Urinary Incontinence Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Urinary Incontinence Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


Understanding urine and the bladder


The kidneys make urine continuously. A trickle of urine is constantly passing to the bladder down the ureters (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat.

The bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles below the bladder that surround and support the urethra (the pelvic floor muscles).

When a certain volume of urine is in the bladder, you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle squeezes (contracts) and the urethra and pelvic floor muscles relax to allow the urine to flow out.

Complex nerve messages are sent between the brain, the bladder and the pelvic floor muscles. These tell you how full your bladder is and tell the correct muscles to contract or relax at the right time.

What Is Urinary Incontinence?


Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.


Urinary Incontinence Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Incontinence can be a symptom of many different health problems, ranging from cancer to kidney stones to an enlarged prostate. It can also be a natural result of the aging process, since your bladder muscles become weaker as you get older.

According to the American Academy of Family Physicians, millions of Americans suffer from urinary incontinence. While the condition is more common among women and those over 50 years of age, anyone be affected by temporary or chronic incontinence.

You should see a doctor for any instance of incontinence. The condition interferes with your daily life, and can possibly be a symptom of a very serious condition. In most cases, simple lifestyle changes or medical treatment can ease your discomfort or stop urinary incontinence.

Types of Urinary Incontinence


Urinary incontinence is divided into three different categories, or types. However, you may experience a mix of the types or all three.

Stress Incontinence


This type of incontinence may occur when you participate in some types of physical activity—such as when you are exercising, coughing, sneezing, or laughing. The activity causes the sphincter muscle, which normally holds your urine in the bladder, to weaken and release urine.

Urge Incontinence


Urge incontinence occurs when you feel a sudden and strong urge, or need, to urinate. Very soon after the urge strikes, you lose control of your bladder. Often, you do not have time between the urge and the loss of urine to make it to a bathroom.

Overflow Incontinence


This type occurs when you urinate but do not completely empty the bladder. Later, you may lose some urine. Overflow incontinence can also be called dribbling.

Causes of Urinary Incontinence


Causes of temporary urinary incontinence


Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.

  • Alcohol. Alcohol acts as a bladder stimulant and a diuretic, which can cause an urgent need to urinate.
  • Overhydration. Drinking a lot of fluids, especially in a short period of time, increases the amount of urine your bladder has to deal with.
  • Caffeine. Caffeine is a diuretic and a bladder stimulant that can cause a sudden need to urinate.
  • Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — artificial sweeteners, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate your bladder.
  • Medications. Heart medications, blood pressure drugs, sedatives, muscle relaxants and other medications may contribute to bladder control problems.
Easily treatable medical conditions also may be responsible for urinary incontinence.

  • Urinary tract infection. Infections can irritate 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 increase urinary frequency. In addition, compacted stool can sometimes interfere with the emptying of the bladder, which may cause overflow incontinence.

Causes of persistent urinary incontinence


Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

  • 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 muscles needed for bladder control. The changes that occur during childbirth can also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. 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.
  • Changes with aging. Aging of the bladder muscle leads 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.
  • After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues may deteriorate, which can aggravate incontinence.
  • Hysterectomy. In women, the bladder and uterus lie close to one another and are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — may damage the supporting pelvic floor muscles, which can lead to incontinence.
  • Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, which is inflammation of the prostate gland — a walnut-sized organ located just below the male bladder. Even so, urinary incontinence sometimes occurs with this common condition.
  • Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH).
  • 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 or 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 block 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. Stones can be present in your kidneys, bladder or ureters.

Symptoms of urinary incontinence


Urinary incontinence is the inability to control the release of urine from your bladder. Some people experience occasional, minor leaks — or dribbles — of urine. Others wet their clothes frequently.

Types of urinary incontinence include:

Stress incontinence


This is loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs when the sphincter muscle of the bladder is weakened. In women, physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to stress incontinence.

Urge incontinence


This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson's disease, Alzheimer's disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there's no known cause, urge incontinence is also called overactive bladder.

Overflow incontinence


If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes, multiple sclerosis or spinal cord injury. In men, overflow incontinence can also be associated with prostate gland problems.

Mixed incontinence


If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.

Functional incontinence


Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. This is called functional incontinence.

Total incontinence


This term is sometimes used to describe continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine.

Diagnosing urinary incontinence 


If you experience urinary incontinence, see your GP so they can determine the type of condition you have.

