The 2021 Ultimate Guide to Incontinence
Urinating when you don't mean to is embarrassing for anyone, but it's actually a common issue. In fact, according to the American Urological Foundation, a quarter to a third of men and women in the U.S. -- millions of Americans -- struggle with urinary incontinence.
Urinary incontinence, or the involuntary leakage of urine, occurs when control over the urinary sphincter is weakened or lost. This isn't just a "normal part of aging"; it can be caused by various reasons and may be temporary depending on the cause. Treatment and management options are available.
If you think you may be experiencing urinary incontinence or know someone who is, it's best to talk to your doctor. But before you do, this guide will provide you with everything you need to know, including types of incontinence, incontinence causes and symptoms, and treatment & management options.
Temporary vs. Persistent Urinary Incontinence
Temporary urinary incontinence
Not all incontinence is permanent or even long-lasting. Sometimes, it can be caused by a temporary or easily treatable issue. These include:
- Diet: Sometimes, what you eat or drink can be behind your incontinence, as many foods and beverages can stimulate the bladder and increase your urine output. This can include caffeine, carbonated beverages, vitamin C, alcohol, chili peppers, chocolate, and artificial sweeteners.
- Medication: Medications like heart and blood pressure medication, sedatives, and muscle relaxers can also stimulate the bladder and increase urine volume in your bladder.
- Urinary tract infection: A urinary tract infection can irritate the bladder, causing strong urges to urinate that can sometimes lead to incontinence.
- Constipation: When you're constipated, the hard stool can stimulate the nerves around your bladder and increase urges to urinate.
Persistent urinary incontinence
On the other hand, urinary incontinence can also be more persistent or even permanent due to underlying conditions or changes. Many conditions can cause urinary incontinence, but some include:
- Aging: As we age, our bladder muscles can weaken, causing our bladder to hold less urine and more involuntary bladder contractions to occur.
- Pregnancy: Hormonal changes and weight of the fetus putting pressure on the bladder can cause incontinence
- Childbirth: Vaginal childbirth can weaken bladder muscles or damage bladder nerves and tissue, causing a prolapsed pelvic floor, which can be associated with incontinence
- Menopause: Menopause causes a drop in estrogen production, leading to weakened bladder and urethra tissues.
- Hysterectomy: Removal of the uterus can sometimes damage the pelvic floor and lead to incontinence.
- Prostate cancer: Incontinence can sometimes be a side effect of treatment for prostate cancer.
- Obstruction: Obstruction of the bladder by a tumor or an enlarged prostate can cause some forms of incontinence.
- Neurological disorders, such as multiple sclerosis, Parkinson's disease, stroke, brain tumor, or spinal injury, can interfere with the nerves that manage bladder control.
Types of Incontinence
There are many types of incontinence:
In this section, we'll go through what each type is and their symptoms and typical causes.
What is Stress Incontinence?
Stress incontinence is the most common type of incontinence. It is especially common in women who have experienced pregnancy or menopause. It is characterized by involuntary urination when physical stress or pressure is placed on the bladder.
The main symptom of stress incontinence is the involuntary leakage of urine when extra pressure is suddenly placed on the bladder. This can occur in many situations, including when:
- Lifting heavy objects
Leakage may be just a few drops of urine to a tablespoon or more. Stress incontinence may be mild, moderate, or severe, depending on how weakened the pelvic floor muscles have become. In more severe cases, bladder leakage may occur when walking, standing up, or bending over.
Common factors that may cause stress incontinence include:
- Pregnancy and childbirth
- Menopause (lowered estrogen levels can cause weak bladder muscles)
- Hysterectomy and other surgical procedures
These factors can cause weak pelvic floor muscles, causing urine to leak out more easily when the bladder is under physical stress.
What is urge Incontinence?
Urge incontinence, sometimes referred to as "overactive bladder," is another common type of urinary incontinence. It is characterized by a sudden, uncontrollable urge to urinate. When this urge occurs, the urine can typically only be held in for a few seconds.
According to the American Urological Foundation, urge incontinence affects more than 30% of men and 40% of women in the U.S. Often, urge incontinence affects their entire lives. It keeps them from partaking in daily activities out of fear that they will suddenly have to urinate when there isn't a bathroom nearby.
The main symptom of urge incontinence is the sudden, uncontrollable urge to urinate. Because of this urge, those with urge incontinence may leak urine or feel as though they may leak urine if they don't get to a bathroom right away.
This urgency may not have an apparent cause, but it can sometimes occur due to:
- The sound of running water
- A sudden change in position
- Sex, especially during orgasm
Other symptoms of urge incontinence include frequently urinating (more than eight times in 24 hours) and waking up to urinate more than once throughout the night.
