About Urinary Incontinence (Loss of Bladder Control)
Urinary incontinence can have several causes and risk factors, and more than one may be present. Some causes are temporary, such as a urinary tract infection or constipation, while others may be longer lasting:
- Pelvic floor weakness or injury: Pregnancy, childbirth, pelvic surgery, aging, and other factors can weaken or damage the muscles and tissues that help support the bladder and urethra.
- Bladder muscle overactivity: The bladder may squeeze too often or at the wrong time, causing urgency, frequency, and urge leakage.
- Prostate problems: An enlarged prostate, prostate cancer treatment, or prostate surgery can contribute to urgency, overflow leakage, or stress incontinence.
- Blockage or incomplete emptying: A urinary tract blockage, bladder stone, tumor, severe constipation, or urethral narrowing can prevent the bladder from emptying fully and lead to leakage.
- Nerve-related conditions: Diabetes, stroke, multiple sclerosis, spinal cord injury, Parkinson disease, dementia, or other neurologic conditions can affect the signals between the brain, bladder, and urethra.
- Infections and irritation: Urinary tract infections, bladder inflammation, kidney stones, caffeine, alcohol, and some medicines such as diuretics can cause or worsen urgency and leakage.
- Pregnancy: Being pregnant puts extra pressure on the bladder and can contribute to urinary incontinence.
- Overweight: Excess weight can weaken the muscles that control urination and increase the risk of incontinence.
- Diabetes: Diabetes can affect nerve function and lead to urinary incontinence.
- Menopause: Hormonal changes during menopause can weaken the pelvic floor muscles and increase the risk of incontinence.
Risk factors that cannot be changed include:
- Age: The risk of urinary incontinence increases as you get older due to natural changes in muscle strength and function.
- Gender: Women have a higher chance of experiencing stress incontinence than men, especially if they have had children.
Risk factors that may be influenced or managed include:
- Obesity: Being overweight puts extra pressure on the bladder and weakens the surrounding muscles, increasing the risk of incontinence.
- Smoking: Chronic coughing from smoking can lead to episodes of incontinence.
- Prostate disease: In men, urinary incontinence may occur after prostate surgery or radiation therapy.
- Constipation, chronic coughing, and medications that increase urine production or affect bladder function may also contribute to symptoms.
Because UI can have many causes, evaluation is important—especially if symptoms are new, worsening, painful, or associated with blood in the urine. Maintaining a healthy weight, treating constipation, staying physically active, reducing bladder irritants when helpful, and stopping smoking may reduce symptoms or lower risk for some people.
Symptoms depend on the type and cause of urinary incontinence. Common symptoms include:
- Unintentional release (leakage) of urine
- Leakage triggered by physical pressure, such as coughing, sneezing, laughing, heavy lifting, or exercise
- Sudden, involuntary contraction of the bladder muscles that causes an urgent need to urinate
Contact a healthcare professional if leakage is bothersome, affects daily activities, is new or worsening, or occurs with symptoms that could suggest another health problem, such as:
- Pressure or spasms in the pelvic area that cause a strong urge to urinate
- Increased frequency of urination (going to the bathroom more than eight times a day or more than twice at night)
- Urinating while sleeping (bedwetting)
- Pain during urination
- Pink, red, or dark discoloration of urine
- Urine odor
- Abdominal or back pain
- Frequent urinary tract infections
- Painful sexual intercourse
- Tissue sticking out from the vagina that may be bleeding or tender
- Lower abdominal, pelvic, lower back, groin, or vaginal pain
Diagnosis starts with identifying the type of leakage and looking for treatable causes. A healthcare professional may use:
- Medical history: Your healthcare provider will ask about your medical history and any previous experiences with incontinence.
- Physical exam: This may include an abdominal, pelvic, rectal, or neurologic exam, depending on symptoms and anatomy. In men, a rectal exam may be used to check prostate size.
- Pelvic floor assessment: This test measures the strength of your pelvic floor muscles, which play a role in bladder control.
- Urinalysis: This test checks for signs of infection or abnormalities in the urine.
- Urine culture: If a urinary tract infection is suspected, this test can determine the specific strain of bacteria present.
