Urinary Incontinence

What is urinary incontinence?

Urinary incontinence (UI) occurs when you leak urine. Your bladder is an organ that stores urine until it leaves your body through your urethra. There are muscles around your urethra, called sphincter muscles, that keep your urethra closed. Normally, when your bladder is full the bladder muscle contracts (tightens), and the sphincter muscles relax and open. Once the sphincter muscles open, the urine can flow through your urethra and out of your body. With UI, you are not able to control when urine leaves your bladder.

What are the most common types of urinary incontinence and their causes?

• Stress incontinence: Stress incontinence occurs when there is increased pressure on your bladder. Small amounts of urine leak out when the sphincter muscles and other nearby muscles cannot support the extra pressure. Pressure on your bladder may increase with activities, such as lifting, exercising, coughing, or sneezing.
  
  
• Urge incontinence: With urge incontinence, your bladder has trouble storing and emptying urine. This may be caused by weak bladder, pelvic, or sphincter muscles. Urge incontinence can also occur when your bladder contracts more often than it normally should. You may feel the need to urinate right away, causing you to leak small or large amounts of urine.
  
  
• Mixed incontinence: Mixed incontinence occurs when you have both stress and urge UI.

What increases my risk for urinary incontinence?

Ask your caregiver for more information about the following:

• Pregnancy or childbirth: Pregnant women have increased pressure on their pelvic muscles, causing the muscles to stretch and weaken. Vaginal injuries from giving birth, such as a tear may also weaken the pelvic muscles. Once the pelvic muscles are weak, the risk for UI increases.
  
  
• Surgery or radiation: Past surgeries, such as pelvic surgery, prostate surgery, or a hysterectomy, may lead to UI. A hysterectomy is surgery to remove a woman's uterus. Radiation therapy on the pelvic area may weaken the pelvic muscles, leading to UI.
  
  
• Brain diseases and conditions: Brain diseases that increase your risk for UI include Parkinson's, Alzheimer’s, and dementia. Other brain conditions, such as a stroke, may also lead to UI. Your brain may send more messages to your bladder to contract, causing a sudden, strong urge to urinate. You may not recognize the urge to urinate as a signal to go to the bathroom. With a spinal cord injury, your brain may not be able to send the message to signal the need to urinate.
  
  
• Medical conditions: Medical conditions, such as kidney stones or bladder tumors (growths), may lead to UI. An infection in your urinary tract, which includes your bladder and urethra, may also lead to UI. Pelvic organ prolapse (POP) occurs when the pelvic organs are not supported and move out of place. This includes when a woman's uterus sinks into her vagina. The prolapsed organ may put pressure on the bladder and urethra, leading to UI. Ask your caregiver for more information about these and other medical conditions that may lead to UI.
  
  
• Aging: As you age, your muscles may begin to weaken. Women in menopause (no longer having monthly periods) make less of the hormone (body chemical) estrogen. Decreased estrogen can cause the pelvic muscles to weaken. As men age, the risk for prostate disease increases. The prostate is the male sex gland. Prostate disease can cause the prostate gland to grow and put pressure on, or block, the urethra, leading to UI.
  
  
• Obesity: Weighing more than your caregiver suggests increases the pressure on your bladder, increasing your risk for UI.
  
  
• Constipation: Constipation occurs when you have hard, dry bowel movements (BMs) that are hard to pass. When you are constipated, the BMs increase pressure on the bladder, and may cause you to leak urine.
  
  
• Medicines and substances: Certain blood pressure medicines, called ACE inhibitors, may cause excess coughing leading to UI. Medicines to decrease the fluid in your body can also lead to UI. Drinks with caffeine or alcohol can increase how often the bladder contracts, causing you to leak urine. Caffeine may be found in coffee, tea, and some soft drinks. Alcohol is found in beer, wine, whiskey, and other adult drinks.

What are the signs and symptoms of urinary incontinence?

Signs and symptoms may depend on the type of UI you have. You may have any of the following:

• You do not feel like your bladder empties completely when you urinate.
  
  
• You need to urinate more often than usual, and right away. You may not be able to make it to the bathroom before you start to urinate.
  
  
• You leak urine while you sleep, or you wake often from sleep with the urge to urinate.
  
  
• You leak urine when you cough, sneeze, laugh, lift, jump, or exercise. You may also leak urine while having sex.
  
  
• You leak urine while washing your hands, drinking cold liquids, or when you are out in cold weather.

How is urinary incontinence diagnosed?

