Urinary Incontinence Causes and Treatment

Urinary incontinence is the sudden loss of bladder control. If you have had this experience, you know that it can cause personal distress as well as embarrassment. There are a number of causes of incontinence, including illnesses, previous surgeries, childbirth, infections, medications, and weight gain.

Woman wetting herself
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Both men and women can experience incontinence. Most people don't realize that incontinence is often treatable. The first step is talking to your doctor, who can work with you to determine the cause.

Causes

With incontinence, you may completely lose control of urination all of the time, but it is more common to lose control some of the time. And, incontinence can mean a small flow or leak of urine, or it may mean the loss of significant amounts of urine. Incontinence can be temporary and reversible, or it may be permanent.

The most common causes include:

Pregnancy

During pregnancy, some women experience urinary incontinence as a result of pressure on the bladder exerted by the expanding uterus, which contains the developing baby. This problem is more noticeable during the later stages of pregnancy, but it may increase or decrease throughout pregnancy as the baby shifts position, changing the impact of pressure on the bladder. Incontinence from pregnancy does usually resolve after delivery.

Childbirth

Multiple vaginal deliveries can also increase your future risk of incontinence. Some women experience more severe incontinence after childbirth if there is damage to the nerves or muscles during the delivery process. In many cases even if there is an injury the symptoms can resolve.

Stress Incontinence

Stress incontinence can be caused by laughing, sneezing, coughing, or physical movements that put pressure on the lower abdominal area where your bladder is located. Most cases of stress incontinence are due to the disturbance of or weakening of the muscles in the pelvic floor or in the urethra, which controls urine flow in both men and women.

Rarely, stress incontinence results when the bladder is too full of urine because you have held it for too long or because you have bladder dysfunction as a result of diabetes or strokes.

Bladder Spasm

Bladder spasm is the sudden contraction (squeezing) of the bladder, which can lead to involuntary urination. There are a number of causes of bladder spasm, including stress, medication side effect, kidney or bladder stones, or too much caffeine. Doctors refer to leakage of urine from bladder spasms as having "urge incontinence."

Overactive Bladder

Overactive bladder is a tendency to either feel the sudden urge to urinate or to have involuntary spasms of the bladder. (A person who repeatedly experiences bladder spasms may be suffering from overactive bladder. ) Overactive bladder can be a symptom of several medical conditions, including infections and neurological illnesses.

Diabetes

Diabetes may cause incontinence, particularly in patients with undiagnosed diabetes. Polydipsia (drinking more than the usual amount of fluid) and polyuria (excessive urination) are among the early signs of diabetes. Often, the high volume of urine produced as a result of diabetes can make a person lose control of urine, particularly during sleep. Poorly controlled diabetes in the longterm can cause permanent damage to the bladder and cause retention of urine that leads to a complete inability of the bladder to function.

Menopause

Menopause is often associated with both urge and stress urinary incontinence. After menopause, the vaginal tissue can thin and affect the surrounding structures, including the urethra. These changes can lead to incontinence.

Prostate Enlargement

The prostate is a walnut-sized gland located between the bladder and urethra in men. As men age, the prostate enlarges, obstructing the flow of urine and potentially causing incontinence. Prostate enlargement can also result from benign prostatic hyperplasia or prostate cancer. It's important for men with urinary symptoms to get checked by their doctor for prostate cancer.

Neurological Disease

Multiple sclerosis, stroke, spine disease, and other neurological disorders impact the brain or the spine. This can cause incontinence due to lack of control of the nerves that power the muscles involved in urination or due to a problem with decreased sensation of the bladder which results in decreased awareness of the need to urinate.

Dementia

Dementia is characterized by memory loss and cognitive difficulties. Often, people with dementia experience incontinence due to a decreased sensation of a full bladder or a decreased ability to control the muscles of urination. Some people with dementia experience incontinence due to behavioral changes such as apathy (decreased interest in the world around them) or loss of social inhibition (decreased interest in behaving as socially expected). (Parkinson's disease is another neurological illness that is sometimes associated with incontinence.)

Pelvic Organ Prolapse

Prolapse is when one of more of the pelvic organs drop from their normal position. In women prolapse can be seen on a vaginal exam where parts of the bladder or other organs are seen as bulges or herniates within the vaginal wall. These changes can cause not only incontinence but retention of urine, constant pressure sensation, and painful intercourse.

