What Is Urinary Incontinence? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Medically Reviewed

Urinary incontinence (UI), the involuntary loss of urine, is a very common condition that no one wants to talk about. Because of the stigma that surrounds it, many people are too humiliated to seek help. But most conditions that cause UI can be corrected with medical or alternative interventions.

Occurring much more often in women than men, UI happens when the muscles in the bladder that control the flow of urine contract or relax involuntarily, resulting in leaks or uncontrolled urination. UI itself is not a disease, but it can be a symptom of an underlying medical issue.

According to the Urology Care Foundation, women are at greater risk for UI than men because they have a shorter urethra than men. As a result, any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in your bladder until you are ready to urinate.

Signs and Symptoms of Urinary Incontinence

The following are signs you should see a doctor: (1)

  • Leaking urine during normal activities like lifting, bending, coughing, or exercising
  • Sudden, strong urges to urinate; feeling like you might not make it to the toilet in time
  • Leaking urine without feeling any warning sign or urge
  • Bed-wetting

Causes of Urinary Incontinence (UI)

Incontinence may be a temporary problem caused by a vaginal or urinary tract infection (UTI), constipation, or certain medications, or it can be a chronic condition.

The most common causes of chronic incontinence include: (2)

The stigma around urinary incontinence stops many people from seeking treatment. Yet most conditions that cause UI can be corrected with medical or alternative interventions.

Types and Varieties of Urinary Incontinence (UI)

While there are many different types of urinary incontinence, the most common include stress incontinence and overactive bladder (also called urge incontinence).

RELATED: Overactive Bladder: Causes, Risk Factors, and Symptoms

Stress Incontinence

Stress incontinence occurs when there is unexpected leakage of urine caused by pressure or sudden muscle contractions on the bladder. This often occurs during exercise, heavy lifting, coughing, sneezing, or laughing. Stress incontinence is the most common bladder control problem in young and middle-aged women. In younger women, the condition may be due to an inherent weakness of the pelvic floor muscles or an effect from the stress of childbirth. In middle-aged women, stress incontinence may begin to be a problem at menopause. (2)

Urge Incontinence

Sometimes called overactive bladder, or OAB, urge incontinence occurs when a person feels the urge to urinate but is unable to hold back the urine long enough to get to a bathroom. Urge incontinence sometimes occurs in people who've had a stroke or have chronic diseases such as diabetes, Alzheimer's disease, Parkinson's disease, or multiple sclerosis. In some cases, urge incontinence may be an early sign of bladder cancer. (2)

RELATED: What Are the Different Reasons for Frequent Urination?

Other Types of Urinary Incontinence

  • Overflow incontinence This occurs when a person is unable to empty their bladder completely and it overflows as new urine is produced. It's often found in people with diabetes or spinal cord injuries. (2)
  • Mixed incontinence You show evidence of more than one type. (2)
  • Functional incontinence This type of incontinence has less to do with a bladder disorder and more to do with the logistics of getting to a bathroom in time. It's usually found in elderly or disabled people who have normal or near normal bladder control but cannot get to the toilet in time because of mobility limitations or confusion. (2)
  • Nocturia The need to urinate twice or more during the night, usually affecting men and women over the age of 60. (3) In men, nocturia can be a symptom of an enlarged prostate.

Forms of Urinary Incontinence That Affect Men Only

Forms of Urinary Incontinence That Affect Women Only

  • Pelvic organ prolapse occurs when the bladder, uterus, or rectum fall into the vaginal canal, creating a blockage. (6)
  • Pregnancy and childbirth cause physical trauma that can lead to either stress incontinence or overactive bladder. (6)
  • UI affects more than 50 percent of post-menopausal women. (7)
Incontinence is more common in older people, but it is not considered a normal part of aging.

Risk Factors for Urinary Incontinence

The following factors may put you at higher risk for developing UI. (6)

Being female Women experience stress incontinence twice as often as men. Men, on the other hand, are at greater risk for urge and overflow incontinence.

Advancing age As we get older, our bladder and urinary sphincter muscles often weaken, which may result in frequent and unexpected urges to urinate. Even though incontinence is more common in older people, it is not considered a normal part of aging.

Excess body fat Extra body fat increases the pressure on the bladder and can lead to urine leakage during exercise or when coughing or sneezing.

Other chronic diseases Vascular disease, kidney disease, diabetes, prostate cancer, Alzheimer's disease, multiple sclerosis, Parkinson's disease, and other conditions may increase the risk of urinary incontinence

Smoking A chronic smoker's cough can trigger or aggravate stress incontinence by putting pressure on the urinary sphincter.

