An Overview of How Doctors Diagnose and Treat Urinary Incontinence

Urinary incontinence—the loss of bladder control—is a frustrating condition but one that is more common than many people think. According to the National Health and Nutrition Examination Survey conducted by the Center for Disease Control and Prevention (CDC), roughly 51% of females and 14% of males in the United States experience some level of urinary leakage,

Although urinary incontinence is often very treatable, people are sometimes too embarrassed to seek treatment or are not sure who they speak to about their symptoms. Others mistakenly believe that it is just "one of those things" you have to live with you as you get older.

This article walks you through what urinary incontinence is about, how is it managed, and who you can turn to for an evaluation and treatment. It also looks at the unique concerns related to females with urinary incontinence, including why they are at greater risk.

Doctor with older patient holding urinary incontinence pad

Adam Gault / SPL / Getty Images

What Is Incontinence?

Urinary incontinence is an unintentional loss of control in releasing urine (pee) from your bladder. It is caused by problems that directly or indirectly affect the muscles and nerves of the lower urinary tract.

What Causes Incontinence?

Incontinence often occurs because the muscles of the bladder, called the detrusor muscles, involuntarily contract (squeeze) and force urine out of the body. It can also occur when the urethral sphincter muscles that regulate the flow of urine become lax, causing leakage.

Types of urinary incontinence include:

  • Stress incontinence: This is when physical movement or activity—such as coughing, laughing, sneezing, running, or heavy lifting—puts pressure on the bladder, causing urinary leakage.
  • Urge incontinence: This is the sudden, strong desire to urinate that cannot be postponed, also referred to as overactive bladder (OAB).
  • Mixed incontinence: This is typically the combination of stress and urge incontinence.
  • Overflow incontinence: This is when a person is unable to completely empty their bladder or is unable to sense whether their bladder is empty.
  • Functional incontinence: This is when a person has normal bladder function but difficulty getting to the toilet in time due to things like impaired mobility or mental confusion.
  • Neurogenic bladder: This is when a person lacks bladder control due to a brain, spinal cord, or nerve problem.

Incontinence in Women

Women are disproportionately affected by urinary incontinence mainly because of the physical vulnerabilities of the female urinary tract.

Pregnancy and childbirth can damage the pelvic floor muscles that support the bladder, uterus (womb), bowels, and urethra (the tube through which urine exits the body). When these muscles are weakened, the urinary tract needs to work harder to hold the urine in. This places excessive pressure on the bladder and urethra, leading to stress incontinence.

Similarly, the reduction of hormone levels during menopause contributes to the loss of bladder control. This is because the hormone estrogen helps keep the bladder and urethra healthy. The loss of estrogen can cause pelvic floor muscles to become weak and vulnerable to urinary leakage.

The female urethra is also shorter than the male urethra. As such, any weakness in the urethral sphincter in a woman is more likely to cause incontinence because there is less muscle holding the urine in.

Signs and Symptoms of Urinary Incontinence

The signs and symptoms of urinary incontinence vary by the type of incontinence you have. Symptoms may include:

  • Leaking urine during everyday activities, such as lifting, coughing, bending, or exercising
  • Leaking urine without warning or any sense that you needed to pee
  • Having the sudden, strong urge to urinate that causes you to rush to the bathroom
  • Being able unable to physically reach the toilet in time
  • Wetting your bed at night
  • Leaking urine during sex

If these symptoms are causing you distress or undermining your quality of life, it is important to seek help from a qualified healthcare provider.

Types of Doctors Who Can Diagnose and Treat Incontinence

There are different healthcare providers who are qualified to diagnose and treat urinary incontinence, Even so, the provider you choose may end up referring you to another specialist if the underlying condition is beyond the scope of their practice.

Urinary incontinence may be diagnosed and treated by the following practitioners:

  • Primary care, family practice, and internal medicine practitioners can handle most uncomplicated cases of urinary incontinence.
  • Urologists have extensive training in diseases and disorders of the urinary tract. Some specialize in female urology, while others have a subspecialty in neurology.
  • Obstetrician-gynecologists (OB/GYNs) focus on diseases and disorders of the female reproductive system as well as managing all phases of pregnancy and childbirth.
  • Urogynecologists have specialized training in the female urinary tract, including conditions affecting the pelvic organs.
  • Neurologists treat diseases and disorders of the nervous system, including conditions like a neurogenic bladder.

You may also receive care from nurses, physical therapists, and other healthcare providers who frequently assist in the treatment of urinary incontinence.

