Managing Incontinence

Medically Reviewed by Jabeen Begum, MD on March 15, 2024
Written by Sandra Gordon
11 min read

Incontinence means you have trouble controlling when you pee or poop. This can happen for many different reasons. It can be occasional and mild, or it can seriously interfere with your daily life.

With urinary incontinence, pee might leak when you laugh or cough. You could wet the bed or be unable to make it to the toilet in time.

Bowel incontinence can range from sometimes releasing a little poop when you pass gas to having sudden and uncontrollable urges to poop.

While incontinence can feel embarrassing, it's important to talk to a doctor if it happens to you. They can recommend the most effective ways to treat and manage it. Often, simple treatments like changes in your diet and exercises to strengthen certain muscles can improve your symptoms.

What is urinary incontinence?

Urinary incontinence is a common condition that most often happens because of problems with the muscles and nerves that help your bladder hold or release urine. It's most common in older people and after you've been through childbirth or menopause. It affects about 25 million adults in the U.S.

 Types of urinary incontinence

There are five basic kinds:

  1. Stress incontinence. It causes you to leak pee when you sneeze, cough, laugh, lift heavy objects, exercise, or do other things that put pressure on your bladder.
  2. Urge incontinence. Also known as overactive bladder (OAB), it is when you leak pee after feeling a sudden, strong urge to go. You may have OAB if you have to go eight or more times a day and more than once at night. Or you may feel the urge to go when you touch or hear running water. There's also a dry form of OAB: You get the urge to go even if your bladder is empty.
  3. Mixed incontinence. It is when you have stress and urge incontinence at the same time. This is more common in women.
  4. Overflow incontinence. It is more common in men and happens because you're unable to empty your bladder completely. Pee leaks out of your bladder once it's full.
  5. Functional incontinence. It is what happens when a medical condition, like arthritis, keeps you from getting to the bathroom in time.

Urinary incontinence causes

What causes incontinence? Some common reasons include:

Urinary tract infection. This infection can irritate your bladder, leaving you with a strong urge to pee and, sometimes, incontinence.

Pregnancy and childbirth. The strain from carrying a baby and giving birth can weaken muscles, ligaments, and nerves in your pelvis, leading to incontinence.

Menopause. Stress incontinence and OAB are more common during and after menopause when estrogen levels drop. Estrogen helps keep your bladder, pelvic muscles, and urethra healthy.

Prostate problems. You're more likely to have incontinence if you've had prostate surgery or have an enlarged prostate.

Smoking. Experts aren't sure why, but smokers are at a higher risk of incontinence than nonsmokers.

Being overweight. Excess pounds can put pressure on your bladder, causing it to leak.

Medical conditions. Some conditions damage nerves or muscles, such as diabetes, multiple sclerosis, and Parkinson's disease. Anxiety can also trigger incontinence in some people.

Medications. Some medications, such as diuretics ("water pills"), sedatives, sleeping pills, and some drugs to treat depression can cause incontinence or make it worse. Ask your doctor if your incontinence might be a side effect of your medication and whether there are other treatment options for you.

Hysterectomy. The muscles and ligaments that support your bladder may be damaged when you have surgery to remove your uterus.

Urinary incontinence treatments

Your doctor can create a treatment plan that addresses your symptoms and any conditions that might be causing the problem. Some options include:

Medication. Over-the-counter and prescription drugs can calm muscles and nerves and prevent bladder spasms.

Surgery. Your doctor may suggest surgery if your symptoms are serious and other treatments don't help. One common type of surgery, called a sling procedure, uses a small ribbon of mesh to support the bladder.

Devices. A pessary is a ring that's inserted into your vagina to reposition your urethra to prevent leaks.

Bladder training. By using the restroom at set times instead of waiting to feel the urge, you can slowly get control over your bladder and raise the time between bathroom trips.

Kegel exercises. Squeezing your pelvic floor muscles, which hold up your bladder, can make them stronger and help stop leaks. Here's how to do them:

  • To get a feel for the muscles you're targeting, stop the stream of pee while you're going. If you feel a sense of pulling, you're squeezing the right muscles.
  • When your bladder is empty, squeeze your pelvic floor muscles for a count of five, then relax them for 5 seconds. That's one rep.
  • Aim for three sets of 10 reps per day.