Loss of Consciousness

People who become unconscious as a result of a medical condition such as a seizure, a heart attack, a stroke, a drug overdose, head trauma or any other health problem may lose control of urine while unconscious.

Surgery

Sometimes, surgical procedures may damage the structures that are involved in the normal function of urination. This may be an unavoidable process, for example when a cancerous tumor is removed, or it may be the result of anatomical changes resulting from surgery.

In men, prostate resection surgery for enlarged prostate or prostatectomy (removal of the prostate) for cancer can cause incontinence. In women, a hysterectomy can cause incontinence. In men and women, procedures performed on the back or spinal cord can disturb the nerves and cause incontinence as a side effect.

Cancer

Cancer anywhere in the pelvic region can interfere with the ability to control urine. Cancers and tumors that affect urination include bladder cancer, prostate cancer or uterine cancer, which are nearby organs, or they may be cancers from another area of the body, such as the lungs or breast, that spread to the area in or around the bladder.

Neuropathy

Neuropathy is a disease of the nerves. There are a number of causes of neuropathy, the most common being diabetic neuropathy and alcoholic neuropathy. Neuropathy can make the nerves that control urination less effective, resulting in urinary incontinence.

Diuretics

There are a variety of foods, drinks, and medications that cause the body to produce excessive amounts of urine. The most well known is caffeine, which is naturally present in drinks such as coffee, tea, and cocoa. Several medications can also cause excessive production of urine. For example, many medications that are used for the treatment of high blood pressure have diuretic effects. Taking a diuretic does not necessarily result in incontinence, but it can increase the likelihood especially if you also have another cause of incontinence.

Urinary Tract Infection

A urinary tract infection (UTI) is an infection involving the kidneys, the ureters, the bladder or the urethra. UTIs can happen in both men and women and are treated with antibiotics. The infection can irritate the bladder and cause urinary symptoms which may include incontinence. Once the infection is cleared the urinary symptoms typically resolve. In some cases, recurrent infections patients can lead to chronic overactive bladder.

Treatment

Behavioral changes, including diet and exercise, can help some people regain bladder control if performed consistently. In some cases, medications may be prescribed to supplement these strategies.

The most common therapeutic and supportive techniques include:

  • Bladder training involves a structured urination schedule.
  • Pelvic muscle training teaches you how to squeeze and release your kegel muscles to better control the urinary flow. This is particularly helpful for women who have lost some of their bladder control after pregnancy or for men who have had their prostates removed.
  • Modifying fluid intake restricts the amount of fluids you drink as well as any beverages which have a diuretic effect. These include caffeinated drinks (coffee, tea, cola) or alcoholic beverages that not only promote urination but can also irritate the bladder. Restricting fluids two to three hours before bedtime can reduce nighttime incontinence.
  • Sacral nerve neuromodulation is the equivalent of a pacemaker for the bladder. It is a minimally invasive procedure where a small lead connected to a battery is implanted to alleviate symptoms of overactive bladder or help the bladder empty better when there is retention of urine.
  • A pessary is a small block that is inserted into the vagina by a doctor. It may be used for post-menopausal women with bladder control issues, dropped bladder, or prolapse.
  • Male incontinence devices: Male stress incontinence that has failed medical therapy can be treated with the surgical placement of an artificial sphincter or male sling. Both procedures are minimally invasive surgeries done by urologists.
  • Bulking agents are substances, like collagen, that can be injected around the urethra to add volume to the urethra. Women may require only a local anesthetic for this procedure, while men may require general or regional anesthesia.
  • A suburethral sling is a minimally invasive surgical procedure that aims to increase compression of the urethra in women. This is most typically used to treat stress incontinence.

A Word From Verywell

Whatever your experience with incontinence, you should seek medical attention for it. Usually, your doctors can find the cause, and treatment can help you avoid the symptoms, substantially improving your quality of life.

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Article Sources
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Additional Reading
  • Jiao B, Lai S, Xu X, Zhang M, Diao T, Zhang G. A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence. Medicine (Baltimore). 2018;97(14):e0283. doi:10.1097/MD.0000000000010283.

  • Patrick Weledji E, Eyongeta D, Ngounou E. The Anatomy of Urination: What Every Physician Should Know. Clin Anat. 2018 Oct 10. doi:10.1002/ca.23296. [Epub ahead of print]