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Urinary incontinence is an inability to hold your urine until you get to a toilet.
More than 13 million people in the United States--male and female, young and old--experience
incontinence. It is often temporary, and it always results from an underlying medical
condition.
(In this fact sheet, the term "incontinence" will be used to mean urinary
incontinence.)
Women experience incontinence two times more often than men. Pregnancy and childbirth,
menopause, and the structure of the female urinary tract account for this difference.
But both women and men can become incontinent from strokes, multiple sclerosis, and
physical problems associated with old age.
Older women, more often than younger women, experience incontinence. But incontinence
is not inevitable with age. Incontinence is treatable and often curable at all ages.
If you experience incontinence, you may feel embarrassed. It may help you to remember
that loss of bladder control can be treated. You will need to overcome your embarrassment
and see a doctor to learn if you need treatment for an underlying medical condition.
Incontinence in women usually occurs because of problems with muscles that help to
hold or release urine. The body stores urine--water and wastes removed by the kidneys--in
the bladder, a balloon-like organ. The bladder connects to the urethra, the tube
through which urine leaves the body.
During urination, muscles in the wall of the bladder contract, forcing urine out
of the bladder and into the urethra. At the same time, sphincter muscles surrounding
the urethra relax, letting urine pass out of thebody. Incontinence will occur if
your bladder muscles suddenly contract ormuscles surrounding the urethra suddenly
relax.
If coughing, laughing, sneezing, or other movements that put pressure on the bladder
cause you to leak urine, you may have stress incontinence. Physical changes resulting
from pregnancy, childbirth, and menopause are common events that cause stress incontinence.
It is the most common form of incontinence in women and is treatable.
Pelvic floor muscles support your bladder. If these muscles weaken, your bladder
can move downward, pushing slightly out of the bottom of the pelvis toward the vagina.
This prevents muscles that ordinarily force the urethra shut from squeezing as tightly
as they should. As a result, urine can leak into the urethra during moments of physical
stress. Stress incontinence also occurs if the muscles that do the squeezing weaken.
Stress incontinence can worsen during the week before your menstrual period. At that
time, lowered estrogen levels might lead to lower muscular pressure around the urethra,
increasing chances of leakage. The incidence of stress incontinence increases following
menopause.
If you lose urine for no apparent reason while suddenly feeling the need or urge
to urinate, you may have urge incontinence. The most common cause of urge incontinence
is inappropriate bladder contractions.
Medical professionals describe such a bladder as "unstable," "spastic,"
or "overactive." Your doctor might call your condition "reflex incontinence"
if it results from overactive nerves controlling the bladder.
Urge incontinence can mean that your bladder empties during sleep, after drinking
a small amount of water, or when you touch water or hear it running (as when someone
else is taking a shower or washing dishes).
Involuntary actions of bladder muscles can occur because of damage to the nerves
of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves.
Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors,
and injury--including injury that occurs during surgery--all can harm bladder nerves
or muscles.
People with functional incontinence may have problems thinking, moving, or communicating
that prevent them from reaching a toilet. A person with Alzheimer's disease, for
example, may not think well enough to plan a timely trip to a restroom. A person
in a wheelchair may be blocked from getting to a toilet in time. Conditions such
as these are often associated with age and account for some of the incontinence of
elderly women in nursing homes.
If your bladder is always full so that it continually leaks urine, you have overflow
incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence.
Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors
and urinary stones can block the urethra. Overflow incontinence is rare in women.
Stress and urge incontinence often occur together in women. Combinations of incontinence--and
this combination in particular--are sometimes referred to as "mixed incontinence."
"Transient incontinence" is a temporary version of incontinence. It can
be triggered by medications, urinary tract infections, mental impairment, restricted
mobility, and stool impaction (severe constipation), which can push against the urinary
tract and obstruct outflow.