Biofeedback. An electrical patch is placed on your skin over your bladder and urethra. The patch is connected to a monitor so you can see when the muscles contract. This will help you learn to control them to prevent leaks.

Nerve stimulation. This sends quick pulses of electricity to muscles around your bladder, which may help strengthen them.

Lifestyle changes for incontinence

Drink plenty of water. You might think cutting back on water would make you have to go less, but not drinking enough can make the problem worse. Aim for six to eight 8-ounce glasses a day.

Watch what you eat. Cutting back on alcohol, carbonated drinks, coffee, tea, and spicy and acidic foods may improve your symptoms.

Lose weight. Taking off extra pounds can make incontinence symptoms better. Losing just 5% of your body weight can help. That's 10 pounds for a 200-pound person.

Quit smoking. You may have fewer leaks if you stop smoking.

If you have urge urinary incontinence and other treatments haven't worked for you, injections of botulinum toxin (Botox) may be an option. Your urologist injects it into your bladder to help relax the muscles there. This gives you more time to get to the bathroom once you feel the urge to pee.

The shots can be done in your doctor's office and usually take less than 5 minutes. You may get relief from your symptoms within a few days, and the results can last as long as 6 months.

This treatment isn't for everyone. It's not recommended if you're at a risk of an enlarged prostate, take blood thinners or muscle relaxers, or are pregnant or nursing. Ask your doctor if it might be right for you.

What is bowel incontinence?

Bowel incontinence, also called fecal incontinence, happens when you're not able to control your bowel movements, leading you to leak solid or liquid poop. It's more common in older people, but anyone can get it. Nearly 18 million adults in the U.S. have bowel incontinence.

Bowel incontinence causes

Some common causes are:

Diarrhea. Loose poop is harder to hold than solid poop.

Constipation. Watery poop may build up behind large, hard stools and leak around them.

Muscle damage or weakness. Childbirth injuries, cancer surgery, and hemorrhoid surgery may damage or weaken the muscles that keep your anus closed, leading to leakage.

Nerve damage. Some conditions, like diabetes and multiple sclerosis, can affect the nerves around the rectum.

Being physically inactive. People who spend many hours sitting or lying down, such as older adults who can't move around well, are at a risk of bowel incontinence.

Childbirth. Injuries to muscles and nerves in the pelvic floor can lead to bowel incontinence, especially when forceps are used or if you have an episiotomy (a cut in the vaginal area to prevent tearing during delivery).

Hemorrhoids. This can prevent the muscles around the anus from working properly, leading to incontinence.

Medical conditions. If you are lactose intolerant or have intestinal disorders, like inflammatory bowel disease (IBD) and irritable bowel syndrome, you may get bowel incontinence.

Medications. Some medications, like laxatives, can lead to incontinence.

Bowel incontinence treatment

Some common treatments include:

Medication. Over-the-counter and prescription drugs may help. Antidiarrhea medicines can reduce the number of times you poop and the urge to go, while bulking agents, like fiber supplements, can make poop firmer and easier to control.

Bowel training. Getting your body used to going at scheduled times, like after every meal, can cut down on incontinence.

Surgery. Several different procedures are available that can repair injuries (like a muscle torn during childbirth) that cause incontinence. A colostomy is another surgery that provides a way to collect stool in a bag outside of your body.

Kegel exercises and biofeedback. They're not just for urine incontinence. Having strong pelvic floor muscles and an understanding of which muscles to squeeze can improve bowel control.

Diet changes. Eating more (or less) fiber and avoiding caffeine, alcohol, dairy, and spicy foods may help. Keeping a food diary can help you understand what foods might be playing a role in your incontinence. Your doctor can suggest diet changes based on your situation.

Anal electrical stimulation. A small probe is inserted into the rectum for a few minutes every day for 8-12 weeks. It sends a mild electrical current to the muscles around the rectum, causing them to contract, which helps make them stronger.

Aids that can help you manage incontinence and live an active life come in a variety of styles and sizes. Look for a type that fits your body well, wicks away moisture, and offers the level of protection you need. Here's an overview of what's available.

Liners. These thin, throwaway pads are for light to moderate urinary incontinence They work best with female anatomy and women's underwear.

