Urinary incontinence (UI), or the unintentional loss of urine, is a problem for more than 13 million Americans—85 percent of them women. Although about half of the elderly have episodes of incontinence, bladder problems are not a natural consequence of aging, and they are not exclusively a problem of the elderly.
Incontinence has several causes. Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles. Older men can become incontinent as the result of prostate surgery. Pelvic trauma, spinal cord damage, caffeine, or medications including cold or over-the-counter diet tablets also can cause episodes of incontinence.
If you have urinary incontinence, you don’t necessarily have to resign yourself to wearing pads and carrying extra changes of clothing. Whether you’re experiencing leaking because you were pregnant, have prostate issues, do high-impact sports or are getting older, ongoing incontinence isn’t a given.
With effective medications, surgical procedures or physical therapy that extends beyond routine Kegels, many people have their urinary incontinence cured or significantly reduced. Learn about the types of incontinence and treatments that can improve your quality of life by keeping you active and dry.
But even though urinary incontinence can be improved in 8 out of 10 cases, fewer than half of those with bladder problems ever discuss the condition with their health care professional. The condition often goes untreated.
Urinary incontinence is a common health condition that involves the loss of bladder control and involuntary leakage of urine. It can vary in severity, from occasionally losing a few drops of urine to leaking a substantial amount several times each day.
Urinary incontinence can have a significant impact on an individual’s quality of life, particularly as the condition can pose embarrassing situations in social or public environments. In most cases, urinary incontinence occurs as a result of an underlying health condition, which can be treated and lead to a dramatic improvement in symptoms.
The urinary system
The bladder plays a central role in the complex process of urination, as it stores the urine until it is ready to be excreted via the urethra. There are several nerves and muscles involved in this process, along with the brain and central nervous system (CNS) that control these actions.
The detrusor muscles in the bladder compose the sac used to store urine and contract to squeeze urine out. The sphincter muscles are located at the bottom of the bladder and are naturally contracted to hold the “gate” of the bladder closed and keep urine inside the bladder. When the sphincter muscles relax and the detrusor muscles contract simultaneously, urine is pushed down to be excreted via the urethra.
What Incontinence Means
Incontinence doesn’t necessarily involve large quantities of pee. “Incontinence means the involuntary loss of urine – when you’ve lost control,” says Dr. Harry Johnson, who specializes in female pelvic medicine and reconstructive surgery at the University of Maryland Medical Center. “There’s not an amount. It just means you leak urine when you don’t want to.”
Urinary incontinence is a “huge” and underreported problem, says Johnson, who is also the associate chairman of the department of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.
“Probably more than 60% of women have some sort of urinary incontinence, maybe less severe in some patients than others,” he says. “It’s very common. The problem is that a lot of people don’t report it to their doctor or think there are treatments available for them. So, it sometimes tends to be a silent problem.”
Women are more likely to have urinary incontinence than men for several reasons including pregnancy and childbirth, hormonal changes from menopause and anatomical differences like women’s shorter urethras.
The CNS is particularly important, as it is responsible for sending messages to the relevant muscles to urinate when needed. When this fails, either due to a fault in the CNS or with particular muscles, urinary incontinence may occur.
Types of urinary incontinence
There are five different types of urinary incontinence, as outlined below.
- Stress incontinence occurs when there is a leakage of urine due to pressure on the abdomen, like when coughing, laughing, or lifting something heavy. This form of urinary incontinence is more common in women and is often caused by circumstances that lead to the weakening of pelvic muscles, such as childbirth or local surgery.
- Urge incontinence involves the sudden need to urinate, such that the individual often does not have enough time to reach a toilet. This is particularly common in elderly people and is often caused by a urinary tract infection (UTI) or overactive bladder.
- Overflow incontinence is when small amounts of urine are leaked due to an overfilled bladder. Patients often have difficulty voiding completely, which affects more men, in particular, who are affected by an enlarged prostate.
- Functional incontinence refers to leaking of urine due to another condition leading to difficulty reaching the toilet in time, rather than a problem with the urinary system. Diseases that make mobility difficult, such as arthritis, may cause this type of incontinence.
- Mixed incontinence is a combination of several types of incontinence. There are often multiple causes to be addressed in the appropriate management of this condition.
Also known as ‘overactive bladder,’ the sudden, strong urge to pee typically leads to leakage before someone can make it to the bathroom. In other cases, people feel a frequent urge to urinate throughout the day, although the amount of urine is relatively small. It’s more likely to affect older women, likely because of age-related hormonal and physical changes, and men. It can happen unexpectedly when triggered by drinking water, hearing or feeling running water, or even during sleep.
For men, urinary incontinence is often related to prostate problems. “They have urinary retention due to an enlarged prostate and that can also contribute to urgency, frequency and urge incontinence, which means it’s a little more difficult to control your urine, so you get involuntary loss,” Johnson says.
Men with an enlarged prostate can have urge incontinence, related to overactive bladder, or overflow incontinence, as a result of urinary retention. Incontinence is also common as a result of prostate surgery, which is referred to as stress incontinence.
When deciding the best course of action to treat urinary incontinence, it is important to consider the cause of the condition. This will often help to identify possible causes and present ways to improve both the primary condition and the symptoms of urinary incontinence.
Pelvic floor muscles are the muscles used to stop the flow of urination voluntarily. Kegel exercises can help to strengthen these muscles and have been shown to improve the symptoms of many people who suffer from urinary incontinence. Overall, kegel exercises have been found to be particularly successful in the treatment of stress incontinence.
Some medications are also able to target the muscles responsible for the process of urination and are able to help control the urine flow. If there is a structural abnormality that is causing the symptoms, surgery may be beneficial to correct the anatomy of the urinary system and improve the condition.
Incontinence Treatment Options
Incontinence treatments include behavior modification, pelvic floor exercises and physical therapy, medications, surgery, injections and implants, depending on whether stress or urge incontinence is the problem, the patients’ gender, athletic activities and other habits.
Here are available effective treatment options for incontinence:
- Behavior modifications.
- Kegel exercises.
- Physical therapy.
- Botox bladder injections.
- Sacral neuromodulation.
- Percutaneous tibial nerve stimulation.
- Urethral sling.
- Periurethral injections
Restricting fluid intake to about six to eight glasses, spread throughout the day, limiting caffeine and doing bladder training to gradually space out your bathroom breaks can reduce incontinence. Caffeine has a diuretic effect, so people pee more, and it may also cause bladder irritation.
Contracting your pelvic floor muscles, doing up to 10 reps for up to 10 seconds, three times a day, can help tighten these muscles to improve bladder control. Both men and women can benefit from Kegels.
Pelvic floor physical therapists who specialize in urinary incontinence and pelvic organ prolapse, or problems with pelvic support, can help patients with a variety of techniques including exercises and biofeedback, which uses sensors to demonstrate how your muscles are being used during pelvic floor exercises. These specialists help create a customized exercise plan for patients to work on independently.
Prescription anticholinergic drugs such as Ditropan and Enablex can treat overactive bladders. “The medication blocks the receptors to the bladder that cause (it) to contract and expel urine,” Johnson explains.
Other medications like mirabegron (Myrbetriq) help relax the bladder muscles, allowing it to fill more. “The bladder decides when it’s going to empty by volume,” he says. “This medication will increase the volume that you can hold before you get the urge to go to the bathroom, and help you control the urge so you can make it to the bathroom.”