- Urinary bladder ultrasound: This procedure allows the doctor to view the anatomy of your bladder and see how much urine is left in the bladder after urinating.
- Cystoscopy: A thin tube with a camera on the end is inserted into your urethra to examine your urethra and bladder.
- Imaging tests: Ultrasound or other imaging may be used when symptoms suggest incomplete emptying, stones, blockage, neurologic disease, or another urinary tract problem. Routine X-rays are not needed for most people with uncomplicated urinary incontinence.
Some people need additional tests if the diagnosis is unclear, symptoms are severe, there is blood in the urine, recurrent infections occur, the bladder may not be emptying well, neurologic disease is suspected, or surgery is being considered:
- Postvoid residual (PVR) measurement: This test assesses how much urine is left in your bladder after urinating.
- Pelvic ultrasound: This procedure provides an image of your pelvic area and may help detect any abnormalities.
- Stress test: During a stress test, you will be asked to apply sudden pressure while the doctor observes for any loss of urine.
- Urodynamic testing: This test determines how much pressure your bladder and urinary sphincter muscle can withstand.
- Neurological examination: A simple neurological examination may be performed to assess anal sphincter tone, voluntary anal contractions, and perineal sensation.
- Voiding diary: Keeping a voiding diary helps document the frequency and severity of urinary incontinence episodes and the circumstances under which leakage occurs.
Treatment depends on the type of incontinence, symptom severity, personal preferences, other health conditions, and the underlying cause. Healthcare professionals often start with lower-risk options and may combine treatments when needed.
Medication:
- Medicines used for urgency incontinence or overactive bladder may include antimuscarinic medicines or beta-3 agonists, which help relax the bladder or reduce unwanted bladder contractions. These medicines are not appropriate for everyone and can have side effects, so they should be discussed with a healthcare professional.
Therapies:
- Pelvic floor muscle training: Also called Kegel exercises, this strengthens the muscles that help control urine flow and can improve stress and mixed incontinence when done correctly and consistently.
- Bladder training and scheduled toileting: These strategies help lengthen the time between bathroom trips, reduce urgency, and lower the risk of leaks.
- Pelvic floor physical therapy, biofeedback, or electrical or magnetic stimulation may be recommended for some people when exercises are difficult to perform or symptoms persist.
Therapeutic procedures:
- Pessaries and urethral inserts: Pessaries are devices placed inside the vagina to support the bladder, treating stress incontinence. Urethral inserts act as plugs to prevent leaking.
- Urethral bulking injections: Material is injected around the urethra to help it close more effectively and reduce stress leakage.
- Botulinum toxin type A (Botox): Injected into the bladder muscle, it relaxes the muscle and increases bladder storage capacity, reducing episodes of incontinence.
- Nerve stimulation: Percutaneous tibial nerve stimulation, sacral neuromodulation, or an implanted nerve stimulator may help some people with urgency incontinence or overactive bladder that does not improve with other treatments.
Health behavior changes:
- Bladder training: Certain exercises, such as pelvic floor exercises or bladder training, can help increase bladder control.
- Behavior therapy: Managing fluid intake, adjusting diet, and using the bathroom at scheduled times before feeling the urge to go can help manage incontinence depending on the cause.
- Condition management: Treating underlying conditions like constipation or urinary tract infections can also improve urinary incontinence.
Treatment plans vary depending on the cause and type of urinary incontinence. Seek urgent care if you cannot urinate, cannot empty your bladder, see blood in your urine, have fever or back pain with urinary symptoms, or develop new leakage with leg weakness, numbness, or loss of bowel control.
Urinary incontinence may stay the same, improve, or worsen over time depending on the cause, treatment, and other health conditions. Possible complications include skin irritation or rash, urinary tract infections, sleep disruption, falls when rushing to the bathroom, social isolation, anxiety, and reduced quality of life. In people who retain urine or cannot empty the bladder well, complications can include recurrent infections and, rarely, kidney problems.
If you are experiencing urinary leakage or have concerns about bladder control, talk with a healthcare professional. The right evaluation can identify reversible causes, guide treatment, and help reduce complications.