Urinary incontinence isn't a disease, it's a symptom. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.
The ins and outs of bladder control
Except when you're urinating, your bladder muscle stays relaxed so that it can expand to store urine. The relaxed bladder gets support from increasing contractions of your pelvic floor muscles. Your bladder and pelvic floor muscles communicate with each other to help hold urine in the bladder without leaking.
When your bladder is full, it sends nerve signals to your brain. In response, and at an appropriate time and place, you relax your pelvic floor muscles and your bladder contracts, allowing urine to pass through the urethra and out of your body.
Causes of temporary urinary incontinence
Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.
Alcohol. Beer, wine and spirits are all diuretics. They cause your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate and act on that need in a timely manner.
Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.
Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.
Caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly and hold less than usual so that you suddenly and perhaps uncontrollably need to urinate.
Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.
Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.
Other illnesses or injuries. Any serious illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence.
Easily treatable medical conditions also may be responsible for urinary incontinence.
Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and trigger urine frequency.
Causes of persistent urinary incontinence
Urinary incontinence can also be a persistent condition caused by some underlying physical problem — weakened pelvic floor or bladder muscles, neurological diseases, or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:
Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of a vaginal delivery can weaken the pelvic floor muscles and the ring of muscles that surrounds the urethra (urinary sphincter). The result is often stress incontinence — urine escapes past the weakened muscles whenever pressure is placed on your bladder. The changes that occur during childbirth can also damage bladder nerves and supportive tissue and can lead to a dropped (prolapsed) pelvic floor, producing a vaginal bulge. With prolapse, your bladder, uterus, rectum or small bowel can get pushed down from the usual position and protrude into your vagina. Such protrusions can be associated with incontinence. Incontinence related to childbirth may develop right after delivery or, more likely, may not develop until years later.
Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.
Women produce less of the hormone estrogen after menopause, a decrease that can contribute to incontinence. Estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues lose some of their ability to close — meaning that your urethra can't hold back urine as easily as before.
Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — runs the risk of damaging the supporting pelvic floor muscles, which can lead to incontinence.
Painful bladder syndrome (interstitial cystitis). This rare, chronic condition can be associated with an inflammation of the bladder wall. It occasionally causes urinary incontinence, as well as painful and frequent urination. Interstitial cystitis affects women more often than men, and its cause isn't clear.
Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, or inflammation of the prostate gland — a walnut-sized organ located just below the male bladder. Even so, urinary incontinence sometimes occurs with this extremely common condition. The prostate actually surrounds the urethra, so inflammation of the prostate occasionally swells and constricts the urethra, blocking normal urine flow and leading to urinary urgency and frequency. Rarely, this also causes incontinence.
Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). The prostate begins to enlarge in many men after about age 40. As the gland enlarges, it can constrict the urethra and block the flow of urine. For some men, this problem results in urge or overflow incontinence.
Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments — surgery or radiation — for prostate cancer.
Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Urinary obstruction can also occur after overcorrection during a surgical procedure to correct urinary incontinence, leading to more urine leakage.
Talking about bladder control problems is hard. So hard, in fact, that many women live with bladder control problems for years before finally seeking treatment. You may be too shy or too ashamed to talk about your problems with anyone — even your doctor. After all, it's a highly personal matter.
But if you're one of the millions of women who experience bladder control problems, don't let embarrassment keep you from getting the help you need. Leaking urine, having to urinate frequently and experiencing other symptoms of urinary incontinence aren't trivial consequences of childbirth or a natural part of aging.
Not all doctors ask about urinary function. It's up to you to take the first step. If you have bladder control problems, tell your doctor about them and ask for help.
Why to seek help
Bladder control problems require medical attention for several reasons. Reduced bladder control may, for instance:
Indicate a serious underlying medical condition, such as diabetes or multiple sclerosis
Cause you to restrict your physical activities
Lead you to withdraw from social interactions
Increase your risk of falling if you have balance problems and you often rush to the bathroom to avoid leaking urine
When to seek help
A few isolated incidents of urinary incontinence don't necessarily require medical attention. But if the problem is frequent or affects your quality of life, you should consider treatment.
A visit with your primary care provider is definitely advisable if:
You're embarrassed by urine leakage, and you avoid certain activities because of it.
You often feel urgency to urinate and rush to a bathroom but sometimes don't make it in time.
You have frequent bladder infections.
You urinate much more frequently than you used to even when you don't have a bladder infection.
You experience pain that's unrelated to a bladder infection when your bladder fills and when you urinate.
You often feel the need to urinate, but you're unable to pass urine.
You notice that your urine stream is getting progressively weaker, and you feel like you can't empty your bladder completely.
In most circumstances, effective treatment is available.
When to seek a specialist
Many health care providers can treat bladder control problems without referring you to a specialist. But not all primary care providers have the necessary training or experience. In spite of improved understanding and treatment of urinary incontinence, some practitioners consider it an inevitable consequence of childbearing, menopause or normal aging — a belief that makes them unlikely to consider treatment.
But that doesn't have to be the case. If your doctor dismisses your symptoms or seems uninformed about possible treatments, ask for referral to a specialist.
Doctors who specialize in urinary disorders include:
Urogynecologist. This is an obstetrician-gynecologist with additional training in problems that affect a woman's pelvic floor — the network of muscles, ligaments, connective tissue and nerves that help support and control the bladder and other pelvic organs.
Urologist. A urologist specializes in male and female urinary disorders as well as the male reproductive system.
Geriatrician. This medical doctor specializes in the care of older adults, often with special emphasis on problems related to medications and quality-of-life issues, such as incontinence.
The bladder diary: A detailed symptom record
Whether you see a primary care provider or a specialist, keep a bladder diary for several consecutive days before your visit. This diary is a detailed, day-to-day account of your symptoms and other information related to your urinary habits. It can help you and your doctor determine the causes of bladder control problems.
Record what and how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of times you leaked urine. If you leak urine, note the approximate amount and what you were doing when it happened. Don't worry about getting exact measurements of urine output. Just describe the quantity in general terms, such as small, medium or large. If a more precise measurement is needed, your doctor may give you a pan that fits over your toilet rim. The pan has markings like a measuring cup.
The diary should cover a period in which you stick to your normal routine — not a vacation. If you're premenopausal, don't start the diary during your menstrual period. Increased trips to the bathroom during this time may distort the findings.
Click ----> Bladder Diary
Medical history review
Your visit will be more productive if you can provide a detailed medical history. If necessary, make a list of:
Previous surgeries, births, illnesses, injuries and medical procedures, along with approximate dates
Current health problems — such as diabetes or arthritis — for which you're seeing a doctor or taking medication
The approximate date or your age when you stopped having menstrual periods, if you've been through menopause
Past and current problems with your urinary system
Medications you're currently taking, including each drug's brand and generic name, dosage, when you take it and what you take it for
Medications are among the most common causes of bladder control problems, so list everything — prescriptions, over-the-counter drugs, vitamins, minerals and other supplements. If you're not sure whether something counts as a medication, err on the side of caution and put it on the list anyway.
Finally, if you want a report of your consultation with your new doctor sent to other health care providers, be sure to take their addresses to your appointment.
What to expect from treatment
Treatments for bladder control problems vary from learning special exercises to taking medications to having surgery. What's best for you depends on the type of bladder control problem you have. Nearly all women with bladder control problems can be helped through some form of treatment.
Your bladder function could be greatly improved — even completely restored — after treatment. Any improvement, however, counts as a success, as long as it frees you to do what you like and enhances your quality of life.