Urinary Incontinence

Urinary incontinence means not being able to control the release of urine. Sometimes it's caused by a temporary problem, like a urinary infection, and goes away when the infection is treated. In other cases, it's caused by changes in the muscles or nerves around the bladder and the problem is an ongoing one. Treatment includes exercises, medicines, and sometimes surgery.

Education Topics

Definition

Urinary incontinence

Urinary incontinence means not being able to control the release of urine. Sometimes it's caused by a temporary problem, like a urinary infection, and goes away when the infection is treated. In other cases, it's caused by changes in the muscles or nerves around the bladder and the problem is an ongoing one. Treatment includes exercises, medicines, and sometimes surgery.

Diagnostics

How is urinary incontinence diagnosed?

To diagnose the cause of your urinary incontinence, your doctor will do a physical exam and ask about your past health.

Your doctor will ask about what and how much you drink. You will also be asked how much and how often you urinate and leak urine. It may be easier for you to answer questions if you keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.

Your doctor may do some simple tests to look for the cause of your bladder control problem. For example, your doctor may ask you to cough while you are standing to see if you leak urine. If your doctor thinks that your problem may have more than one cause, you will likely have more tests.

Here are some tests that may be done to find the type and cause of your urinary incontinence.

  • Urinalysis and urine culture. These tests show whether you have a urinary tract infection (UTI) or blood or sugar in your urine. It can also show if a man has prostatitis.
  • Bladder stress test. It simulates the accidental release of urine that may occur when you cough, sneeze, laugh, or exercise. Women may also get a Bonney test. It's similar to the bladder stress test, but the bladder neck is lifted slightly with a finger or tool inserted into the vagina while the bladder stress is applied.
  • Pad test. This can help show how much urine is leaking. You are given an absorbent pad that has been weighed. You wear the pad until urine leaks, and then you return the pad to be weighed again. The increased weight of the pad gives an estimate of how much urine leaked.
  • X-rays or ultrasound. These are used to examine changes in the position of the bladder and urethra when you urinate, cough, or strain.
  • Urodynamic testing. It is typically done only if surgery is being considered or if treatment has not worked for you. The tests may include:
    • Uroflowmetry. This test measures your rate of urine flow. A low peak flow rate can be a sign of a blockage or a weak bladder.
    • Pressure flow studies. This testing measures pressure changes in the bladder as the flow changes. It's often used when the cause of your symptoms isn't clear. It can help show if the cause may be a blockage or a problem with the bladder muscles or nerves.
    • Post-void residual volume. This test measures the amount of urine left after you empty your bladder.
    • Cystometry. This is a series of tests to measure bladder pressure at different levels of fullness.
  • Electromyogram (EMG). This test records the electrical activity of muscles.
  • Cystoscopic exam. This is a test that allows your doctor to see inside the urinary tract by using a thin, lighted tube.
  • Cystourethrogram. This is an X-ray of your bladder and urethra while you are urinating.

Effectiveness

How well do absorbent products for urinary incontinence work?

Absorbent products are an effective way to relieve the embarrassment and discomfort of urine leakage.

How well do behavioral methods for urinary incontinence work?

Bladder training

  • Bladder training does not work well for everyone. But some people benefit significantly.
  • Many people who use bladder training have fewer symptoms of incontinence. For some people, the incontinence completely stops.

Biofeedback

There is not a lot of evidence for biofeedback combined with other behavioral therapies for urinary incontinence. More research is needed.

Pelvic floor muscle training in men

Two reviews were done of men using pelvic floor muscle training to improve continence after prostate surgery. Results were not the same, but there does seem to be a benefit in men who do pelvic floor muscle exercises. One review showed that pelvic floor muscle training did help men control leakage of urine after a radical prostatectomy for prostate cancer. But the other review showed no benefit overall in men trying pelvic floor muscle training after any prostate surgery.

Another study showed that men who did pelvic floor muscle exercises after prostate surgery had much improved urine leakage compared to men who did not do the exercises.

Pelvic floor muscle training in women

Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better. Women who do these exercises during and after pregnancy can reduce their chance of urine leakage after delivery.

Women who did these exercises for urinary incontinence (urge, stress, or mixed incontinence) got better. The exercises seem to work better in women who have stress urinary incontinence and who keep doing the exercises.

Overview

Absorbent products for urinary incontinence: Overview

Absorbent products are items that absorb urine, such as adult diapers, plastic-coated underwear, pads, or panty liners that attach to underwear. Most commercially available items are disposable (such as Depend or Poise). Some absorbent cloths can be washed and reused. Drip collectors that fit over the penis are also available.