High-impact sports While sports don't cause incontinence, running, jumping, and other activities that create sudden pressure on the bladder can lead to occasional episodes of incontinence during sports activities. (8)

RELATED: Why Does Diabetes Make You Urinate So Much?

How Is Urinary Incontinence Diagnosed?

Urinary incontinence is easy to recognize. The primary symptom most people experience is an involuntary release of urine. But the type and cause of the incontinence can be more difficult to determine and may require a variety of exams and tests. Most physicians will use the following: (9)

A bladder diary Your doctor may have you track your fluid intake and output over several days. This may include any episodes of incontinence or urgency issues. To help you measure the amount of urine you pass during an episode of incontinence, you may be asked to use a calibrated container that fits over your toilet to collect the urine.

Urinalysis A urine sample can be checked for infections, traces of blood, or other abnormalities, such as the presence of cancer cells. A urine culture can assess for infection; urine cytology looks for cancer cells.

Blood tests Blood tests can look for chemicals and substances that may relate to conditions causing the incontinence.

Pelvic ultrasound In this imaging test, an ultrasound device is used to create an image of the bladder or other parts of the urinary tract to check for problems.

Postvoid residual (PVR) measurement In this procedure, the patient empties the bladder completely and the physician uses a device to measure how much urine, if any, remains in the bladder. A large amount of residual urine in the bladder suggests overflow incontinence.

Stress test In this test, the patient is asked to cough or vigorously tense her midsection as though exerting herself while the physician checks for loss of urine.

Urodynamic testing This test measures the pressure that the bladder muscles and urinary sphincter can tolerate both at rest and during filling.

Cystogram In this series of X-rays of the bladder, a dye is injected into the bladder and as the patient urinates, the dye shows up in the X-rays and can reveal abnormalities in the urinary tract.

Cystoscopy This procedure uses a thin tube with a tiny lens and a light at one end called a cystoscope. After the administration of some sedation medications or anesthesia, the cystoscope is inserted into the urethra and the physician visually checks the lining of the bladder and urethra.

RELATED: How Doctors Diagnose Kidney Stones and What to Know Before Your Appointment

Prognosis of Urinary Incontinence

UI is usually curable, and if not, then controllable. (5)

Duration of Urinary Incontinence

Most cases of UI are chronic, and will remain so until treated. Depending on the cause, however, not all UI cases are chronic. If the cause is temporary, such as a vaginal infection or a urinary tract infection, the UI will stop once the issue is addressed. (10)

RELATED: What Do the Color and Smell of Your Urine Tell You?

Treatment and Medication Options for Urinary Incontinence

There are many ways to treat UI. Your healthcare professional will help you tailor a treatment plan that is directed at the underlying cause.

Medication Options

These drugs are commonly used to treat UI, specifically urge incontinence: (2)

  • To calm overactive bladders and help suppress urge incontinence: oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and trospium (Sanctura)
  • Mirabegron (Myrbetriq) Mirabegron treats urge incontinence by relaxing the bladder muscle and increasing bladder capacity, and helps you completely void your bladder.
  • Alpha blockers For men with urge or overflow incontinence, these medications relax bladder neck muscles and prostate muscle fibers, enabling easier emptying of the bladder: tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura), and terazosin.
  • Topical estrogen For women, this low-dose, topical estrogen in the form of a vaginal cream, ring, or patch can help strengthen urethra and vaginal area tissues. (Warning: The pill version may make UI worse.)

Surgery or Implants

The two most common surgical procedures used to treat stress incontinence include sling procedures (there are male and female sling designs) and bladder neck suspension procedures. (10)

Sacral nerve stimulation is sometimes used to treat overactive bladder. This treatment involves a surgical procedure that implants a small device below the skin of the buttock. This device periodically generates a mild electrical stimulation to the sacral nerves, which results in increased tension in the bladder, sphincter, and pelvic floor muscles. (11)

Injectable implants feed bulking material into the urethra to control UI caused by a weak sphincter muscle. (12)

Alternative and Complementary Therapies

The treatment of urinary incontinence varies depending on the cause of the bladder control problem. In most cases, a physician will try the simplest treatment approach before resorting to medication or surgery. (2)

Bladder habit training This is the first approach for treating most incontinence issues. The goal is to establish a regular urination schedule with set intervals between urination. A doctor will usually recommend urinating at one-hour intervals and gradually increasing the intervals between urination over time.