Management and Prevention

Urinary incontinence can be effectively managed in many cases and may even be fully resolved in some people.

The treatment approach varies by the underlying cause but may include:

  • Medications: These include drugs like Myrbetriq (mirabegron) and Gemtesa (vibegron) which relaxes the bladder muscles, anticholinergics which help treat overactive bladder, and Oxytrol (oxybutynin) used to treat neurogenic bladder.
  • Medical devices: These include a vaginal pessary (a silicone ring inserted into the vagina to prevent leakage) or a urinary catheter (a flexible tube inserted into the urethra that can help regulate urine flow).
  • Injected therapies: These include bulking agents that are injected around the urethra to narrow the opening and reduce urine flow. Botox is also sometimes injected into the bladder to help treat overactive bladder or neurogenic bladder.
  • Electrical therapies: These include electrical stimulation therapy in which electrodes are temporarily inserted into the rectum or vagina to stimulate and strengthen pelvic floor muscles. There are also implanted stimulators that help treat overactive bladder by tempering nerves that cause bladder contractions.
  • Surgery: These include procedures known as sling surgery and bladder neck suspension that support the urethra and the area of thickened muscle where the bladder connects to the urethra (called the bladder neck).

Tips and Lifestyle Practices

As you and your healthcare provider explore the most effective treatments for your condition, there are simple, everyday things you can do to prevent bladder leakage. These include:

  • Avoid fluids a few hours before bedtime if nighttime urination is a problem.
  • Avoid alcohol, caffeine, and spicy foods that can promote urination or irritate the bladder.
  • Practice pelvic floor exercises such as Kegel exercises that can strengthen the urethral sphincter muscles.
  • Schedule trips to the toilet every two to four hours rather than waiting until when you need to go.
  • When the first urge to urinate strikes, try holding it for as long as possible. The aim of the strategy, called bladder training, is to gradually increase the time between toilet trips.
  • After urinating, wait a few minutes and try again. The strategy, called double voiding, can help you avoid accidental urine overflow.
  • If needed, lose weight with a healthy diet and routine exercise. This reduces the physical stress placed on the lower abdomen and bladder.

Summary

Urinary incontinence is a common problem that causes bladder leakage or the loss of bladder control. It is common in females but also affects many males.

There are different types of urinary incontinence. Some are caused by abnormal contractions of the bladder muscles, while others are due to the weakening of the muscles that help hold urine in. Others still are caused by damage to nerves that regulate these muscles.

Healthcare providers who can diagnose and treat urinary incontinence include urologists, obstetrician-gynecologists (OB/GYNs), urogynecologists, and neurologists. Primary care, family practice, and internal medicine specialists also commonly treat the condition.

The treatment of urinary incontinence varies by the cause but may include bladder training, fluid management, oral or injectable medications, vaginal pessaries, urinary catheters, and surgery.

A Word From Verywell

Although many adults experience urinary incontinence, it is not always easy to discuss the problem with a healthcare provider. Even so, "living with it" is not a solution and can end up reducing your quality of life and sense of well-being.

One of the major and well-known consequences of untreated incontinence is depression, resulting in increased isolation, low self-esteem, and high levels of stress.

If you don't feel comfortable talking with your family doctor about bladder control problems, seek a referral for a urologist or OB/GYN who is practiced in discussing such issues. Alternately, you can discuss the problem with a telehealth urologist from the privacy of your own home.

Frequently Asked Questions

  • Can you reverse urinary incontinence?

    It is possible to reverse urinary incontinence depending on the underlying cause. A 2011 study from Australia suggests that around 17% of females with urinary incontinence achieve full resolution within two years. With that said, urinary incontinence almost never goes away on its own.

  • What types of urinary incontinence are there?

    Types of urinary incontinence include:

    • Stress incontinence: Caused by activities such as sneezing or bending
    • Urge incontinence: Caused by the sudden, strong need to urinate
    • Mixed incontinence: Involving both stress and urge incontinence
    • Overflow incontinence: Caused when you don't fully empty the bladder
    • Functional incontinence: Caused when you cannot physically get to the toilet in time
    • Neurogenic bladder: Caused by the injury to nerves regulating urination
  • What will help treat my urinary incontinence?

    The treatment of incontinence is individualized based on the cause and severity of your condition. While many cases can be improved with things like fluid restriction and pelvic floor exercises, others may require oral or injectable drugs, bladder control devices, and even surgery to improve bladder control.

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