Sometimes, urge incontinence is caused by overactive or weak bladder muscles, which can contract to release urine even when the bladder isn't full. Alternatively, the sudden urge to urinate can also be caused by damaged nerve signals between the brain and the bladder. In this case, the brain suddenly signals the bladder to release urine, even if the bladder isn't full.
Some factors that may cause urge incontinence to occur are:
- Urinary tract infection
- Hormone changes
- Cystitis, or an inflammation of the bladder lining
- Neurological conditions, such as Alzheimer's, Parkinson's disease, multiple sclerosis, or stroke
- Enlarged prostate
What is Mixed Incontinence?
Mixed incontinence is the experience of multiple types of incontinence. This is often a combination of stress incontinence and urge incontinence. According to the American Urological Association, over half of women with stress incontinence also experience urge incontinence.
The symptoms of mixed incontinence are usually a combination of those symptoms found in stress and urge incontinence. Including:
- Leaking urine when sudden pressure is put on the bladder, such as when laughing, coughing, or sneezing.
- Leaking urine after getting a sudden urge to urinate, while sleeping, or after drinking or being around water.
Mixed incontinence also, of course, shares causes with both stress incontinence and urge incontinence. Overall, it is caused by weakened pelvic floor and bladder muscles. Many factors can cause this weakening, including:
- Pregnancy and childbirth
- Hormone changes
- Urinary tract infection
- Hysterectomy and other surgical procedures
- Cystitis, or an inflammation of the bladder lining
- Neurological conditions
- Enlarged prostate
What is Overflow Incontinence?
Overflow urinary incontinence can be characterized by the bladder's inability to hold as much urine as the body is making or to empty completely. This type of incontinence is rare in women and most common among men with prostate issues, as an enlarged prostate can obstruct the bladder and urethra.
The main symptoms of urinary overflow incontinence include:
- Frequent urination of a small amount
- "Dribbling," or a constant dripping of urine
Typically, these symptoms will occur when the bladder is full.
Typically, overflow incontinence is caused by an obstruction to the bladder or urethra. This blockage may be caused by:
- Enlarged prostate gland
- Urinary stones
- Bladder surgery
Overflow incontinence may also be caused by a damaged bladder that does not contract as it should. This damage may be caused by:
- Parkinson's disease
- Multiple sclerosis
What is Functional Incontinence?
Functional incontinence differs from other types of incontinence because it is not caused by issues with bladder control. Instead, functional incontinence can be characterized by having a functional bladder but difficulty making it onto the toilet in time. This type of incontinence is most common among older adults.
The main symptom of functional incontinence is involuntary urination caused by difficulty getting to the restroom, taking off clothing, or transferring from a wheelchair onto the toilet in time. This could be just a few drops of urine or everything in the bladder and is typically caused by other conditions. Functional incontinence itself is not known to be painful.
Functional incontinence is most commonly caused by mobility issues, as that can cause many people to take a lot longer to walk to the restroom when they have to urinate. However, it can also be caused by:
- Dementia, delirium, and other cognitive issues
- Poor eyesight
- Environmental factors that impede getting to the restroom
- Poor dexterity or musculoskeletal issues
- Depression, anxiety, or anger causing the person to be unwilling to use the restroom
Depending on the permanence of the underlying cause, functional independence may be temporary.
Male vs. Female Incontinence
Urinary incontinence is much more prevalent in women of all ages than it is in men. It affects 33% of older women compared to 15 to 20% of older men and up to 17% of women compared to 11% of men overall.
Women most commonly experience stress, urge, or mixed incontinence. This is because many experiences unique to people with vaginas, such as pregnancy, childbirth, and menopause, can weaken the pelvic floor and bladder muscles. Thus, putting them more at risk for these types of incontinence.
On the contrary, it's rare for men to experience stress incontinence (although it is possible). Rather, they are more likely to experience urge and overflow incontinence due to the presence of a prostate, which is unique to those with penises. For instance, an enlarged prostate gland, prostate surgery, or other prostate issues can often cause overflow or urge incontinence.
Some factors that may put you more at risk for developing urinary incontinence include:
Many people associate urinary incontinence with old age, and while anyone can develop urinary incontinence, that association isn't entirely unfounded. As we age, our bladder and urethra muscles weaken, putting us more at risk of urinating involuntarily.
Due to pregnancy, childbirth, and menopause, women are more likely than men to develop stress incontinence.
Being overweight can put pressure on the bladder and bladder muscles, which may weaken them over time and cause stress incontinence to develop.
Smoking tobacco can irritate the bladder and cause a persistent cough that may weaken the bladder muscles.
Other Diseases and Conditions
Many conditions such as diabetes, stroke, and other neurological disorders can increase your risk of developing urinary incontinence. Additionally, men who experience prostate problems or undergo prostate surgery are more likely to develop overflow incontinence.
You may be more prone to developing urge incontinence if an immediate family member has the condition.
