Urinary incontinence—the involuntary leakage of urine—can take a toll on one’s self-image, leading to depression and social isolation. It affects an estimated 10 to 30 percent of older people, mostly women, as well as many younger women. But it’s never normal. The good news is that it’s usually treatable.
There are several types of urinary incontinence. In urge incontinence there is a sudden need to urinate, accompanied by an uncontrollable release of urine from the bladder, even if the bladder isn’t full. It may be set off by cold temperature, washing your hands, or anticipation of going to the toilet. In the related condition called overactive bladder (as in the “gotta go, gotta go” commercials), there is increased frequency and urgency, but not always accidents. Both urge incontinence and overactive bladder occur when the muscles surrounding the bladder go into spasm.
In stress incontinence, the most common type in younger women, small amounts of urine leak when a person coughs, laughs, lifts, exercises or performs any activity that increases stress on the bladder. It’s often a result of childbirth, which weakens pelvic muscles. In overflow incontinence, more common in men, something blocks the bladder from emptying, or bladder muscles fail to contract; the bladder becomes too full, resulting in a continual dribbling. Functional incontinence occurs when people don’t have the mobility (as in arthritis or Parkinson’s) or the mental capacity (as in dementia) to make it to the bathroom in time. In mixed incontinence, people experience more than one type, typically urge and stress incontinence.
What causes incontinence
While urinary tract infections, some medications (diuretics, sleeping pills and tranquilizers, for example), and even constipation may cause temporary incontinence, chronic incontinence may be due to some problem in the muscles or nerves involved in urination. Some things that cause or worsen incontinence are:
- Age-related changes in the urinary tract, such as weakened bladder muscles and reduced bladder sensation
- Decreased estrogen in postmenopausal women, which contributes to the thinning of pelvic muscles and loss of tone of the urethra, the tube leading from the bladder
- Childbirth, which weakens the pelvic floor muscles
- An enlarged prostate, which may interfere with urine flow
- Pelvic surgery involving the prostate, bladder or uterus
- Damage to the nerves involved in bladder control, from diabetes, trauma or certain medications
- Being overweight, which puts pressure on the bladder
- Though not proven, some foods and beverages may play a role, including coffee, tea and alcohol.
Regaining bladder control
If you’re having bladder control problems, see your doctor for a full evaluation, which would include a history, physical, and various lab and other tests. Treating some reversible causes, such as a bladder infection, may eliminate the problem altogether. Once you have a proper diagnosis, start with lifestyle changes.
- Lose weight if you’re overweight.
- Bladder training involves taking bathroom trips every two hours and gradually lengthening the interval to four hours to help the bladder adapt to a schedule. If an urge arises sooner, relax until the sensation passes; then walk slowly to the bathroom.
- Kegel exercises, which strengthen the pelvic muscles that support the bladder, are especially helpful for stress and urge incontinence. The benefits were confirmed by a 2012 research review from the federal Agency for Healthcare Research and Quality (AHRQ). Once you have identified the correct muscles (an easy way to do this is by stopping and starting your stream of urine), contract them for 10 seconds (or as long as possible) and repeat 10 to 15 times, several times a day. You can do the exercises anywhere—sitting, lying down, standing, walking—and should notice improvement in two to three months. To learn the exercises, you may want to get instruction from a gynecologist, urologist, physical therapist or other knowledgeable practitioner.
- Biofeedback, which uses special equipment to provide visual feedback, helps you gain increased awareness of pelvic floor muscles and may be a useful addition to Kegel exercises. There's been little positive research on biofeedback for incontinence of late.
- An older study from Oregon Health and Science University, reported in Obstetrics & Gynecology, suggested that acupuncture may help overactive bladder syndrome. Women who underwent four weekly acupuncture sessions had a 60 percent decrease in incontinence episodes and significant improvements in urinary frequency, urgency, and bladder capacity. More recent research has not been as promising.
- Ask your doctor if any drugs you’re taking may be a factor. If so, you may be able to adjust the timing of the dose, or your doctor may be able to prescribe something else.
- Eat a high-fiber diet to avoid constipation. A food diary can help you identify any foods or beverages that worsen symptoms.
- Limit fluids after dinner to avoid nighttime accidents.
- Women with stress incontinence can wear a tampon while exercising. The tampon compresses the urethra, which may help prevent leaking.
- If these lifestyle changes are not effective, medications, internal devices that can be fitted and other nonsurgical options are available. Surgery may be appropriate in some cases.