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Urinary incontinence is the accidental release of urine. It can happen when you
cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the
bathroom but can't get there in time. Bladder control problems are very common,
especially among older adults. They usually don't cause major health problems,
but they can be embarrassing.
Incontinence can be a short-term
problem caused by a
urinary tract infection, a medicine, or constipation.
It gets better when you treat the problem that is causing it. But this topic
focuses on ongoing urinary incontinence.
There are two
main kinds of urinary incontinence. Some women—especially older women—have both.
Bladder control problems may
be caused by:
Stress incontinence can be caused by
childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles can't support your bladder properly, the bladder
drops down and pushes against the vagina. You can't tighten the muscles that
close off the
urethra. So urine may leak because of the extra
pressure on the bladder when you cough, sneeze, laugh, exercise, or do other
Urge incontinence is caused by an overactive bladder
muscle that pushes urine out of the bladder. It may be caused by irritation of
the bladder, emotional stress, or brain conditions such as
Parkinson's disease or
stroke. Many times doctors don't know what causes it.
main symptom is the accidental release of urine.
Your doctor will ask about what and
how much you drink. He or she will also ask how often and how much you urinate
and leak. It may help to keep track of these things using a bladder diary for 3 or 4 days before you
see your doctor.
Your doctor will examine you and may do some
simple tests to look for the cause of your bladder control problem. If your
doctor thinks it may be caused by more than one problem, you will likely have
Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. After your doctor knows what has caused the incontinence, your treatment may include exercises, bladder training, medicines, a pessary, or a combination of these. Some women may need surgery.
There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.
If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people can be helped or cured.
Strengthening your pelvic muscles with Kegel exercises may lower your
risk for incontinence.
If you smoke, try to quit.
Quitting may make you cough less, which may help with incontinence.
Learning about urinary incontinence:
Living with urinary incontinence:
Health Tools help you make wise health decisions or take action to improve your health.
Stress incontinence is caused by conditions that stretch the pelvic floor muscles, such as:
When these muscles can't support your bladder well, the bladder
drops down and pushes against the vagina. Then you can't tighten the muscles that
usually close off the
urethra. So urine may leak because of the extra
pressure on the bladder when you cough, sneeze, laugh, exercise, or do other
This is the most common type of urinary incontinence in women.
A chronic cough from smoking can make
stress incontinence worse.
Urge incontinence is caused when the bladder muscle involuntarily
contracts and pushes urine out of the bladder. Many times doctors don't know what causes this. But sometimes the cause is:
Overactive bladder is a kind of urge incontinence.
But not everyone with overactive bladder leaks urine. For more information, see
Less common types of urinary incontinence have other causes. These types
The main symptom of
urinary incontinence is a problem controlling
is common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.
Urinary incontinence usually starts gradually and
slowly becomes worse. As it gets worse, a woman may:
Treating the cause of incontinence often gets rid of
or controls these problems.
Some bladder problems are temporary. For example, you may have a urinary tract infection that causes incontinence, but the problem goes away after the infection is cured.
Sometimes several things
combine to cause
urinary incontinence. For example, a woman may have
had multiple childbirths, be older, and have a severe cough because of
chronic bronchitis or smoking. All of these might
contribute to her incontinence problem.
Physical conditions that
make urinary incontinence more likely include:
Diseases and conditions that may cause urinary
Medicines and foods that may make urinary incontinence worse include:
Call your doctor if:
Don't be embarrassed to discuss urinary incontinence with
your doctor. Urinary incontinence is not an inevitable result of
aging. Most women with incontinence can be helped or cured.
If you have urinary incontinence that develops
slowly, you may be able to control the problem yourself. If home
treatment is not effective, or if incontinence interferes with your lifestyle,
ask your doctor about other treatments.
Health professionals who can diagnose and treat
urinary incontinence include:
Your health professional may want you to see a doctor who
specializes in problems of the urinary tract (urologist) or
who specializes in treating older people (geriatrician).
If you need surgery, it is
important to find a
surgeon who is experienced in the types of surgical
procedures used to treat incontinence.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To diagnose the cause of your
urinary incontinence, your doctor will ask about your
medical history and do a physical exam. It may be easier for you to answer questions if you keep a bladder diary(What is a PDF document?) for 3 or 4 days before you see your doctor.
To check for stress incontinence, your doctor may ask you to cough while
you are standing.
Your doctor may also order these tests:
is expensive. It is typically done only if surgery is being considered or if
treatment has not worked for you and you need to know more about the cause. It
provides a more advanced way to check bladder function.
The actual tests done in urodynamic testing often
vary. They may include:
If the cause of incontinence is not identified by the
above tests, more extensive tests may be needed.
Urinary incontinence isn't an inevitable result of
aging. Most women who have it can be helped or cured.
The best treatment depends on
the cause of your incontinence and your personal preferences. Treatments include:
Behavioral training, exercises
and lifestyle changes, and medicines are usually tried first. If the problem does not get better,
your doctor may try another treatment or do more tests.
When there is more than one cause for incontinence, the most significant cause is treated first, followed by treatment
for the secondary cause, if needed.