Pads. For heavier pee leaks, you can wear disposable absorbent pads with your regular underwear.

Male guards. For light to medium protection, these disposable guards fit in briefs and have a sticky backing to keep them in place.

Protective underwear. These look similar to regular underwear, but they are designed with extra padding in the crotch for female anatomy and a leak-proof panel in the front for male anatomy. They're suitable for moderate to heavy incontinence. There are both disposable and reusable varieties. Some can be worn with a liner or pad.

Underpads. You place these cloth-like waterproof pads on your bed to protect your mattress and the sheets when you sleep. You can also use them while you're sitting in a chair or on a sofa to absorb any wetness. There are washable and disposable varieties.

When you have bowel or urinary incontinence, you're more likely to have skin problems around your hips, pelvis, rectum, or genitals. You may develop redness, peeling, and yeast infections because of too much moisture in those areas.

Here are steps you can take to protect your skin:

  • Clean and dry yourself after peeing or pooping. Consider a premoistened wipe to keep your skin clean and dry.
  • Use soap-free, fragrance-free cleansers.
  • Apply a moisturizer that doesn't contain alcohol.
  • Create a moisture barrier by applying creams or ointments that contain zinc oxide, lanolin, or petrolatum. Reapply after each time you urinate or have a bowel movement.
  • Treat yeast infections (itchy red rashes) with an over-the-counter antifungal medication.
  • Talk to your doctor if you have a serious skin problem or if the irritation or yeast infection won't go away.

A few studies show that people with urinary incontinence are more likely to have low back pain and vice versa. It's not clear what the connection might be. But when you have urinary incontinence, your pelvic floor muscles may not work as well as they should. Some researchers think this contributes to instability in the lower trunk and overloads muscles in the spine.

We need more research into whether the two conditions are related and why. The two conditions share some risk factors, such as older age and obesity, so it's possible they simply affect some of the same populations.

A rare disorder called cauda equina syndrome (CES) can cause both back pain and incontinence. It happens when a bundle of nerves in your lower spine (the cauda equina) get pinched or compressed. Because these nerves help provide feeling and movement to your legs and groin area, CES can lead to urinary or bowel incontinence as well as back pain.

It may be caused by a ruptured disk, a tumor, or wear and tear on your spine. It can happen suddenly or over time. If you have sudden back pain and incontinence, get medical help right away. If it's not treated, CES could lead to permanent never damage or even paralysis.

 

 

 

Discussing incontinence with anyone may feel awkward. But incontinence is treatable, so getting your doctor's advice is the first step. Treatment can help you get back to your normal activities and make you feel better about yourself.

These tips can help you feel more comfortable when you're out in public:

  • Wear a pad or protective underwear.
  • Always use the bathroom just before going out.
  • Wear clothes and underwear that are easy to get on and off.
  • Find out ahead of time where the bathrooms are in the place where you're going.
  • Carry a change of clothes and supplies to clean yourself up, just in case.
  • Use over-the-counter fecal deodorants, pills that can reduce the smell of gas and poop.

Getting advice from others who also have incontinence can help, too. You can find out what treatments and lifestyle changes have worked for them. Blogs and message boards can be convenient places for you to get ideas and talk openly with others. The National Association for Continence has an active online community. If you're feeling frustrated or down about your condition, support can make all the difference.

Incontinence is a common condition in which you have trouble controlling when you pee or poop. It can be inconvenient and embarrassing, but there are ways to treat and manage it. See your doctor if incontinence affects you.

Can I use a sanitary pad to manage my incontinence?

Sanitary pads are designed to absorb slow menstrual flow not full urination or liquid poop. If you have very light urinary incontinence, sanitary pads may be enough. Otherwise, incontinence aids will provide more protection against leaks and odor and will keep moisture away from your skin.

Does incontinence ever go away?

If your incontinence is caused by a short-term condition, like a urinary track infection or diarrhea from a bout of food poisoning, it will go away once your illness does. Giving birth will probably take care of incontinence caused by pregnancy. But if it's due to a long-lasting condition like diabetes or IBD, you'll likely need treatment to keep your symptoms under control.

What age does incontinence start?

Incontinence is more common in people over 50, but it's not considered a normal part of aging. If incontinence is interfering with your life, ask your doctor about ways to treat and manage it, no matter what your age.

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