Urinary Incontinence
Urinary incontinence, also known as UI, is a loss of bladder control that affects between a quarter to a third of adult Americans, according to the Urology Care Foundation. UI is an involuntary leakage of urine that may range from a few drops to emptying the entire contents of the bladder unexpectedly.
The bladder is a hollow organ made of stretchy tissue that includes the detrusor muscle. When the detrusor relaxes, the bladder walls stretch as it fills with urine. When the detrusor contracts, urine is pushed out of the body through a tube called the urethra. UI can occur when the detrusor and other muscles around the bladder do not control urine flow as they should.
Though UI occurs more often in older adults, it does not have to be an inevitable part of aging. Many types of UI can be successfully managed or cured with treatment.
Types and Causes of Urinary Incontinence
- Bedwetting is urine leakage during sleep. In adults, causes include health problems such as BPH, diabetes, kidney stones, sleep apnea or a UTI.
- Functional incontinence occurs when a physical or mental disability such as arthritis or Alzheimer’s disease prevents someone from reaching a toilet in time.
- Mixed incontinence combines multiple types of UI, most often stress and urge incontinence.
- Overflow incontinence occurs when the bladder does not empty completely, leaving behind urine that then leaks out. Causes include kidney stones, BPH, and nerve damage due to injury, surgery or diseases such as multiple sclerosis.
- Stress urinary incontinence (SUI) is a loss of urine during everyday activities that place pressure on the bladder, such as laughing, coughing, sneezing or lifting a heavy object. Most often, the cause is weak pelvic floor muscles.
- Transient incontinence is urine leakage due to a temporary, or transient, cause such as a starting new medication.
- Urge incontinence is a sudden, uncontrollable need to urinate. Causes include urinary tract infection (UTI), bladder stones, diabetes, Parkinson’s disease or stroke. In men, one common cause is benign prostatic hyperplasia (BPH) or enlarged prostate.
Signs and Symptoms of Urinary Incontinence
Depending on the type and cause, symptoms of urinary incontinence may include:
- frequent urination
- leaking urine during daily activities
- sudden, strong urge to urinate that cannot be delayed
- urinating during sleep
- waking up repeatedly to urinate
How Is Urinary Incontinence Diagnosed?
In addition to physical examination and review of symptoms, diagnostic tests may include:
- urinalysis — to look for signs of infection or other abnormalities in urine
- urodynamic testing — a range of procedures such as cystometry, electromyography, leak point pressure measurement and imaging studies to evaluate bladder and urinary tract function
Treatments for Urinary Incontinence
Depending on the type and underlying cause, treatment for UI usually starts with lifestyle changes to reduce leaks, such as:
- bladder training — urinating on a schedule to gradually increase the amount of urine the bladder can hold
- pelvic floor exercises — to strengthen muscles around the bladder
If these approaches are not effective, additional options may include:
- bulking agent injections — to thicken bladder and urethra tissues
- electrical nerve stimulation — to improve bladder control
- injections of Botox — botulinum toxin type A, to relax bladder muscles
- medical devices — such as a catheter (tube to pass urine out of the body) or pessary (ring-shaped vaginal insert to support the bladder)
- medications — such as anticholinergics, beta-3 agonists or tricyclic antidepressants to relax bladder muscles, and/or drugs such as alpha blockers to relax prostate muscles and improve urine flow
- radiofrequency therapy — to firm up urinary tract tissue
- surgery — such as pelvic reconstruction to restore the bladder to its normal position