Urinary (or bladder) incontinence happens when you are not able to keep urine from leaking out of your urethra, the tube that carries urine out of your body from your bladder. You may leak urine from time to time. Or, you may not be able to hold any urine.
The three main types of urinary incontinence are:
Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise.
Urge incontinence -- involves a strong, sudden need to urinate. Then the bladder squeezes and you lose urine. You don't have enough time after you feel the need to urinate to get to the bathroom before you do urinate.
Overflow incontinence -- occurs when the bladder cannot empty. This leads to dribbling.
Mixed incontinence -- involves more than one type of urinary incontinence.
Bowel incontinence is when you are unable to control the passage of stool. It is not covered in this article.
Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary
Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine.
You should feel the first urge to urinate when there is around 200 mL (just under 1 cup) of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. At the same time, the bladder should keep filling.
The average person can hold around 350 to 550 mL (more than 2 cups) of urine in the bladder. Two muscles help control the flow of urine:
The sphincter (the circular muscles around the opening of the bladder) must be able to squeeze to prevent urine from leaking.
The bladder wall muscle (detrusor) must stay relaxed so the bladder can expand.
When it is time to empty the bladder, the bladder wall (detrusor) muscle contracts or squeezes to force urine out of the bladder. Before this muscle squeezes, your body must be able to relax the sphincter to allow the urine to pass out of your body.
To control urination, you must have:
A working urinary system
A working nervous system
The ability to feel and respond to the urge to urinate
Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not incontinent before they have been toilet trained. Children up to age 6 may still have accidents sometimes. Young (and sometimes teenage) girls may leak a little bit of urine when they laugh.
It is normal for children to wet the bed until age 5 or 6.
Causes of urinary incontinence include:
Blockage in the urinary system
Brain or nerve problems
Dementia or other mental health problems that make it hard to feel and respond to the urge to urinate
Problems with the urinary system
Nerve and muscle problems
Incontinence may be sudden and go away after a short period of time. Or, it may continue long-term. Causes of sudden or temporary incontinence include:
Bedrest -- for example, when recovering from surgery
Certain medications (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines for allergies)
Prostate infection or inflammation
Stool impaction from severe constipation, which causes pressure on the bladder
Nervous system conditions, such as multiple sclerosis or stroke
Nerve or muscle damage after radiation treatment to the pelvis
Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vagina, which may be caused by pregnancy and delivery
Problems with the urinary tract
Spinal cord injuries
Weakness of the sphincter, the circle-shaped muscles that open and close the bladder (this can be caused by prostate surgery in men, or surgery to the vagina in women)
See your health care provider for tests and a treatment plan. What type of treatment you get depends on what caused your incontinence and what type you have.
The following methods are used to strengthen the muscles of your pelvic floor:
Bladder retraining -- You urinate on a schedule, whether or not you feel a need to go. In between bathroom visits, you try to wait until the next scheduled time. At first, you may need to schedule urination every hour. Gradually, you can increase by 1/2 hour at a time until you only urinate once every 3 - 4 hours without leaking.
Kegel exercises -- squeeze the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises three times a day. You can do Kegel exercises any time, in any place.
For urine leaks, wear absorbent pads or undergarments. There are many well-designed products that no one else will notice. See also: Urinary incontinence products
Other treatments include:
Keep your bowel movements regular to avoid constipation. Try increasing the fiber in your diet.
Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
Avoid alcohol and caffeinated drinks such as coffee, which can stimulate your bladder.
Lose weight if you need to.
Avoid foods and drinks that may irritate your bladder, like spicy foods, carbonated drinks, and citrus fruits and juices.
If you have diabetes, keep your blood sugar under good control.
Deng DY. Urinary incontinence in women. Med Clin North Am. 2011;95:101-109.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.