Do not be embarrassed to speak to your GP about your condition.

Bladder diary


Your GP may suggest that you keep a diary of your bladder habits for at least three days, so you can give them as much information as possible about your condition. This should include details such as:
  • how much fluid you drink
  • the types of fluid you drink
  • how often you need to pass urine
  • the amount of urine you pass
  • how many episodes of incontinence you experience 
  • how many times you experience an urgent need to go to the toilet

Tests and examinations 


You may also need to have some tests and examinations so that your GP can confirm or rule out external factors that may be causing your incontinence. Some of these are explained below.

Physical examination

Your GP may examine you physically to assess the health of your urinary system.

If you are female, your GP will carry out a pelvic examination, which usually involves undressing from the waist down. You may be asked to cough to see if any urine leaks out.

Your GP may also examine your vagina. In over half of women with stress incontinence, part of the neck of the bladder may bulge into the vagina.

Your GP may place their finger inside your vagina and ask you to squeeze it with your pelvic floor muscles. These are the muscles that surround your bladder and urethra (the tube through which urine passes out of the body). Damage to your pelvic floor muscles can lead to urinary incontinence.

If you are male, your GP may check whether your prostate gland is enlarged. The prostate gland is located between the penis and bladder, and surrounds the urethra. If it is enlarged, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.

Your GP may carry out a digital rectal examination to check the health of your prostate gland. This will involve your GP inserting their finger into your bottom. 

Dipstick test

If your GP thinks that your incontinence may be caused by an infection, a sample of your urine may be tested for bacteria. A small, chemically treated stick will be dipped into your urine sample. It will change colour if bacteria are present. The dipstick test can also check the blood and protein levels in your urine.

Residual urine test

If your GP thinks you may have overflow incontinence, also called chronic urinary retention, they may suggest a residual urine test. 

A residual urine test involves inserting a thin, flexible hollow tube, called a catheter, into your urethra and feeding it through to your bladder. Any urine that is left in your bladder will drain out through the catheter and the amount can be measured.

Further tests


Some further tests may be necessary if the cause of your urinary incontinence is not clear. Your GP will usually start treating you first and could then suggest these tests if treatment is not effective. 

Bladder ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body. An ultrasound scan of your bladder can show how much urine is left in your bladder after you go to the toilet.

Cystoscopy

A cystoscopy involves using a flexible viewing tube, known as an endoscope, to look inside your bladder and urinary system.

This test can identify abnormalities that may be causing incontinence.

Urodynamic tests

Urodynamic tests are a group of tests used to check the function of your bladder and urethra. This may include keeping a bladder diary for a few days (see above) and then attending an appointment at a hospital or clinic for some tests. These could include:
  • measuring the pressure in your bladder by inserting a catheter into your urethra
  • measuring the pressure in your abdomen by inserting a catheter into your bottom
  • asking you to urinate into a special machine that measures the amount and flow of the urine

Treatments and drugs for Urinary Incontinence


Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. A combination of treatments may be needed.

In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques and physical therapy first and move on to other options only if these techniques fail.

Behavioral techniques


Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

Bladder training

Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid overflow incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

Scheduled toilet trips

This means timed urination — going to the toilet according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis — usually every two to four hours.
Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity are other lifestyle changes that can eliminate the problem.

Physical therapy


Pelvic floor muscle exercises

These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises frequently. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegel exercises), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use to stop urinating and hold for a count of three and repeat.

With Kegel exercises, it can be difficult to know whether you're contracting the right muscles and in the right manner. In general, if you sense a pulling-up feeling when you squeeze, you're using the right muscles. Men may feel their penises pull in slightly toward their bodies. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor.

If you're still not sure whether you're contracting the right muscles, ask your doctor for help. Your doctor may suggest you work with a physical therapist or try biofeedback techniques to help you identify and contract the right muscles. Your doctor may also suggest vaginal cones, which are weights that help women strengthen the pelvic floor.

Electrical stimulation

In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work.

Medications


Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Anticholinergics

These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Several drugs fall under this category, including oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Possible side effects of these medications include dry mouth, constipation, blurred vision and flushing.

Topical estrogen

Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce some of the symptoms of incontinence.
Imipramine. Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat mixed — urge and stress — incontinence.

Duloxetine

The antidepressant medication duloxetine (Cymbalta) is sometimes used to treat stress incontinence.