Pelvic muscle exercises Also called Kegel exercises (named after the gynecologist Dr. Arnold Kegel, who developed them), this exercise routine helps strengthen weak pelvic muscles and improve bladder control.

The person contracts the muscles used to keep in urine, holds the contraction for 4 to 10 seconds, then relaxes the muscles for the same amount of time.

It may take weeks or months of regular pelvic exercise to show improvement.

Another way to perform Kegel exercises is to interrupt the flow of urine for several seconds while urinating.

RELATED: Can Mindfulness Help Treat Overactive Bladder?

Products to Help Manage Incontinence

Many people find the following products (13) useful for dealing with incontinence symptoms:

  • Pads and undergarments Absorbent, non-bulky pads and underwear are worn discreetly under clothing and are available in different sizes for both men and women. For those with mild or moderate leakage, panty liners are sometimes all that's required.
  • Patches and plugs Many women are able to manage light leakage from stress incontinence by using products that block the flow of urine, such as a small, disposable adhesive patch that fits over the urethral opening, a tampon-like urethral plug, or a vaginal insert called a pessary.
  • Catheters For otherwise unmanageable incontinence, a physician can place a catheter in the urethra to continually drain the bladder. Due to a higher risk of developing infections and kidney stones, catheters are usually a last resort and used only for severely ill patients.

Prevention of Urinary Incontinence

You can decrease your risk of developing UI by: (2)

  • Maintain a healthy weight.
  • Practice pelvic floor exercises.
  • Avoid irritants to the bladder (such as caffeine, alcohol, and acidic food).
  • Drink no more than 64 ounces of liquids per day.
  • Get more fiber into your diet, which can help prevent constipation.
  • Quit smoking.

Complications of Urinary Incontinence

If left untreated, UI can lead to: (2)

Research and Statistics

UI is a very common issue, and more than 25 million Americans experience urinary leakage every day. (14) It affects women twice as often as men, occurring in approximately 20 to 30 percent of young women, 30 to 40 percent in midlife and up to 50 percent of women in their senior years. (7)

Related Conditions and Causes of Urinary Incontinence

Fecal incontinence is light to moderate bowel leakage due to diarrhea, constipation, or muscle or nerve damage. (15)

As described in the section above on causes of urinary incontinence, common conditions may contribute to chronic urinary incontinence, including: (2) urinary tract infection (UTI), constipation, interstitial cystitis (chronic bladder inflammation) or other bladder conditions, nerve damage that affects bladder control, side effects from a prior surgery, and neurological disorders.

Resources We Love

American College of Obstetricians and Gynecologists

ACOG provides education for women with UI. It also helps you find a gynecologist in your area.

National Association for Continence

NACF offers support and education for patients, caregivers, and professionals.

National Institute of Diabetes and Digestive and Kidney Diseases Health and Information Center

NIDDK conducts and supports research on health issues related to many diseases, including urological ones.

Urology Care Foundation

The official foundation of the American Urological Association, UCF provides support and education and helps you find a urologist in your area. You can also opt in to receive free copies of its UrologyHealth Extra magazine.

Learn More About Urinary Incontinence Resources

Editorial Sources and Fact-Checking

  1. Symptoms and Causes of Bladder Control Problems (Urinary Incontinence). National Institute of Diabetes and Digestive and Kidney Diseases. June 2018.
  2. Urinary Incontinence. Mayo Clinic. April 13, 2019.
  3. Nocturia. Cleveland Clinic. January 6, 2020.
  4. Men’s Conditions. National Association for Continence.
  5. Urinary Incontinence in Older Adults. National Institute on Aging. May 16, 2017.
  6. Women’s Conditions. National Association for Continence.
  7. Kolodynksa G, et al. Urinary Incontinence in Post-Menopausal Women — Causes, Symptoms, Treatments. Menopause Review. April 2019.
  8. Brito Cardoso AM, et al. Prevalence of Urinary Incontinence in High-Impact Sports Athletes and Their Association With Knowledge, Attitude, and Practice About This Dysfunction. European Journal of Sport Science. July 19, 2018.
  9. Urinary Incontinence Diagnosis. Stanford Health Care.
  10. What Is Urinary Incontinence? Urology Care Foundation. April 2020.
  11. Neuromodulation for Female Urinary Incontinence. NYU Langone Health.
  12. Urinary Incontinence: Injectable Implant. Penn State Milton S. Hershey Medical Center. January 31, 2019.
  13. Urinary Incontinence Products. MedlinePlus. September 11, 2020.
  14. Home Page. National Association for Continence.
  15. Bowel Health. National Association for Continence.
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