency over time. Breathing deeply and practicing Kegel exercises may be helpful when you are trying to extend the length of time before urinating.

Other lifestyle factors

Certain aspects of your lifestyle can impact on urinary incontinence. Smoking may lead to chronic coughing that puts additional stress on the pelvic floor muscles. Being overweight can put pressure on the bladder as well.

Constipation may cause straining during bowel movements that can damage the pelvic floor muscles. Maintaining a healthy diet that is rich in high-fiber foods, fresh fruits and vegetables can help reduce constipation.

In some cases, medications for other conditions can lead to urinary incontinence. These may include:

  • Drugs for high blood pressure or heart disease
  • Antidepressants
  • Sedatives or muscle relaxants
  • Diuretics
  • Antihistamines
  • Discuss any urinary side effects, including difficulty urinating or incontinence, with your physician.

Pessary or urethral insert

Some women may find that they need additional support for preventing urine leakage. A small device called a pessary can be inserted into the vagina that will help hold the bladder in place.

Another medical device, called a urethral insert, can be used to prevent incontinence during specific activities that predictably cause leakage. The insert is put in place before the activity and then removed before urinating.

Injection treatments

A medical intervention that may help prevent leakage is the injection of bulking agents, like collagen or other materials, into the tissue that surrounds the urethra. This treatment can help keep the urethra closed, but will need to be repeated every six to 12 months.

Injections of botulism toxin type A (commonly known as Botox) may also be used to treat certain types of urinary incontinence.

Nerve stimulators

For some women, a small neurotransmitter device can be implanted under the skin of the buttock area that will send mild electrical impulses to the sacral nerve, improving bladder control.

A similar procedure can be performed using the tibial nerve, located in the ankle. This treatment stimulates the nerve, which passes the same painless electrical signals to the sacral nerve. Tibial nerve stimulation treatments are usually performed in weekly sessions over a period of several months.

Surgical treatments for urinary incontinence: When other treatments and lifestyle changes are not successful at improving urinary incontinence, surgery may be an option.

Several different procedures may be performed to lift the bladder and/or urethra back into place. Some common types of surgical procedures include sling procedures (tension-free, adjustable, and conventional) and bladder neck suspension.

Do I Need to See a Urogynecologist?

Pelvic floor disorders (PFDs), such as urinary incontinence and uterine prolapse, affect as many as one in three women in the U.S. PFDs can severely impact your quality of life, but many conditions can be treated or cured.

Pelvic floor disorders involve the muscles, ligaments, connective tissue, and nerves in the uterus, vagina, bladder and rectum. Although a primary care physician or general OB/GYN can address certain pelvic floor disorders, a female pelvic medicine specialist (urogynecologist) has the extra training necessary to administer appropriate treatment and improve a patient’s quality of life in a blend of gynecology and reconstructive surgery.