What is urinary incontinence?

The main symptom of urinary incontinence is the accidental release of urine. Symptoms depend on the type of incontinence. You may leak urine when you sneeze or cough, or you may always leak urine. Or you may feel a strong urge to urinate, but urine leaks because you can't reach the toilet in time.

Stress incontinence means leaking urine while coughing or jogging. Urge incontinence means not getting to the toilet in time. Overflow incontinence means leaking urine because your bladder doesn't empty completely. Or you may have a mix of these types. And functional incontinence is being physically unable to get to the toilet in time.

Treatment for urinary incontinence depends on the type you have and how much it affects your life.

Treatments may include:

• Bladder training. This can help you better control when you have to urinate.
• Pelvic floor exercises (Kegels). These help strengthen the muscles that control the flow of urine.
• Medicines. An antidepressant medicine or other medicines may help with bladder control. Estrogen cream used in the vagina may also help.
• Changes in your diet and lifestyle. One example is to limit caffeine, carbonated drinks, and alcohol. These can make you urinate more.
• Medical devices.
  • Urinary catheter. This includes condom catheters.
  • Penile clamp. This may work for short-term use.
  • Incontinence pessary. This fits into the vagina and compresses the urethra.
• Surgery. When other treatments aren't helping enough, you may need surgery. Types of surgery include urethral bulking, surgery to treat an enlarged prostate, and perineal or urethral sling surgery.

You may reduce your chances for urinary incontinence by:

• Doing pelvic floor (Kegel) exercises. They strengthen your pelvic muscles.
• Getting to and staying at a healthy weight.
• Quitting smoking. Smoking causes coughing, which can make it harder to control your urine.
• Limiting caffeine, carbonated drinks, and alcohol.
• Avoiding constipation by eating a healthy, high-fiber diet.

Your doctor will ask about your health history. You'll be asked how often and how much you urinate and leak urine. Your doctor will do a physical exam and check a sample of your urine. And you may need other tests to make sure your incontinence isn't caused by another condition.

Any of the following health professionals can diagnose and treat urinary incontinence:

• Family medicine physician
• Internist
• Physician assistant
• Nurse practitioner
• Urologist
• Geriatric medicine specialist

If you need surgery to treat your incontinence, make sure to find a surgeon who is experienced in the type of surgery you need, usually a urologist.

Several types of behavioral methods are used for treating urinary incontinence: bladder training, pelvic muscle exercises (Kegels), and biofeedback. People who have incontinence due to physical or mental limitations (functional incontinence) also have options. They can plan to use the toilet before they feel like they need to go. Or they can schedule regular times to use the toilet.

Bladder training

Bladder training helps to increase how long you can wait before having to urinate. You can start by keeping a voiding diary for 24 hours. This will help you track the shortest time you have before you need to urinate again.

Using your shortest time, make a schedule to go to the toilet at this interval all day long. Go to the toilet at these times whether or not you feel the need. Once you can avoid leaking for a full day, increase your scheduled time by 15 minutes. Do this until you are able to be comfortable urinating every three to four hours.

Biofeedback

Biofeedback can be helpful if you are having difficulty doing pelvic floor exercises. During biofeedback, you'll get information on how well you are contracting your pelvic floor muscles.

Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:

• Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
• Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.

If you are having trouble finding out what muscles to squeeze, you can try stopping the flow of urine a few times. But don't make it a practice to do Kegels while urinating.

If doing these exercises causes pain, stop doing them and talk with your doctor. Sometimes people have pelvic floor muscles that are too tight. In these cases, doing Kegel exercises may cause more problems.

If you aren't sure how to do these exercises, talk to your doctor about getting a referral to a pelvic floor physical therapist.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working.

Surgery is usually considered when other kinds of treatments aren't helping enough. The surgery options will depend on what is causing the incontinence. Surgery won't always cure the symptoms. But it will usually improve them.

Surgery choices

For incontinence caused by an enlarged prostate (benign prostatic hyperplasia, or BPH), options include:

• Minimally invasive procedures, such as prostatic urethral lift and water vapor thermal therapy.
• Transurethral resection of the prostate (TURP).
• Simple prostatectomy.

Severe incontinence caused by removal of the prostate (radical prostatectomy) may be treated with surgery if the incontinence doesn't go away after a period of watchful waiting. These procedures include:

• Urethral bulking. Material is injected around the urethra, the tube that carries urine from your bladder to the outside of your body. This procedure makes it less likely that urine will leak out.
• Perineal sling. A sling is placed beneath the urethra to lift and compress the urethra. This gives the urethra greater resistance to pressure from the belly.
• Artificial urinary sphincter. A silicone cuff is fitted around the urethra. The device also includes a balloon reservoir and a pump. You can inflate or deflate the device to control urination.

For incontinence not helped by other treatments, options may include:

• Sacral nerve stimulation (SNS). An electrical stimulator is placed under your skin. It sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.
• Surgery to make the bladder bigger (augmentation cystoplasty).
• Surgery to make another way to store and pass urine (urinary diversion).

Many things have been linked to an increased risk of urinary incontinence in men.

Physical conditions or lifestyle factors include:

• Having something that blocks the flow of urine, like scar tissue or an enlarged prostate.
• Injury to the bladder or urethra. This can happen with radiation therapy or prostate surgery.
• Bladder infection or prostatitis.
• Obesity.
• Constipation.
• Slowness in getting to the toilet due to mobility problems.

Medicines and foods include:

• Spicy or acidic foods.
• Caffeinated and fizzy drinks, such as coffee, tea, and soda pop.
• Alcohol.
• Prescription medicines, such as antidepressants, diuretics, and opioids.
• Over-the-counter medicines, such as allergy and cold medicines.

Diseases and health conditions include:

• Enlarged prostate. This is also called benign prostatic hyperplasia (BPH).
• Neurological conditions. Examples are Parkinson's disease, stroke, and multiple sclerosis.
• Having a history of smoking.

Keeping a daily record can help you and your doctor find the best treatment for urinary incontinence.

Keep a record of what you drink and all urine released, whether voluntary or involuntary. Your doctor may call this a voiding diary or bladder record. This may be a 24-hour diary or one that covers several days.

Record in your diary:

• The time and amount of each urination. (You'll need a measuring container to collect and measure the amount of urine.)
• The conditions under which urine release occurred, such as voluntary urination in the toilet, involuntary urine release, or leakage due to sneezing, laughing, or physical exertion.
• The amounts and types of all liquids consumed. This includes frozen liquid items such as ice cream and frozen fruit juice bars.
• Whether the liquid consumed contained caffeine (if your doctor asks you to specify this information).

You can find information about a bladder diary or voiding diary online. Or your doctor's office may have one available.

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 toilet but can't get there in time. These problems are very common, especially among older adults. They usually don't cause major health problems.

Urinary incontinence may be caused by:

• Weak or damaged pelvic floor muscles.
• Problems or damage either in the urinary tract or in the nerves that control urination.
• A bladder that gets too full. This can happen if your bladder doesn't empty when it should. It can also happen if something is blocking your urethra.

In women, it can be caused by childbirth, weight gain, or other conditions that stretch or weaken the pelvic floor muscles.

In men, incontinence is often related to prostate problems or treatments.

It also may be caused by conditions such as multiple sclerosis, Parkinson's disease, or stroke. Other causes include certain medicines, such as antihistamines and decongestants. Often doctors don't know what causes it.