The first step toward relief is to see a doctor who is well acquainted with incontinence
to learn the type you have. A urologist specializes in the urinary tract. Gynecologists
and obstetricians specialize in the woman's reproductive tract and childbirth. A
urogynecologist focuses on urological problems in women. Family practitioners and
internists see patients for all kinds of complaints. Any of these doctors may be
able to help you.
To diagnose the problem, your doctor will first ask about symptoms and medical history.
Your pattern of voiding and urine leakage may suggest the type of incontinence. Other
obvious factors that can help define the problem include straining and discomfort,
use of drugs, recent surgery, and illness. If your medical history does not define
the problem, it will at least suggest which tests are needed.
Your doctor will physically examine you for signs of medical conditions causing incontinence,
such as tumors that block the urinary tract, stool impaction, and poor reflexes or
sensations, which may be evidence of a nerve-related cause.
Your doctor will measure your bladder capacity and residual urine for evidence of
poorly functioning bladder muscles. To do this, you will drink plenty of fluids and
urinate into a measuring pan, after which the doctor will measure any urine remaining
in the bladder. Your doctor may also recommend:
Stress test--You relax, then cough vigorously as the doctor watches for loss
of urine.
Urinalysis--Urine is tested for evidence of infection, urinary stones, or
other contributing causes.
Blood tests--Blood is taken, sent to a laboratory, and examined for substances
related to causes of incontinence.
Ultrasound--Sound waves are used to "see" the kidneys, ureters,
bladder, and urethra.
Cystoscopy--A thin tube with a tiny camera is inserted in the urethra and
used to see the urethra and bladder.
Urodynamics--Various techniques measure pressure in the bladder and the flow
of urine.
Your doctor may ask you to keep a diary to record when you void for a day or more,
up to a week. This diary should note the times you urinate and the amounts of urine
you produce. To measure your urine, you can use a special pan that fits over the
toilet rim.
Stress
Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising)
Urge
Leakage of large amounts of urine at unexpected times, including during sleep
Functional
Untimely urination because of physical disability, external obstacles, or problems
in thinking or communicating that prevent a person from reaching a toilet
Overflow
Unexpected leakage of small amounts of urine because of a full bladder
Mixed
Usually the occurrence of stress and urge incontinence together
Transient
Leakage that occurs temporarily because of a condition that will pass (infection,
medication)
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles
can reduce or cure stress leakage. Women of all ages can learn and practice these
exercises, which are taught by a health care professional.
Most Kegel exercises do not require equipment. However, one technique involves the
use of weighted cones. For this exercise, you stand and hold a cone-shaped object
within your vagina. You then substitute cones of increasing weight to strengthen
the muscles that help keep the urethra closed.
Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis
in a way similar to exercising the muscles. Electrodes are temporarily placed in
the vagina or rectum to stimulate nearby muscles. This will stabilize overactive
muscles and stimulate contraction of urethral muscles. Electrical stimulation can
be used to reduce both stress incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your body's functioning.
By using electronic devices or diaries to track when your bladder and urethral muscles
contract, you can gain control over these muscles. Biofeedback can be used with pelvic
muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder training are techniques that use biofeedback.
In timed voiding, you fill in a chart of voiding and leaking. From the patterns that
appear in your chart, you can plan to empty your bladder before you would otherwise
leak. Biofeedback and muscle conditioning--known as bladder training--can alter the
bladder's schedule for storing and emptying urine. These techniques are effective
for urge and overflow incontinence.
Medications
Medications can reduce many types of leakage. Some drugs inhibit contractions of
an overactive bladder. Others relax muscles, leading to more complete bladder emptying
during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing
leakage. And some, especially hormones such as estrogen, are believed to cause muscles
involved in urination to function normally.
Some of these medications can produce harmful side effects if used for long periods.
In particular, estrogen therapy has been associated with an increased risk for cancers
of the breast and endometrium (lining of the uterus). Talk to your doctor about the
risks and benefits of long-term use of medications.
Pessaries
A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina,
where it presses against the wall of the vagina and the nearby urethra. The pressure
helps reposition the urethra, leading to less stress leakage. If you use a pessary,
you should watch for possible vaginal and urinary tract infections and see your doctor
regularly.