In some cases, such as neurological conditions, urinary incontinence may not be preventable. However, in some cases, you can prevent or decrease your risk of developing the condition by:
- Practicing pelvic floor exercises, or Kegels, to strengthen your pelvic muscles
- Losing weight or maintaining a healthy weight
- Avoiding smoking or seeking help in quitting smoking
- Avoiding caffeine, alcohol, and acidic foods, which can irritate the bladder
- Eating high-fiber foods and staying hydrated to prevent constipation, as constipation can cause urinary incontinence.
Incontinence treatment often varies depending on the type, severity, and underlying cause of the condition. So, to determine the best course of treatment, your doctor will want to diagnose you first. The diagnosis process may include a discussion of symptoms and medical history, as well as a physical exam. From there, your doctor might also suggest:
- Urinalysis: Tests conducted on a sample of your urine to check for signs of infection, blood, or other abnormalities.
- Stress test: Your doctor may ask you to cough or otherwise put sudden pressure on your bladder to check if that causes urine loss.
- Bladder diary: This is a record kept of how much you drink, how often and how much you urinate, and how often incontinence occurs.
- Post-void residual measurement: During this test, you will be asked to urinate in a container. The amount you urinate will be measured. Then the doctor will use a catheter or ultrasound test to check the amount of urine leftover in your bladder. Often, this test can determine if you are experiencing overflow incontinence.
If necessary, your doctor may also suggest a blood test, pelvic ultrasound, urodynamic testing, cystogram, or cystoscopy. These more in-depth tests are often conducted if you consider surgery or if the tests mentioned above don't provide enough information.
Once your doctor diagnoses you with a type of incontinence and determines its severity and any underlying causes, they may recommend trying a range of treatments. These include:
Natural Remedies for Incontinence
Obesity and incontinence can sometimes go hand in hand, as extra weight can add pressure to the bladder. One study found that losing 5% to 10% of body weight can significantly reduce incontinence episodes. Your doctor may suggest this first if you are overweight or obese, especially if you're experiencing stress incontinence.
A change in your diet can often help reduce urinary incontinence. For example, your doctor may suggest you cut out bladder irritants such as caffeine, alcohol, and artificial sweeteners. They might also suggest that you eat certain foods, like high-fiber fruits and vegetables, and drink more water to reduce constipation. Eating pumpkin seeds can also help improve urinary function.
Herbal supplements such as Gosha-jinki-gan, Hachimi-jio-gan, and Ganoderma lucidum can improve urinary and bladder function. Your doctor may not recommend herbal remedies outright. Still, you should always consult your doctor before taking herbal supplements to ensure that they won't interact with any medicine you're taking.
Pelvic Floor Exercises
Pelvic floor exercises, also known as Kegel exercises, can help strengthen your bladder muscles. To do these incontinence exercises, first, try to stop your urine mid-stream when peeing to identify the muscles. These are the muscles you will exercise with Kegels. When you have an empty bladder, try tightening those muscles and holding for about 5 seconds before relaxing, and repeat. As those muscles get stronger, you can increase the duration to 10 seconds. Try to do these exercises at least ten times a day.
Bladder training involves waiting 5-10 minutes after getting the urge to urinate actually to go to the bathroom. This process strengthens your bladder muscles and trains them to hold urine longer. Over time, you can slowly increase the amount of time you wait until you're only urinating every 2-3 hours. This works best in combination with pelvic floor exercises.
If you experience overflow incontinence, your doctor may suggest you try "double voiding." Double voiding involves urinating, waiting a few minutes, and then trying to urinate again. This can help you empty your bladder more completely.
In some cases, it may help to plan your trips to the toilet every 2-3 hours rather than waiting until you have the urge to urinate.
If natural remedies alone don't work, there are a few incontinence medications that your doctor may prescribe you depending on the type of incontinence you experience. These include:
- Anticholinergics: These are usually prescribed in the case of urge incontinence, as they help to relax overactive bladders.
- Mirabegron: Also known as Myrbetriq, this is usually prescribed for urge incontinence. It can relax the bladder muscles, help the bladder hold more urine, and sometimes help empty the bladder more completely.
- Topical estrogen: While taking estrogen as a pill will not reduce symptoms of incontinence (and can sometimes make them worse), topical estrogen may be prescribed. This is a low dose of estrogen, usually, in the form of a cream, patch, or ring, that can aid the urethra and vaginal tissues.
- Alpha-blockers: Alpha-blockers can help ease symptoms of urge and overflow incontinence in men by relaxing bladder muscles and muscle fibers in the prostate. This can remove some of the blockages and help empty the bladder more completely.
Depending on your urinary incontinence's underlying cause, your doctor may prescribe you medication to treat that as well. Typically, medication will be used alongside natural remedies such as pelvic floor exercises.