Absorbent products may be used to manage any form of incontinence. Bladder control pads are a better choice than menstrual pads. Bladder control pads are made to absorb fluid faster, so they keep you dry and comfortable. And they are designed to reduce the odor of urine.

Behavioral methods for urinary incontinence: Overview

Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. People who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.

Bladder training

Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. You are taught about the structure of the lower urinary tract and the causes of incontinence.

A schedule for urinating is established, and you are trained to resist the first urge to urinate and to refrain from urinating until the scheduled time. The interval between scheduled bathroom visits is increased until you can refrain from urinating for several hours.

Biofeedback

Biofeedback is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.

People with incontinence are taught bladder-sphincter biofeedback methods along with pelvic floor exercises. During biofeedback, bladder, rectal sphincter, and abdominal pressures as well as electrical activity are recorded and displayed for you. By watching the information, you learn to relax your bladder and abdominal (belly) muscles and contract your pelvic floor muscles based on the information displayed.

Women may also use a weighted cone inserted in the vagina as a biofeedback technique during pelvic floor muscle training.

Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:

  • Squeeze the same muscles you would use to stop your urine. Your belly and thighs should not move.
  • Hold the squeeze for 3 seconds, then relax for 3 seconds.
  • Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
  • Repeat the exercise 10 to 15 times a session. Do three or more sessions a day.

Kegel exercises can be done when you are at home or away from home. They can be done at any time of day. No one will be aware that you are doing the exercises. So you can do them often, no matter where you are.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working. To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.

Prevention

How can you prevent urinary incontinence?

You may reduce your chances for urinary incontinence by:

  • Doing pelvic floor (Kegel) exercises. They strengthen your pelvic muscles.
  • Getting to and staying at a healthy weight.
  • Quitting smoking. Smoking causes coughing, which can make it harder to control your urine.
  • Limiting caffeine and alcohol.
  • Avoiding constipation by eating a healthy, high-fiber diet.

Providers

Who can diagnose and treat urinary incontinence in men?

Any of the following health professionals can diagnose and treat urinary incontinence:

  • Family medicine physician
  • Internist
  • Physician assistant
  • Nurse practitioner
  • Urologist
  • Geriatric medicine specialist

If you need surgery to treat your incontinence, make sure to find a surgeon who is experienced in the type of surgery you need, usually a urologist.

Who can diagnose and treat urinary incontinence in women?

Health professionals who can diagnose and treat urinary incontinence include:

  • Family medicine physicians.
  • Physician assistants.
  • Nurse practitioners.
  • Obstetricians/gynecologists.
  • Urologists.

Your health professional may want you to see a urogynecologist.

If you need surgery, it is important to find a surgeon who is experienced in the types of surgical procedures used to treat incontinence.

Recovery

What can you expect after using absorbent products for urinary incontinence?

Absorbent products do not cure incontinence. But they may be used for any duration of time. Skin irritations may be a recurring problem if soiled or wet absorbent products have extended contact with the skin.

What can you expect after using behavioral methods for urinary incontinence?

These methods are often successful in reducing or stopping urinary incontinence.

Risk Factors

What increases the risk of urinary incontinence in men?

Many things have been linked to an increased risk of urinary incontinence in men.

Physical conditions or lifestyle factors include:

  • Age-related changes. Examples are decreased bladder capacity and physical frailty.
  • Smoking tobacco.
  • Injury to the bladder or urethra. This can happen with radiation therapy or prostate surgery.
  • Bladder infection or prostatitis.
  • Obesity.
  • Problems with the structure of the urinary tract.

Medicines and foods include:

  • Caffeinated and fizzy drinks, such as coffee, tea, and soda pop.
  • Alcohol.
  • Prescription medicines that increase urine production, such as diuretics.
  • Other prescription medicines. These include sedatives, opioids, and calcium channel blockers.
  • Nonprescription medicines, such as diet, allergy, and cold medicines.

Diseases and health conditions include:

  • Neurological conditions. Examples are Alzheimer's disease, Parkinson's disease, stroke, diabetes, spinal injury, and multiple sclerosis.
  • Bladder cancer.
  • Chronic bronchitis.
  • Interstitial cystitis.
  • Anxiety and depression.

What increases the risk of urinary incontinence in women?

Sometimes several things combine to cause urinary incontinence in women. For example, a woman may have had multiple childbirths, be older, and have a severe cough because of chronic bronchitis. All of these might add to her incontinence problem.

Physical conditions that make urinary incontinence more likely include:

  • Pregnancy and vaginal delivery.
  • Having had a hysterectomy.
  • Obesity or being overweight.
  • Older age.
  • Bladder stones.
  • Problems with the structure of the urinary tract.
  • Blockage of the bladder.
  • Chronic bladder infections.

