What Is Incontinence?

Urinary incontinence is an unintentional loss of control in releasing urine (pee) from the bladder. With urinary incontinence, urine leaks out of the body. This problem can be caused by a variety of factors that affect the muscles and nerves of the bladder.

Having urinary incontinence could mean anything from a small leak when coughing or sneezing to a complete lack of control that causes a flow of urine from the body. People of any sex can experience incontinence.

Types of urinary incontinence include stress incontinence, urge incontinence, overflow incontinence, functional incontinence, and mixed incontinence.

Urinary Bladder

The bladder stores urine until it is released from the body. The bladder is located in the pelvis. It is hollow inside and it expands as it fills with urine, functioning somewhat like a balloon. An adult bladder can hold between 1.5 and 2 cups of urine.

Urine leaves the body through the urethra, a thin tube located between the bladder and the outside of the body. When the bladder is full, the brain receives a signal that it is time to urinate.

Two sets of muscles, called sphincters, help control the flow of urine. These sphincters are shaped like a ring and are located in the neck of the bladder and the urethra.

When the sphincters are closed, they hold the urine in the bladder. When they relax, the urine is sent down the urethra and out of the body.

People do have control over these muscles and can clench them or relax them. Not having complete control over stopping and/or starting the body from urinating can result in urinary incontinence.

Types of Incontinence

There are several types of urinary incontinence and each has different potential causes.

Stress Incontinence

Stress incontinence occurs when urine leaks from the body with physical movements like coughing, sneezing, laughing, bending over, exercising, having sex, or lifting something heavy. Stress incontinence is more common in females than it is in males. 

This type of incontinence is caused by weakness of the muscles of the urinary sphincter or the urethra. When a force is placed on the muscles in the abdomen, it can cause pressure on the bladder and lead to leaking urine.

Stress incontinence may develop when the muscles are weakened by childbirth, and it can occur begin during pregnancy. It can also occur after prostate surgery, which weakens the muscles of the sphincter.

First line treatment of stress incontinence includes doing exercises of the pelvic floor muscles. Bladder training can help you learn how and when to void on a schedule to avoid symptoms of stress incontinence.

Specialized devices can be used for treating stress incontinence. A patient can insert and remove a urethral insert by the patient as needed. And a vaginal pessary must be implanted by a healthcare professional.

Surgery that helps support the muscles in the urethra and the neck of the bladder may also be used to prevent leakage.

Urge Incontinence

Urge incontinence is a feeling of a sudden urge to urinate that is followed by a loss of muscle control and leaking urine. Some people who experience urge incontinence also need to go to the bathroom more often, and sometimes get up during the night (nocturia).

This condition is caused by abnormal contractions in the bladder. The muscles contract involuntarily and cause urination to occur.

There are several risk factors for urge incontinence, including previous abdominal surgery (such as cesarean section or prostate surgery), obesity, cancer of the bladder or prostate, urinary tract infections, and older age.

The treatment for urge incontinence may start with biofeedback, which is a type of training to learn how and when to empty the bladder to avoid leaks. Exercises called Kegels, which involve contracting certain muscles of the pelvic floor, might also be helpful.

Medications, nerve stimulation therapy, and surgery might also be used for incontinence that doesn’t improve with more conservative methods.

If you have frequent nocturia this may be a sign of diabetes or obstructive sleep apnea (OSA) and you should be evaluated for these conditions.

Overflow Incontinence

Overflow incontinence occurs when the bladder doesn't fully empty after urinating. And, you might not have the urge to urinate (feeling like you need to empty your bladder) when it is full. That leads to excess urine remaining in the bladder, which eventually causes an overflow of the retained urine.

This type of incontinence is often more common in the male urinary tract than in the female urinary tract. Some of the causes of overflow incontinence include a blocked urethra, nerve damage in the bladder, weakened muscles in the bladder, and certain medications.

Treating overflow incontinence may start with a practice called “double voiding,” which means going to the bathroom to urinate twice—a few minutes apart. This may help to completely empty the bladder. Other management techniques might include careful timing of fluid intake and using the bathroom right away when feeling an urge to do so.

Treating any underlying related conditions, for instance, a problem with the prostate, may also be recommended to help treat overflow incontinence. 

Functional incontinence

This type of incontinence is characterized by leaks when a person cannot get to a bathroom in time to urinate. It can also occur as an adverse effect of certain medications. Functional incontinence is more common in people with a female urinary tract than people with a male urinary tract.

In some cases, it can be caused by problems with the spine, nerves, or neurological conditions such as Parkinson's disease or multiple sclerosis.

Restricted movement, such as due to arthritis, can make it take too long to get to a bathroom to urinate, especially when there are not easily accessible bathrooms. It might also occur with intellectual disabilities, when a person may not recognize the need to use the bathroom to urinate. 

Bladder training and scheduled bathroom trips may help. Treating this type of incontinence for those who have altered mobility may involve addressing societal issues such as bathroom access.

Mixed Incontinence

Mixed incontinence is a combination of both stress incontinence and urge incontinence. The treatment might include strategies that are used for either or both of those types of incontinence.

Coping

Urinary incontinence is common, but it is also upsetting and can impair quality of life. However, there are many treatments available for the various types of incontinence. In some cases, the problem may be managed through the use of non-invasive measures such as pelvic floor exercises or biofeedback.

For leakage that is preventing the ability to work or attend social events, using urinary pads or underwear can help. This should be a temporary solution until a healthcare provider can help to find a more long-term treatment plan.

It is important to speak with a healthcare professional about urinary incontinence, even though it is an uncomfortable topic. Some other lifestyle measures that may be recommended by a healthcare professional and can help in coping with urinary incontinence include:

• Avoiding drinking a few hours before bedtime if waking to urinate is a problem
• Avoiding alcoholic drinks, caffeine, and spicy foods if they cause irritation
• Pelvic floor exercises such as Kegels to strengthen the muscles in that area
• Reducing or changing the dosage or dose schedule of medications that may be associated with incontinence
• Scheduling trips to the toilet every few hours
• Training the bladder to urinate on a more regular schedule through delaying urination (as directed by a physician)

A Word From Verywell

Even though many adults experience urinary incontinence, it is not always easy to discuss the problem with a healthcare provider. A primary care physician, internal medicine physician, urogynecologist, or urologist are some of the physicians that can help with diagnosing and treating urinary incontinence.

In some cases, making some lifestyle changes can be helpful in reducing the symptoms.

The most important point to remember is that if urinary incontinence is having a significant negative effect on your quality of life, treatments are available and they may help in getting back to regular activity.