Your caregiver will ask you about your signs and symptoms and any health problems that you have. Tell your caregiver what medicines you are taking, and how long you have been taking them. Your caregiver may ask you to keep a diary of how often you leak urine, and how much you leak. You will also need to write down what you were doing when you leaked urine. Your caregiver may do a physical exam and check your stomach, genitals (vagina or penis), rectum, and pelvic area. Your rectum stores your BMs in your bowel until they pass out of your body. You may also need the following tests:

• Urine sample: For this test you need to urinate into a small container. You will be given instructions on how to clean your genital area before you urinate. Do not touch the inside of the cup. Follow instructions on where to place the cup of urine when you are done.
  
  
• Cotton swab test: During a cotton swab test, used only for women, the caregiver puts a moist cotton swab into the urethra. You will be asked to strain or bear down as if you are having a BM. Your caregiver will watch the swab for movement each time you strain. If the swab moves when you strain, the muscles around your bladder may be weak, leading to UI
  
  
• Cough stress test: A cough stress test is done when you have a full bladder. Your caregiver will watch for urine leakage while you cough. The cough stress test may be done when you are lying down and standing.
  
  
• Pad test: During the pad test, you will wear an absorbent pad for a certain amount of time. When the test is complete, caregivers check if the pad weighs more after you take it off.
  
  
• Post-void residual: Post-void residual is a test that measures the urine left in your bladder after you urinate. You will be asked to urinate when you feel your bladder is full. After you urinate, your caregiver checks for any urine left in your bladder. He may insert a catheter (thin, bendable tube) into your bladder to drain any remaining urine. Your caregiver may also use an ultrasound to check for urine in your bladder. An ultrasound is a test that uses sound waves to show pictures of your bladder on a TV-like screen.
  
  
• Urodynamics: Urodynamic testing checks the function of your urinary tract. Tests may be done to check the pressures in your bladder while filling your bladder with liquid. Your bladder pressure may also be tested when your bladder is full, and while it empties.

How is stress incontinence treated?

Ask your caregiver for more information about the following treatments for stress UI:

• Pelvic floor muscle exercises: Pelvic floor muscle exercises help strengthen your pelvic muscles. The exercises may help to bring back or improve your bladder control. These exercises are done by tightening and relaxing your pelvic muscles. Ask your caregiver how to do pelvic floor muscle exercises, and how often to do them.
  
  
• Biofeedback: Biofeedback is a special way to help you control how your body reacts. Biofeedback uses pictures and words to help you learn to control your pelvic floor muscles. Biofeedback may help you learn how to strengthen your pelvic floor muscles and decrease urine leakage.
  
  
• Bulking agents: Caregivers may give you an injection (shot) of a bulking agent, such as silicone, into the wall of your urethra. Bulking agents thicken the wall of your urethra to help keep your urethra closed and decrease urine leakage.
  
  
• Devices: Devices may be used to support your urethra and bladder to stop urine leakage. For men, a penile clamp may be used. For women, a vaginal cone, pessary, or tampon may be placed into the vagina to stop urine leaks. A vaginal cone is a small weight put inside the vagina. A pessary is a plastic or rubber ring. Tampons may be used to help stop urine from leaking during exercise. Some devices may also be used to treat urge UI.
  
  
• Electrical stimulation: During electrical stimulation, electrodes send a small amount of electrical energy to your pelvic floor muscles. Electrodes may be placed outside your body or in your rectum. For women, the electrodes may be placed in the vagina. The electrical energy tightens your pelvic floor muscles to help make the area stronger. Electrical stimulation treatment may be used with biofeedback to decrease UI.
  
  
• Medicines:
  
  
  • Alpha adrenergic agonists: Alpha adrenergic agonist medicine may be given to help strengthen your urethral sphincter muscles.
    
    
  
  
• Surgery: You may need surgery to treat your stress UI if other treatments have not worked. Ask your caregiver for more information about the following surgeries:
  
  
  • Artificial urinary sphincter: During this surgery, your caregiver inserts an artificial (man-made) urinary sphincter (AUS) around your urethra. An AUS allows you to control when you urinate.
    
    
  • Bladder sling: During this surgery, a sling is placed around your bladder neck and urethra. Your bladder neck is where the bottom of your bladder and urethra connect. The sling is made of mesh or other man-made material. The sling may also be made of tissue from another area in your body. The sling supports your urethra and bladder neck, so you do not leak urine.
    
    
  • Colposuspension: During colposuspension surgery, your bladder and urethra are pulled up into a more stable position. Sutures (stitches) are placed into the bladder neck and secured to tissue or bone. The sutures support your urethra and bladder neck, so you do not leak urine.
    