Diseases and conditions that may cause urinary incontinence include:

  • Chronic cough from smoking or bronchitis.
  • Pelvic organ prolapse.
  • Diabetes.
  • Parkinson's disease.
  • Alzheimer's disease.
  • Multiple sclerosis.
  • Bladder cancer.
  • Stroke.
  • Spinal cord injury.

Medicines and foods that make urinary incontinence more likely include:

  • Caffeinated and fizzy drinks, such as coffee, tea, and soda pop.
  • Alcohol drinks.
  • Prescription medicines that increase urine production (like diuretics).
  • Smoking.

Risks

What are the risks of using behavioral methods for urinary incontinence?

No risks are associated with these treatments.

What are the risks of using absorbent products for urinary incontinence?

When using absorbent products:

  • The area around the groin may become irritated.
  • The risk of urinary tract infections increases.

Self-care Treatment

How do you keep a daily record for urinary incontinence?

Keep a daily diary of all liquids taken in and all urine released, whether voluntary or involuntary. Your health professional may also call this a voiding log, bladder record, frequency-volume chart, incontinence chart, or voiding diary. The diary is usually kept for 3 to 4 days.

Record in your diary:

  • The time and amount of each urination.
  • The conditions under which urine release occurred, such as voluntary urination in the toilet, involuntary urine release, or leakage due to sneezing, laughing, or physical exertion.
  • The amounts and types of all liquids consumed. This includes frozen liquid items such as ice cream and frozen fruit juice bars.
  • Whether the liquid consumed contained caffeine (if your health professional instructs you to specify this information).

Why might you keep a daily record for urinary incontinence?

A diary is sometimes requested before you see a doctor about urinary incontinence.

You may be asked to keep a voiding log when:

  • You experience the involuntary release of urine.
  • No cause for the incontinence is discovered in the medical history and physical exam.
  • You are not sure of the frequency and amount of urine leakage.

Why are Kegel exercises done?

Kegel exercises make your pelvic floor muscles stronger. These muscles control your urine flow and help hold your pelvic organs in place.

Doctors often prescribe Kegels for:

  • Stress incontinence.
    • This means leaking urine when you laugh, cough, sneeze, jog, or lift something heavy.
  • Urge incontinence.
    • This is a need to urinate that is so strong you can't reach the toilet in time.
  • Pelvic floor weakness.
    • Age, being overweight, pregnancy, childbirth, and surgery are all things that can weaken pelvic floor muscles. And that can cause urine control problems. It can also result in uterine prolapse. Doing daily Kegels during and after pregnancy may prevent or help treat prolapse.

Self-care Treatment Options

Changing diet and lifestyle to help control urinary incontinence

If you have urinary incontinence, you can take some steps on your own that may stop or reduce the problem. These include simple changes to your diet and lifestyle.

  • Reduce or stop drinking caffeinated and carbonated drinks.

    These include coffee, tea, and soda pop.

  • Limit alcohol to no more than 1 drink a day.
  • Eat less of any food that might irritate your bladder.

    Such foods include citrus fruit, chocolate, tomatoes, vinegars, spicy foods, dairy products, and aspartame. Some people might find this helpful.

  • If you smoke, quit.

    This may reduce coughing, which may reduce your problem with incontinence.

  • Avoid constipation.
    • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
    • Drink plenty of fluids. Don't avoid drinking fluid because you are worried about leaking urine.
  • If you are overweight, try to lose some weight.

    Be more active, and make small, healthy changes to what and how much you eat. You will notice good results over time.

  • Try pelvic floor (Kegel) exercises.

    They will help to strengthen your pelvic muscles.

  • Try absorbent pads or underwear.

    These can help you manage any form of incontinence.

  • Use a tampon while doing activities.

    If you're a woman, using a tampon can help control urine leaks. A tampon puts a little pressure on your urethra and temporarily slows or stops leakage while you do things like jog or dance. Or you may want to try to prevent leaks with a product like Poise Impressa, which you insert like a tampon.

  • Talk with your doctor about all medicines you take.

    This includes prescription and over-the-counter medicines. Find out if any of them may be making your incontinence worse. These may include certain diuretics, sedatives, and even some cold and allergy medicines.

Changing urinary habits to help control urinary incontinence

If you have urinary incontinence, try one or more of these tips. They may help you gain some control over your symptoms.

  • Set a schedule for urinating every 2 to 4 hours.

    Go whether or not you feel the need.

  • Practice "double voiding."

    This means urinating as much as you can, relaxing for a few moments, and then urinating again.

