What Is Urinary Incontinence?
Urinary incontinence is a condition in which you accidentally leak pee. It affects millions of Americans, most of them women and people assigned female at birth (AFAB). There are many different types, causes, and treatments.
Urinary Incontinence Types
There are many types of urinary incontinence, each caused by different factors.
Stress urinary incontinence
This type is caused by weakened pelvic floor muscles and tissues. It can happen when there’s extra pressure on your bladder, such as when you exercise, laugh, sneeze, or cough.
Pregnancy and childbirth can stretch and weaken the pelvic floor muscles. Other things that can lead to stress incontinence are:
- Being at an unhealthy weight or having obesity
- Neurological conditions
- Trauma to the urethral sphincter muscle
- Taking certain medications
- Menopause
- Prostate surgery
Urge urinary incontinence
Also called overactive bladder, this type occurs when you have an urgent need to go to the bathroom and may not get there in time.
Causes ofoveractive bladder include:
- Damage to your bladder's nerves
- Damage to other parts of the nervous system
- Damage to muscles
- Menopause
- Aging
Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Bladder problems, such as infections and bladder stones, and certain medications can also cause it.
Overflow urinary incontinence
If you can't empty your bladder, you may have overflow incontinence. This means you may dribble urine when your bladder gets too full.
Causes include:
- Weak bladder muscles
- Nerve damage
- Conditions that block the flow of urine, such as tumors or an enlarged prostate
- Constipation
- Certain medications
You need to get the condition treated. If your bladder can't empty, that can lead to health concerns such as infections.
Functional urinary incontinence
This is when conditions that affect your cognitive abilities (such as dementia) or that cause physical problems (such as arthritis) prevent you from getting to the bathroom in time.
Reflex incontinence
This type of incontinence is caused by nerve damage from traumatic injuries or conditions such as multiple sclerosis. The nerves in the bladder lose the ability to correctly communicate with the brain, so your brain might not get the urgency signal. Because of this, your bladder might leak without any warning. It’s also called “unaware” or “unconscious” incontinence.
Mixed urinary incontinence
This means you have more than one type of urinary incontinence. Many women and people AFAB have both stress and urge incontinence.
Treatment for Different Types of Urinary Incontinence
Lifestyle changes and treatments can help with symptoms. Your doctor can help you come up with a plan that’s right for you. For stress incontinence, treatments include:
Treatments for stress incontinence
The goal for treating stress incontinence is to strengthen the pelvic floor muscles — the muscles that support the bladder, urethra, and other organs in the pelvic region.
Pads and vaginal inserts. Vaginal inserts can provide extra support for the bladder and nearby organs. Meanwhile, until you finish strengthening your pelvic floor muscles, pads are a good backup measure to absorb leaks.
Pelvic floor exercises. If you've had a baby, chances are you've been told to doKegel exercises. These help strengthen the pelvic floor after childbirth. They also help prevent stress incontinence. Best of all, you can do Kegels anytime, anywhere.
Here's how:
- Squeeze the muscles that you use to stop the flow of pee.
- Hold the squeeze for 10 seconds, then rest for 10 seconds.
- Do three or four sets daily.
Note: You can learn how to do Kegels by stopping your pee, but don’t do this routinely. Stopping the flow of pee can lead to an infection.
Biofeedback. For this treatment, you have an appointment with a therapist who gently places sensors on either side of your butt hole and on your stomach. As you do pelvic floor exercises, a computer program shows which muscles you are using. This helps you learn how to do them correctly.
Electrical stimulation. This technique uses a weak flow of electricity to trigger your pelvic muscles to tense. Regular sessions can be used together with pelvic muscle exercises. The device is about the size of a coin and is called a tibial neurostimulator. You put it in your vagina and raise the electrical current to a comfortable level (it should feel like a tingle). You can get a device to use at home. Check with your insurer to see if they might help cover the cost.
Pessary. Your doctors may prescribe a device called a pessary. You put it into thevagina, where it repositions the urethra (the tube that carries pee out of your bladder) to help prevent leakage.
Injections and surgery. Shots to strengthen your urethral area may help. In more extreme cases, you may need surgery. One procedure pulls the urethra back up to a more normal position, relieving the pressure and leakage. Another surgery involves securing the urethra with a "sling that holds it up so it won’t leak."
Vaginal estrogen cream. If your leaky bladder is caused by menopause, hormone therapy might help. Ask your doctor about an estrogen patch or a vaginal cream that contains estrogen.
Treatments for urge incontinence
For urge incontinence, treatment options include:
Timed voiding and bladder training. First, you complete a chart of the times you pee and the times you leak. You observe patterns and then plan to empty your bladder before an accident happens. You can also "retrain" your bladder, slowly increasing the time between bathroom visits.Kegel exercises are also helpful.
Medications, electrical stimulation, or surgery. Doctors sometimes prescribe medicines (or inject Botox in the bladder) that block the contractions of an overactive bladder. Electrical stimulation of the bladder nerves helps in some cases. Surgery to increase the amount of pee your bladder can hold is an option, but this is only for severe cases.
Vaginal estrogen cream. Hormone therapy also can help with urge incontinence caused by menopause.
Treatments for overflow incontinence
For overflow incontinence, treatments include:
Pads. These are a good backup measure for absorbing leaks.
Medication or surgery. Medicines called alpha-blockers often can help if the problem is caused by an enlarged prostate. If there's a blockage that prevents pee from leaving your bladder, you may need surgery.
Catheter. Some people use a catheter to make sure their bladder is emptied. It's a thin plastic tube that you insert in your urethra. A doctor or nurse can teach you how to put it in yourself.
It's important to identify any underlying disease or blockage causing overflow incontinence and treat that.
Talk to Your Doctor
You might feel embarrassed to talk about your urinary incontinence, but it’s worth it. Your doctor can help you figure out what’s causing your problem. That’s the first step toward getting help.
You can be honest and direct with your doctor. Simply tell them, "I'm having bladder problems."
Your doctor should ask questions, like how long the leakage has been happening, how bad it is, and how it affects your life. They may suggest tests or refer you to an expert in this kind of problem.
Takeaways
Urinary incontinence (or a leaky bladder) is very common. There are a few different types of urinary incontinence, each with its own treatment options. Talk with your doctor about your symptoms. They can recommend the right treatment for you.
Urinary Incontinence FAQs
What is the most common type of urinary incontinence?
The most common type is stress incontinence.
How is urinary incontinence diagnosed?
Your doctor will probably ask you some questions, give you a physical exam, and take a urine sample. They may recommend an ultrasound of your bladder, stress test, cystoscopy, or urodynamic testing. They may also give you a pad to wear so they can see how much pee you’re leaking.
Can urinary incontinence come and go?
Urinary continence can be temporary. Temporary incontinence could be caused by a urinary tract infection, pregnancy, constipation, and certain medications and beverages.
What types of urinary incontinence are progressive?
An overactive bladder can cause symptoms such as frequent and uncontrollable urges to pee (urge incontinence), which can get worse over time if not treated.
What types of urinary incontinence is physical therapy good for?
Pelvic floor exercises (such as Kegel exercises) can help treat stress incontinence, which is caused by weak pelvic floor muscles.
Why do I have the urge to pee but little comes out?
If you feel like you have to pee but nothing (or very little) comes out, you might have a urinary tract infection.