You may reduce your chances for
urinary incontinence by:
If you have urinary incontinence, you can take some steps
on your own that may stop or reduce the problem.
Pelvic floor (Kegel) exercises can help women who have any type of urinary incontinence.1 These exercises are especially
useful for stress incontinence. But they may also help
weight often helps stress incontinence. Remember that
effective weight-loss programs depend on a combination of diet and exercise.
To learn more, see:
Sometimes making lifestyle changes can help with urge incontinence. Try to identify any foods that might
irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars,
dairy products, aspartame, and spicy foods—and cut back on them. Also, avoid
alcohol and caffeine.
If you smoke, try to quit. This may reduce coughing, which may reduce
your problem with incontinence. For more information, see the topic
Take steps to avoid constipation:
Urinary incontinence may be treated with medicines.
But in many cases, treatment with
behavioral methods (bladder training, timed urination) and Kegel exercises are tried before
medicines. These treatments, when combined with medicine, may help some women more than either treatment alone.
Botulinum toxin (Botox) may be used in people with nervous system diseases or problems (such as multiple sclerosis or a spinal cord injury) to stop bladder contractions that cause severe urge incontinence. But Botox will only be considered if other treatments haven't worked. Botox can cause serious side effects, including not being able to urinate at all.
There are several different kinds of
surgeries to correct
stress incontinence, which occurs when weakened
pelvic floor muscles allow the bladder neck and
urethra to drop. These surgeries seek to lift the
bladder, or both into the normal position. This makes sneezing,
coughing, and laughing less likely to make urine leak from the bladder.
Surgery works to cure stress incontinence better than any other treatment. If other treatments (like pelvic floor muscle exercises) haven't worked to control your incontinence, surgery may be your best option. What kind of surgery you have depends on your preference, your health, and your doctor's experience.
Surgery is done much less often for urge incontinence, and the results are not as good.
Other types of treatment for urinary incontinence include:
Before trying behavioral methods or exercise for urinary
incontinence, ask your doctor the following questions:
The AGS Foundation for Health in Aging was started by
the American Geriatrics Society (AGS). The foundation works on behalf of older
adults in the areas of wellness and preventive care, self-responsibility and
independence, and connections to family and community.
This website has stories about healthy aging, information on caring for elders at home,
and tips on winter safety, preparing for emergencies, and meeting the
challenges of healthy aging. The site also has links to many other Internet
resources on aging.
The American Urogynecologic Society (AUGS) is the
premier society dedicated to research and education in urogynecology and in the
detection, prevention, and treatment of female lower urinary tract disorders
and pelvic floor disorders.
UrologyHealth.org is a website written by urologists
for patients. Visitors can find specific topics by using the "search"
The website provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology A–Z page to find materials about urologic problems.
NAFC is a nonprofit national organization with a mission
of consumer advocacy, education of the public, and information dissemination
through collaboration and networking for the benefit of those with urinary
incontinence. NAFC's booklet "Your Personal Guide to Bladder Health" can be
ordered on the NAFC website.
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
The National Kidney Foundation works to prevent kidney
and urinary tract diseases and help people affected by these conditions. Its
website has a lot of information about adult and child conditions. The site
has interactive tools, donor information, recipes for kidney disease patients,
and message boards for many kidney topics. Free materials, such as brochures
and newsletters, are available.
Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).
Emmons SL, Otto L (2005). Acupuncture for overactive bladder. Obstetrics and Gynecology, 106(1): 138–143.
Other Works Consulted
Barber MD, et al. (2008). Transobturator tape compared
with tension-free vaginal tape for the treatment of stress urinary
incontinence. Obstetrics and Gynecology, 111(3):
Hartmann KE, et al. (2009). Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187 (AHRQ Publication No. 09-E017). Available online: http://www.ahrq.gov/clinic/tp/bladdertp.htm.
Kirchin V, et al. (2012). Urethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews (2).
Lipp A, et al. (2006). Mechanical devices for urinary incontinence in women. Cochrane Database of Systematic Reviews (7).
Naumann M, et al. (2008). Assessment: Botulinum
neurotoxin in the treatment of autonomic disorders and pain (an evidence-based
review): Report of the Therapeutics and Technology Assessment Subcommittee of
the American Academy of Neurology. Neurology, 70(19):
Shamliyan TA, et al. (2008). Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine, 148(6): 1–15.
Sung VW, et al. (2007). Comparison of retropubic vs transobturator approach to midurethral slings: A systematic review. American Journal of Obstetrics and Gynecology, 197(1): 3–11.
Tanagho EA, et al. (2008). Urinary incontinence. In EA
Tanagho, JW McAninch, eds., Smith's General Urology,
17th ed., pp. 473–489. New York: McGraw-Hill Medical.
Waetjen LE, et al. (2008). Factors associated with worsening and improving urinary incontinence across the menopausal transition. Obstetrics and Gynecology, 111(3): 667–677.
September 11, 2012
E. Gregory Thompson, MD - Internal Medicine & Avery L. Seifert, MD - Urology
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