— the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time. Urinary incontinence
Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex.
If you're having enough trouble with bladder control that it affects your day-to-day activities, don't hesitate to see your doctor. In many situations, urinary incontinence can be stopped. Even if the condition can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.
Urinary incontinence is the inability to control the release of urine from your bladder. The problem has varying degrees of severity. Some people experience only occasional, minor leaks or dribbles of urine. Others wet their clothes frequently. For a few, incontinence means both urinary and fecal incontinence the uncontrollable loss of stools.
Types of urinary incontinence include:
- Stress incontinence. This is loss of urine when you exert pressure - stress - on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It has nothing to do with psychological stress. Stress incontinence occurs when the sphincter muscle at the bladder is weakened. The problem is especially noticeable when you let your bladder get too full. Stress incontinence is one of the most common types of incontinence, often affecting women. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to this type of incontinence.
- Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. Some people with urge incontinence have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" — it's contracting even when your bladder isn't full. In fact, urge incontinence is often called an overactive bladder.
- Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, leading to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase the risk of developing overflow incontinence.
- Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence. Usually one type is more bothersome than the other is.
- Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. Someone with Alzheimer's disease may not plan well enough to make a timely trip to the toilet. This type of incontinence is called functional incontinence.
- Gross total incontinence. This term is sometimes used to describe continuous leaking of urine, day and night, or periodic large volumes of urine and uncontrollable leaking. The bladder has no storage capacity. Some people have this type of incontinence because they were born with an anatomical defect. It can be caused by a spinal cord injury or by injury to the urinary system from surgery. An abnormal opening (fistula) between the bladder and an adjacent structure, such as the vagina, also may cause this type of high-grade urinary incontinence.
The ins and outs of bladder control.
Except when you're urinating, your bladder muscle stays relaxed so that it can expand to store urine. The relaxed bladder gets support from increasing contractions of your pelvic floor muscles. Your bladder and pelvic floor muscles communicate with each other to help hold urine in the bladder without leaking.
When your bladder is full, it sends nerve signals to your brain. In response, and at an appropriate time and place, you relax your pelvic floor muscles and your bladder contracts, allowing urine to pass through the urethra and out of your body.
Urinary incontinence isn't a disease, it's a symptom. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.
Causes of temporary urinary incontinence. Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.
- Alcohol. Beer, wine and spirits are all diuretics. They cause your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate and act on that need in a timely manner.
- Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.
- Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.
- Caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly and hold less than usual so that you suddenly and perhaps uncontrollably need to urinate.
- Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.
- Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.
- Other illnesses or injuries. Any serious illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence.
Easily treatable medical conditions also may be responsible for urinary incontinence.
- Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
- 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 trigger urine frequency.
Causes of persistent urinary incontinence. Urinary incontinence can also be a persistent condition caused by some underlying physical problem — weakened pelvic floor or bladder muscles, neurological diseases, or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:
- Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.
- Women produce less of the hormone estrogen after menopause, a decrease that can contribute to incontinence. Estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues lose some of their ability to close — meaning that your urethra can't hold back urine as easily as before.
- Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — runs the risk of damaging the supporting pelvic floor muscles, which can lead to incontinence.
- Painful bladder syndrome (interstitial cystitis). This rare, chronic condition can be associated with an inflammation of the bladder wall. It occasionally causes urinary incontinence, as well as painful and frequent urination. Interstitial cystitis affects women more often than men, and its cause isn't clear.
- Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
- Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
- Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Urinary obstruction can also occur after overcorrection during a surgical procedure to correct urinary incontinence, leading to more urine leakage.
With so many possible causes, it's not surprising that urinary incontinence is common. These factors increase your risk of developing this common condition:
- Sex. Women are more likely than men are to have stress incontinence. Pregnancy and childbirth, menopause, and normal female anatomy account for this difference. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.
- Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release. However, getting older doesn't necessarily mean that you'll have incontinence. Incontinence isn't normal at any age — except during infancy.
- Obesity. Being overweight increases the pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze.
- Smoking. A chronic cough can cause episodes of incontinence or aggravate incontinence that has other causes. Constant coughing puts stress on your urinary sphincter. Longtime smokers often experience stress incontinence for this reason. Smokers are also at risk of developing overactive bladder.
- Vascular disease. People with extensive vascular disease that can occur with aging are at increased risk of overactive bladder.
- Participating in high-impact sports. High-impact sports — such as running, basketball and gymnastics — can cause episodes of incontinence in otherwise healthy women. These vigorous activities put sudden, strong pressure on your bladder, allowing urine to leak past your urinary sphincter. However, no data links high-impact sports to an increased risk of chronic stress incontinence.
Other diseases. Having kidney disease or diabetes may increase your risk of urinary incontinence.