What Is It?

Urinary incontinence is a loss of control over urination so that urine leaks before you are able to get to a toilet. It is considered a medical problem when the loss of urine is frequent enough or severe enough to become a social or hygiene problem. Urinary incontinence can happen during pregnancy, during coughing or sneezing, or during certain body movements that stress the body’s bladder control. It also can be related to a urinary-tract infection, to the effects of a pelvic injury, to radiation therapy or to certain medical and neurologic diseases. Alcohol, caffeinated beverages and a variety of medications also can cause or contribute to urinary incontinence. In some cases, incontinence can be triggered when a patient simply places his or her hands in water or hears the sound of water running. In young women, the most common cause of urinary incontinence is a lack of muscle support at the bladder neck, the place where the bladder joins the urethra (urine tube). In older women, the most frequent cause is an overactive or weak bladder.

Urinary incontinence affects approximately 13 million people in the United States and is more common in women than in men. It occurs in 10 percent to 25 percent of women younger than age 65 and in 15 percent to 30 percent of women older than age 60 who do not live in nursing homes. Among nursing-home residents, incontinence is even more common, affecting more than 50 percent of female patients.

The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent and heavy, or it can be small and rather rare. For an active woman or for a woman who loses a large amount of urine each time, even one episode per week may be too much.

Some other common symptoms of urinary incontinence include:

• A strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
• Urinating more than once in a two-hour period or more than seven times a day
• The need to get up and urinate at least twice during sleep
• Painful urination
• Bed-wetting or urinating while sleeping

Your doctor will review your medical history and will ask questions about all medications you are taking, the number of times you’ve been pregnant, other medical conditions you have and other factors that may affect your urination habits. Your doctor also will ask you to keep a detailed record of the times and amounts of urine leakage over a specific 24- to 72-hour period. This sometimes is called a voiding diary. You may need to record your fluid intake during this period as well, and to document any other factors, such as physical activity, coughing or laughing, and consuming alcohol or caffeinated beverages, that might have contributed to an episode of urinary leakage.

Your doctor can diagnose urinary incontinence by reviewing your history, symptoms and voiding diary and by performing a complete physical examination, including a neurological exam and often, a pelvic examination. The pelvic exam can detect physical conditions that might be linked to incontinence. Your doctor also will try to determine whether you are able to empty your bladder completely. For this test, you will be asked to urinate to empty your bladder. Then, the amount of urine left in the bladder will be measured, either by ultrasound, or by placing a thin tube called a catheter into the urethra to empty the bladder. Certain blood tests also may be done to check for kidney function, and to evaluate for possible medical problems that could be causing or contributing to incontinence. A urinalysis usually is done to rule out the possibility of a urinary-tract infection. Some other possible tests include:

• Stress test — The patient is asked to cough repeatedly while the bladder is full, and any loss of urine is recorded.
• Pad test — The patient wears a preweighed pad for one hour while performing a series of movements. If the pad weighs more at the end of this hour, there was a loss of urine.
• Dye test — The patient wears a pad while a nontoxic dye is put into the bladder. If the pad is stained with the dye, there was a loss of urine.
• Cystometry — This test measures the pressure and volume of the bladder as it is filled with fluid.

Several tests may be needed to evaluate the problem fully. In some patients, more than one cause may be found for the incontinence.

Urinary incontinence may be a short-term problem if it is related to pregnancy or to a urinary-tract infection. In these situations, incontinence often goes away after childbirth or after treatment of the infection. Urinary incontinence that is related to muscle weakness, pelvic injury or nerve problems is usually a long-term problem.

In many cases, women can prevent urinary incontinence by performing pelvic muscle exercises, also called Kegel exercises, that strengthen the muscles that surround the openings of the urethra, vagina and rectum. Your doctor or nurse can provide you with information about how to perform these exercises effectively.

You also can help to prevent urinary incontinence by controlling persistent coughs, obesity, abdominal straining and other factors that put extra pressure on the pelvic muscles. This requires the following lifestyle changes:

• Quit smoking.
• Seek treatment for any persistent cough.
• Maintain a healthy weight.
• Avoid constipation.
• Seek treatment if you routinely strain during bowel movements.
• Avoid heavy lifting.

In addition, urinating every few hours, even if you do not think you need to go to the bathroom, may help.

Because women are sometimes reluctant to tell their doctors about symptoms of urinary incontinence, fewer than 50 percent seek medical care. Instead, they rely on absorbent pads or lifestyle changes to deal with their incontinence problems. Although pads or adult diapers can offer security, these products can also irritate the skin, and they should not be the first or only treatment used for incontinence. Absorbent products should only be used to make other treatments work better, or when other treatments have failed.

There are many effective treatments available to control urinary incontinence. These treatments include:

Behavior modification
The goal of behavioral treatment is to help a woman understand why leakage occurs and how to avoid it. Behavior modification treatment may include bladder retraining, Kegel exercises and biofeedback. In bladder retraining, the patient is taught about normal and abnormal voiding patterns, and she learns to void on a regular schedule. Kegel exercises also can be used, with or without biofeedback. Biofeedback is a process that helps a patient to control body functions by providing immediate information about the body’s responses.

Medications
Medications used to help prevent urine leakage include drugs that control bladder spasms, such as oxybutynin (Ditropan) or tolterodine (Detrol); drugs that strengthen the smooth muscle of the urethra, such as alpha-blockers; antibiotics to treat incontinence that is related to a urinary-tract infection; and estrogen (in postmenopausal women) to improve the elasticity of pelvic muscles and surrounding tissues. Because estrogen raises the risk of heart disease and breast cancer, doctors prescribe smaller doses of estrogen to start. Some women find that vaginal estrogen cream provides better relief of symptoms with lower amounts of estrogen compared to pills or skin patches.

Devices that help to strengthen the pelvic muscles
These devices include weighted cones, which are placed in the vagina to help the patient perform pelvic muscle exercises, electrical stimulation devices, which make the pelvic muscles contract, and pessaries, which are plastic devices placed in the vagina to help support the bladder or uterus.

Surgery
The most common cause of incontinence in women is lack of support at the bladder neck. Surgery is used to treat this problem when other treatment methods have been ineffective. Surgery can be through an incision in the abdomen, through the vagina or with a procedure called a needle suspension. A needle suspension is a fairly minor surgical procedure. Strengthening substances also may be injected into the muscle at the bladder neck.

Urinary incontinence is a very common problem. If you experience discomfort from symptoms of urinary incontinence, or if symptoms affect your daily activities, tell your doctor.

About 80 percent of women who seek treatment for urinary incontinence find that their symptoms improve. Patients who use behavior modification treatments may begin to see good results after only a few weeks of therapy. Kegel exercises improve urine control in 40 percent to 75 percent of women who use them.

Surgery often is significantly riskier than either drugs or behavioral therapy. Operations through an incision in the abdomen have been proven to be very successful, but they also have the greatest risk of complications. Some of these possible complications include:

• Difficulty emptying the bladder
• Bladder spasms
• Bladder infection
• Injury to the bladder during surgery
• Incontinence returning

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.