    
  • Compression device: A compression device is made of two small balloons that are inserted on each side of your urethra. When the balloons are full, they will squeeze your urethra closed, so no urine leaks out. You will empty the balloons when you need to urinate. Emptying and filling the balloons is done with a device implanted (under the skin) in the scrotum or labia. The scrotum is the sac of skin surrounding a man's testicles. The labia are pads of fat found on each side of a woman's vagina.

How is urge incontinence treated?

Ask your caregiver for more information about the following treatments for urge UI:

• Bladder training: The goal of bladder training is to help improve your bladder control. Bladder training includes urinating at certain times and doing pelvic floor muscle exercises. You may also learn to use relaxation and distraction to take your mind off the need to urinate. This may help decrease the urge to urinate, while increasing the amount of urine your bladder can hold.
  
  
• Medicines:
  
  
  • Antibiotic medicine: Antibiotic medicine helps treat an infection caused by germs called bacteria. You may need antibiotic medicine if a urinary tract infection caused your urge UI.
    
    
  • Anticholinergic medicine: Anticholinergic medicine may be given to decrease how often your bladder contracts and causes you to leak urine.
    
    
  • Hormone therapy: Women who have reached menopause may need to take the hormone estrogen. Estrogen may help improve bladder control.
  
  
• Sacral nerve stimulation: Sacral nerve stimulation is done by implanting an electrical device in your body. The device has wires that connect to the sacral nerves in your lower spine. The sacral nerves control your bladder and pelvic muscles. The device sends signals to your sacral nerves to help improve your bladder control. Sacral nerve stimulation may also be used with biofeedback.
  
  
• Self-catheterization: You may need to do self-catheterization if you do not empty your bladder completely when you urinate. You will insert a catheter into your bladder to drain any remaining urine. Caregivers will teach you how to put the catheter in safely. Emptying your bladder helps decrease how often you may feel the urge to urinate, causing you to leak urine.
  
  
• Surgery: You may need surgery to treat your urge UI if other treatments do not work. Ask your caregiver for more information about the following surgeries:
  
  
  • Bladder augmentation: Bladder augmentation surgery increases the size of your bladder so it holds more urine. During surgery, a part of your intestine (bowel) may be removed and used to make your bladder larger.
    
    
  • Urinary diversion: During urinary diversion surgery, a new path is made for urine to exit your body.

How can I manage my urinary incontinence?

• Limit the amount of liquid you drink: You may need to limit the amount of liquid you drink each day to help decrease urine leakage. Limit or avoid drinks with caffeine and alcohol to help prevent increased bladder contractions. Try not to drink liquids before going to bed to prevent having to urinate during the night. Ask your caregiver how much liquid you should drink each day.
  
  
• Maintain a healthy lifestyle: Exercising and maintaining a healthy weight may help improve your bladder control. Talk with your caregiver about a weight-loss plan if you are overweight. If you smoke, it is never too late to quit. Smoking harms your body in many ways. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. Ask your caregiver how to stop smoking if you are having trouble quitting.
  
  
• Take care of your skin: Leaking urine may make your skin red and sore. Wearing a pad can help absorb leaking urine and keep urine off your skin. Using wipes to clean your skin may help prevent odor and help protect your skin.
  
  
• Treat your constipation: Walking is the best way to get your bowels moving. Eat foods high in fiber to make it easier to have a BM. Good examples are high-fiber cereals, beans, vegetables, and whole grain breads. Prune juice may help make the BM softer. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular. You can also buy these medicines at grocery or drug stores.

Where can I find more information?

Contact the following:

• American Urological Association Foundation
  1000 Corporate Boulevard
  Linthicum , MD 21090
  Phone: 1- 410 - 689-3700
  Phone: 1- 866 - 746-4282
  Web Address: http://www.urologyhealth.org
  

• National Kidney and Urologic Diseases Information Clearinghouse
  3 Information Way
  Bethesda , MD 20892-3580
  Phone: 1- 800 - 891-5390
  Web Address: http://kidney.niddk.nih.gov/
  

When should I call my caregiver?

Call your caregiver if:

• You are leaking more urine than usual, or you need to urinate more often.
  
  
• You feel pain when you urinate.
  
  
• You have a fever.
  
  
• You have new lower abdomen (belly) or back pain that does not go away.
  
  
• Your urine is cloudy or smells bad.
  
  
• Your mouth feels dry or you have vision changes.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You feel confused.
  
  
• You see blood in your urine.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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