  • Make it easier to use the toilet in time.

    These ideas can be helpful if you have trouble reaching the bathroom before you urinate.

    • Make a clearer, quicker path to the bathroom.
    • Wear clothes that are easy to take off (such as those with elastic waistbands or Velcro closures).
    • Keep a bedpan or urinal close to your bed or chair.
  • Keep track of your symptoms.

    Write down your symptoms and any leaking of urine in a bladder diary. This can help you and your doctor find the best treatment for you.

Signs and Symptoms

What are the symptoms of urinary incontinence?

The main symptom of urinary incontinence is the accidental release of urine. Symptoms depend on the type of incontinence. You may leak urine when you sneeze or cough, or you may always leak urine. Or you may feel a strong urge to urinate, but urine leaks because you can't reach the toilet in time.

Specific Types or Variations

What are the types of chronic urinary incontinence?

There are different types of urinary incontinence. Stress incontinence means leaking urine when you sneeze, cough, or jog. Urge incontinence means having a strong need to urinate but not getting to the toilet in time. Overflow incontinence means leaking urine because your bladder doesn't empty completely. Other types are total incontinence and functional incontinence.

Surgical Treatment

How is surgery used to treat urinary incontinence in men?

Surgery is usually considered when it's the only treatment that can cure urinary incontinence. One example is when the condition is caused by a bladder blockage.

Surgery works for some people and not others. It may be an option for men who:

  • Have ongoing (chronic) incontinence.
  • Have severe symptoms and total incontinence.
  • Are extremely bothered by their symptoms.
  • Have problems retaining urine.
  • Have moderate to severe blood in the urine (hematuria) that keeps coming back.
  • Have urinary tract infections that keep coming back.
  • Have a medical problem that can be treated only with surgery. One example is a bladder outlet blockage that affects kidney function.

Surgery won't always cure the symptoms. But it will usually improve them. Certain physical factors can sometimes lead to disappointing results. These factors include obesity, long-term cough, radiation therapy, poor nutrition, age, and heavy physical activity.

Surgery choices

Overflow incontinence caused by an enlarged prostate (benign prostatic hyperplasia, or BPH) is most often treated with surgery.

Stress incontinence caused by removal of the prostate gland may be treated with surgery if the incontinence isn't cured after a period of watchful waiting. Surgery for severe stress incontinence that doesn't improve with behavioral methods includes:

  • Artificial sphincter. A silicone rubber device is fitted around the urethra. (This is the tube that carries urine from your bladder to the outside of your body.) You can inflate or deflate the device to control urination.
  • Urethral bulking. Material is injected around the urethra. This controls urination. It either closes a hole in the urethra or builds up the thickness of the wall of the urethra.
  • Bulbourethral sling. A sling is placed beneath the urethra. It's attached to either muscle tissue or the pubic bone. The sling compresses and raises the urethra. This gives the urethra greater resistance to pressure from the belly. Sling surgery may be an option to treat severe urinary incontinence from prostate surgery.
  • Sacral nerve stimulation (SNS). An electrical stimulator is placed under your skin. It sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.

Severe urge incontinence may be treated with surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

Treatment Options

How is urinary incontinence treated?

Treatment depends on the type of urinary incontinence you have. It may include bladder training, changes to your diet, medicines, and Kegel exercises to strengthen the muscles that control the flow of urine. Or it may be a combination of these. Surgery is sometimes needed.

What Causes It

What causes urinary incontinence?

Urinary incontinence may be caused by weak muscles in the lower urinary tract. They can also be caused by problems or damage either in the urinary tract or in the nerves that control urination. Another cause is bladder muscles that squeeze so hard that the sphincter muscle can't hold back the urine.

What It Is

What is urinary incontinence?

Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. These problems are very common, especially among older adults. They usually don't cause major health problems.

Why It's Done

Why are absorbent products for urinary incontinence used?

Absorbent products may be used if:

  • Your incontinence is not a significant disruption in your life.
  • You are waiting for another treatment for incontinence to take effect.
  • Your incontinence cannot be treated by other means.
  • You prefer to use absorbent products rather than medicines or surgery.

Absorbent products also may be used:

  • When you first begin exercises or behavioral treatment methods. Absorbent products can help manage incontinence until the treatment begins to take effect.
  • While you recover from surgery.
  • During other periods in which protection may be needed while you are pursuing other treatment.
  • If you are not a candidate for other forms of treatment.

Why are behavioral methods for urinary incontinence used?

Behavioral methods may be used to treat:

  • Urge incontinence (using bladder training).
  • Stress and urge incontinence (using pelvic muscle exercises).

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