Implants
Implants are substances injected into tissues around the urethra. The implant adds
bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous
natural tissue from cows) and fat from the patient's body have been used. Implants
can be injected by a doctor in about half an hour using local anesthesia.
Implants have a partial success rate. Injections must be repeated after a time because
the body slowly eliminates the substances. Before you receive collagen, a doctor
must perform a skin test to determine whether you would have an allergic reaction
to the material.
Surgery
Doctors usually suggest surgery to alleviate incontinence only after other treatments
have been tried. Many surgical options have high rates of success.
Most stress incontinence results from the bladder dropping down toward the vagina.
Therefore, common surgery for stress incontinence involves pulling the bladder up
to a more normal position. Working through an incision in the vagina or abdomen,
the surgeon raises the bladder and secures it with a string attached to muscle, ligament,
or bone.
For severe cases of stress incontinence, the surgeon may secure the bladder with
a wide sling. This not only holds up the bladder but also compresses the bottom of
the bladder and the top of the urethra, further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac
that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra
closed. By pressing a valve implanted under the skin, you can cause the artificial
sphincter to deflate. This removes pressure from the urethra, allowing urine from
the bladder to pass.
Catheterization
If you are incontinent because your bladder never empties completely (overflow incontinence)
or your bladder cannot empty because of poor muscle tone, past surgery, or spinal
cord injury, you might use a catheter to empty your bladder. A catheter is a tube
that you can learn to insert through the urethra into the bladder to drain urine.
Catheters may be used once in a while or on a constant basis, in which case the tube
connects to a bag that you can attach to your leg. If you use a long-term (or indwelling)
catheter, you should watch for possible urinary tract infections.
Other Procedures
Many women manage urinary incontinence with pads that catch slight leakage during
activities such as exercising. Also, you often can reduce incontinence by restricting
certain liquids, such as coffee, tea, and alcohol.
Finally, many women who could be treated resort instead to wearing absorbent undergarments,
or diapers--especially elderly women in nursing homes. This is unfortunate, because
diapering can lead to diminished self-esteem, as well as skin irritation and sores.
If you are an elderly woman, you and your family should discuss with your doctor
the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises,
and electrical stimulation before resorting to absorbent pads or undergarments.
Urinary incontinence is common in women.
All types of urinary incontinence can be treated.
Incontinence can be treated at all ages.
You need not be embarrassed by incontinence.
American Foundation for Urologic Disease
The Bladder Health Council
1128 North Charles Street
Baltimore, MD 21201
(800) 242-2383 or (410) 468-1800
American Uro-Gynecologic Society
401 North Michigan Avenue
Chicago, IL 60611-4267
(312) 644-6610
Continence Restored, Inc.
407 Strawberry Hill Avenue
Stamford, CT 06902
(203) 348-0601 or (914) 285-1470
National Association for Continence
(formerly Help for Incontinent People, Inc.)
P.O. Box 8310
Spartanburg, SC 29305
(800) BLADDER or (803) 579-7900
The Simon Foundation for Continence
P.O. Box 835
Wilmette, IL 60091
(800) 23-SIMON
National Kidney and Urologic Diseases Information
Clearinghouse
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Bethesda, MD 20892-3580
E-mail: nkudic@info.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a
service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The NIDDK is part of the National Institutes of Health under the U.S. Public Health
Service. Established in 1987, the clearinghouse provides information about diseases
of the kidneys and urologic system to people with kidney and urologic disorders and
to their families, health care professionals, and the public. NKUDIC answers inquiries;
develops, reviews, and distributes publications; and works closely with professional
and patient organizations and Government agencies to coordinate resources about kidney
and urologic diseases.
Publications produced by the clearinghouse are carefully reviewed for scientific
accuracy, content, and readability.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub
to duplicate and distribute as many copies as desired.
NIH Publication No. 97-4132
July 1997
e-text last updated: 11 February 1998
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