Medical Devices and Therapies
For women with incontinence, there are two medical devices your doctor may provide you with to treat your condition:
- Urethral insert: If you experience stress incontinence, you might use a urethral insert. This is a tampon-like device placed in your urethra before an activity that may put pressure on your bladder, such as exercising. The insert will prevent you from leaking urine during the activity and then be taken out to urinate regularly.
- Pessary: Pessaries are typically given to women with a prolapsed bladder that is causing incontinence. The device is a stiff ring inserted into the vagina to be worn all day. It holds the bladder up and prevents urine leakage.
There are also interventional therapies that may be used to reduce symptoms in both men and women. These include:
- Bulking material injections: These are injections of synthetic material into the tissue around the urethra to help keep the urethra closed. This can help prevent bladder leakage but needs to be done often and is usually less effective than other options.
- Botox: Botox can be injected into the bladder muscles to help calm an overactive bladder.
- Electrical stimulation: Electrodes are temporarily inserted into the vagina or rectum to provide gentle electrical stimulation to the pelvic floor muscles. Over time, this can strengthen these muscles and reduce symptoms of stress and urge incontinence.
- Nerve stimulators: Nerve stimulators are inserted under the skin near the buttocks to stimulate the sacral nerves with a painless electrical pulse. This can aid in bladder control and help ease symptoms of urge incontinence.
If all other less-invasive treatment options don't help, your doctor may suggest surgery to treat your incontinence. Some surgeries they might recommend are:
- Sling procedure: Done to treat stress incontinence. This procedure creates a sling around your urethra and the muscles connecting your urethra and bladder (bladder neck). The sling (usually made of your body's tissue, mesh, or synthetic material) helps keep the urethra closed to prevent urine leakage.
- Bladder neck suspension: This procedure is also for stress incontinence. It lifts the bladder neck -- the muscles connecting your urethra and bladder -- to better support those muscles and the urethra.
- Artificial urinary sphincter: This procedure is suggested for men, and it involves inserting a small, fluid-filled ring around the bladder neck. This keeps the urinary sphincter closed until you have to urinate. To urinate, you press a valve inserted under your skin that deflates the ring and allows urine to be released.
Surgery is usually only suggested if all other treatment options don't help. However, suppose you are experiencing incontinence due to an underlying issue, such as a prolapse. In that case, your doctor may suggest surgery to treat that issue.
Incontinence Supplies and Products
If the treatment options available to you can't entirely eliminate your incontinence, incontinence products, and incontinence supplies are available. They can make the condition more comfortable to live with. These include:
Your doctor may recommend you try a catheter if other treatment options don't work for you. This is a soft tube that is inserted into your bladder through your urethra to drain your urine into a bag throughout the day.
Specialized underwear helps absorb any bowel or bladder incontinence to prevent further messes.
Urinals are portable devices that allow you to urinate while sitting or lying down securely. They can help if mobility or musculoskeletal issues make it hard to get out of bed to urinate. Both male and female urinals are available.
Bedside commodes are portable, non-flushing toilets that can be placed near a bed or chair. This can help those with functional incontinence caused by mobility issues. It dramatically reduces the amount of time necessary to walk to the toilet. For more information on bedside commodes, check out our buyer's guide.
Learn More About Commodes
Commodes for incontinence can make a significant difference in one's quality of life. Our buyer's guide breaks down everything you need to know about selecting the right commode.LEARN MORE
Incontinence Care and Management Products
Coping and Support
Urinary incontinence can impact your entire life. It can be uncomfortable and embarrassing, and you may avoid partaking in activities out of fear that you'll leak urine or get the urge to urinate when you're far from a bathroom. You may even avoid talking about your incontinence altogether, even to a doctor. This can lead to feelings of isolation and depression and keep you from enjoying life.
If you experience urinary incontinence of any kind, know that you are not alone. There is support available for you. Be sure to talk to your doctor about what you're experiencing, as it may be a symptom of an underlying issue. If you're experiencing depression because of incontinence, you might also consider talking to a therapist or psychiatrist.
Support groups can also help those experiencing incontinence, as they can help you feel less isolated and serve as a reminder that incontinence is more common than you think. Your local hospital or clinic may have an incontinence support group already established. There are online support groups and message boards if you're uncomfortable meeting in person.
Some online options include:
- National Association for Continence message boards
- Simon Foundation for Continence support community
- Daily Strength urinary incontinence support group
- Subreddit r/Incontinence
In all, it's best to seek treatment when you're experiencing urinary incontinence, both from your doctor and a mental health professional or support group if necessary. You're not alone in this, and this condition doesn't have to rule your life.
About the Author
Stephanie Schwarten is a freelance writer and editor with a Bachelors degree in Professional Writing. She specializes in content marketing as well as both developmental and copy editing.
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