Urinary incontinence is leaking of urine that you can’t control. Many American men and women suffer from urinary incontinence. We don’t know for sure exactly how many. That’s because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.
Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don’t want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.
Many people think urinary incontinence is just part of getting older. But it’s not. And it can be managed or treated. Learn more here. Talk to your doctor. Find out what treatment is best for you.
Key Statistics
A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.
Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery.
Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence.
Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked.
Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms.
What happens normally?
The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn’t leak.
Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the
What are the types of urinary incontinence?
Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:
Stress Urinary Incontinence (SUI)
With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.
SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.
There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include “Kegel” exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.
To learn more about SUI risk factors, diagnosis and treatments visit our SUI article page.
Overactive Bladder (OAB)
OAB is another common type of urinary incontinence. It is also called “urgency” incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people’s lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren’t near a bathroom. They may not even be able to get a good night’s sleep. Some people have both SUI and OAB and this is known as mixed incontinence.
With OAB, your brain tells your bladder to empty – even when it isn’t full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.
The main symptom of OAB is the sudden urge to urinate. You can’t control or ignore this “gotta go” feeling. Another symptom is having to urinate many times during the day and night.
OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.
To learn more about OAB risk factors, causes and treatments visit our OAB page.
Mixed Incontinence (SUI and OAB)
Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.
Overflow Incontinence
With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.
One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called “dribbling.”
This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.
Symptoms
The symptoms tell you what kind of urinary incontinence you have.
Not all incontinence is long term. Some causes are temporary so that the incontinence ends when the cause goes away. Vaginal infections can cause temporary incontinence. Irritation, medications, constipation and restricted mobility can cause it. Urinary tract infections (UTIs) are a common cause of temporary incontinence and should be addressed.
It remains important that if the cause isn’t temporary or easily treated, the leakage is probably one of the four types described above. With SUI, the pelvis or sphincter muscles (or both) aren’t strong enough to hold the urine by closing the bladder and urethra. With OAB, the bladder muscles contract too much, pushing urine out even when you are not ready to release it. Mixed incontinence is usually both SUI and OAB. With overflow incontinence, the bladder gets too full without releasing.
These are the symptoms for each:
SUI
The key symptom of SUI is leaking when you are active. The activity and amount of leaking depends on how severe the SUI is. To learn more about SUI, visit our SUI article page and www.UrologyHealth.org/SUI.
OAB
The main symptom of OAB is a sudden, strong urge to urinate that you can’t control. The urge may or may not cause your bladder to leak urine.
You can also download our ” Overactive Bladder Assessment Tool” [pdf]. Print the questions and answer them. Use your answers talk to your doctor about your symptoms. The quiz will help you and your doctor know which OAB symptoms you have. It will help your doctor figure out how best to treat you.
Mixed incontinence (SUI and OAB)
The symptoms of mixed incontinence include leaking and a sudden, strong urge to urinate. Mixed incontinence is when you have more than one type of incontinence. Most often, people with mixed incontinence have SUI and OAB.
To find out more about SUI, visit our SUI article page and www.UrologyHealth.org/SUI.
To find out more about OAB, visit our OAB article page and www.UrologyHealth.org/OAB.
Overflow Incontinence
Frequent small urinations and constant dribbling are the main symptoms of overflow incontinence. The bladder is unable to empty. Symptoms happen when the bladder is full. This type is less often in women however, dropped bladders, prior bladder surgeries or diabetes may affect this. It is more common in men with a history of prostate problems or surgery.
Talking about urgency, leakage, pelvic floor dysfunction and other issues might be uncomfortable. But it’s the first step toward treatment.
Talking about urgency, leakage, pelvic floor dysfunction and other issues might be uncomfortable. But it’s the first step toward treatment.
Women with urological problems might not know how common — and treatable — they are, which keeps them from seeking proper care.
INCONTINENCE AFTER PREGNANCY
The scenario: This unintentional leakage after laughing, coughing, sneezing or jumping most often occurs in women in their late 30s and older, typically after having children. Excess bodyweight can also contribute to developing leakage.
The solution: Dr. Nimeh begins with a physical exam and evaluation. Opting for the “least invasive thing first,” he’ll discuss physical and behavioral therapies, including reducing water and caffeine intake as well as trying exercises for the pelvic floor muscles to build strength. Surgical options are available if the problem persists or worsens.
OVERACTIVE BLADDER
The scenario: Having to pee at all hours and with little warning can be a nuisance. The cause, typically is simply a side effect of growing older — and it affects men and women alike. Although doctors still aren’t sure what causes it, lifestyle factors such as caffeine intake, drinking habits and diuretic medications that rid the body of water can play a role.
The solution: Behavioral modifications come first: cutting caffeine and alcohol and, if possible, altering the time of taking a diuretic. Physical therapy and medications also are considered. Dr. Nimeh may suggest nerve therapy, which involves a needle placed in the ankle (“kind of like acupuncture”) to transmit electric stimulation targeting the nerves that control bladder function. More invasive options include Botox injections and an implantable bladder pacemaker.
URINARY TRACT INFECTION
The scenario: Painful, sometimes cloudy or foul-smelling urine, often accompanied by urgency, frequency, burning and pain with urination — and often occurring several times a year. Women too frequently receive antibiotics for this issue without confirming a UTI (a practitioner might also miss an overlapping issue, such as overactive bladder). Worse, antibiotic resistance can develop if overprescribed.
The solution: Dr. Nimeh helps women determine what might be causing a relapse. “Fluid intake is important, as is managing your bowels. Constipation can be a big contributor.” He also rules out anatomic problems that may be a factor. Research has shown the benefit of vaginal estrogen cream for postmenopausal women to alter their pH levels and promote healthy bacteria growth.
PELVIC FLOOR DYSFUNCTION
The scenario: The pelvic floor is a “bowl” of muscles supporting the bladder, vagina and rectum. Those muscles, particularly after childbirth, get disrupted and can become irritated and inflamed.” The muscles need to relax to urinate well and pass a bowel movement. Tension also can cause pain during intercourse, painful or frequent urination and lower back pain.
The solution: Because most women aren’t taught how to relax those muscles, some proactive effort is required. Dr. Nimeh typically directs a patient toward pelvic floor therapy — weekly sessions that help a woman identify and unclench the affected area. Some people hold stress in their pelvis and don’t even realize it. Vaginal medications or muscle injections may help, too.
PELVIC ORGAN PROLAPSE
The scenario: Weak spots in the walls and muscles of the vagina can cause adjacent organs to fall out of their normal positions — essentially a hernia of the vagina. Our best understanding is that injury to the pelvic floor muscles during childbirth causes the loss of support and prolapse. Signs of trouble: a sensation of a bulge in the vagina or discomfort when sitting.The solution: If the patient is bothered or in pain, surgery can follow. Still, it’s not a condition that has to be surgically corrected; it all depends on the patient’s symptoms. A silicone or rubber diaphragm (known as a pessary) inserted into the vagina to support the pelvic floor is an option as well.