Medical devices


Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

Urethral insert

This small tampon-like disposable device inserted into the urethra acts as a plug to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day. Urethral inserts aren't meant to be worn 24 hours a day. They are available by prescription and may work best for women who have predictable incontinence during certain activities, such as playing tennis. The device is inserted before the activity and removed before urination.

Pessary (PES-uh-re)

Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

Interventional therapies


Bulking material injections

Bulking agents are materials, such as carbon-coated zirconium beads (Durasphere), calcium hydroxylapatite (Coaptite) or polydimethylsiloxane (Macroplastique), that are injected into tissue surrounding the urethra. This helps keep the urethra closed and reduce urine leakage. The procedure — usually done in a doctor's office — requires minimal anesthesia and takes about five minutes. The downside is that repeat injections are usually needed.

Botulinum toxin type A

Injections of onabotulinumtoxinA (Botox) into the bladder muscle may benefit people who have an overactive bladder. Researchers have found this to be a promising therapy, but the Food and Drug Administration (FDA) has not yet approved this drug for incontinence. These injections may cause urinary retention that's severe enough to require self-catheterization. In addition, repeat injections are needed every six to nine months.

Nerve stimulators

Sacral nerve stimulators can help control your bladder function. The device,which resembles a pacemaker, is implanted under the skin in your buttock. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits painless electrical pulses that stimulate the nerve and help control the bladder. Another device, the tibial nerve stimulator, is approved for treating overactive bladder symptoms. Instead of directly stimulating the sacral nerve, this device uses an electrode placed underneath the skin to deliver electrical pulses to the tibial nerve in the ankle. These pulses then travel along the tibial nerve to the sacral nerve, where they help control overactive bladder symptoms.

Surgery


If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence.

Some of the commonly used procedures include:

Sling procedures

A sling procedure uses strips of your body's tissue, synthetic material or mesh to create a pelvic sling or hammock around your bladder neck and urethra. The sling helps keep the urethra closed, especially when you cough or sneeze. There are many types of slings, including tension-free, adjustable and conventional.

Bladder neck suspension

This procedure is designed to provide support to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done using general or spinal anesthesia.

Artificial urinary sphincter

This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to flow.

Absorbent pads and catheters


If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.

Pads and protective garments

Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by closefitting underwear. Men and women can wear adult diapers, pads or panty liners, which can be purchased at drugstores, supermarkets and medical supply stores.

Catheter

If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization). This should give you more control of your leakage, especially if you have overflow incontinence. You'll be instructed on how to clean these catheters for safe reuse.

Tips for preventing urinary incontinence


Drinking


Depending on your particular bladder problem, your GP can advise you about the amount of fluids that you should drink.

If you have urinary incontinence, cut down on alcohol and drinks that contain caffeine, such as tea, coffee and cola. These can cause your kidneys to produce more urine and irritate your bladder. 

If you have to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However, make sure you still drink enough fluids during the day.

Exercise


Keeping active is a very important part of leading a healthy lifestyle and can help prevent several serious health conditions, including urinary incontinence. Do a minimum of 30 minutes of exercise at least five times a week.

Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you are pregnant, strengthening your pelvic floor muscles can help prevent urinary incontinence.

Men can also benefit from strengthening their pelvic floor muscles by doing pelvic floor exercises. Find out more about pelvic floor exercises.

Weight


Being obese increases your risk of urinary incontinence. Maintain a healthy weight by eating a balanced diet. Use the healthy weight calculator to see if you are a healthy weight for your height.

Eat more fiber


Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence.

Don't smoke


Get help with quitting if you do smoke.

Home Remedies for Urinary Incontinence


There are certain steps you can take at home to make living with incontinence easier. Your doctor can explain how you can strengthen your pelvic floor muscles, if this is the cause of your incontinence. It may involve urinating on a strict schedule or doing exercises to work the muscles.

You can also arrange your home to help you better manage your incontinence. You can make sure you have a clear and easy path to the bathroom, keep a night light on to make getting to the toilet easier in the dark, and use absorbent undergarments when you leave the house to prevent accidents.

If you have functional incontinence, possible changes may include:

  • Keeping a bedpan in your bedroom
  • Installing an elevated toilet seat
  • Adding a bathroom in a more convenient location
  • Widening an existing bathroom doorway