Urinary incontinence

Definition

Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries urine out of your body from your bladder. You may leak urine from time to time. Or, you may not be able to hold any urine.

The 3 main types of urinary incontinence are:

Mixed incontinence occurs when you have more than one type of urinary incontinence.

Bowel incontinence is when you are unable to control the passage of stool. It is not covered in this article.

Alternative Names

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

Causes

Causes of urinary incontinence include:

Incontinence may be sudden and go away after a short period of time. Or, it may continue long-term. Causes of sudden or temporary incontinence include:

Causes that may be more long-term:

Home Care

If you have symptoms of incontinence, see your health care provider for tests and a treatment plan. Which treatment you get depends on what caused your incontinence and what type you have.

There are several treatment approaches for urinary incontinence:

Lifestyle changes. These changes may help improve incontinence. You may need to make these changes along with other treatments.

For urine leaks, wear absorbent pads or undergarments. There are many well-designed products no one else will notice.

Bladder training and pelvic floor exercises. Bladder retraining helps you gain better control over your bladder. Kegel exercises can help strengthen the muscles of your pelvic floor. Your provider can show you how to do them. Many women do not do these exercises correctly, even if they believe they are doing them correctly. Often, people benefit from formal bladder strengthening and retraining with a pelvic floor specialist.

Medicines. Depending on the type of incontinence you have, your provider may prescribe one or more medicines. These drugs help prevent muscle spasms, relax the bladder, and improve bladder function. Your provider can help you learn how to take these medicines and manage their side effects.

Surgery. If other treatments do not work, or you have severe incontinence, your provider may recommend surgery. The type of surgery you have will depend on:

If you have overflow incontinence or you cannot fully empty your bladder, you may need to use a catheter. You may use a catheter that stays in long term, or one that you are taught to put in and take out yourself.

Bladder nerve stimulation. Urge incontinence and urinary frequency can sometimes be treated by electrical nerve stimulation. Pulses of electricity are used to reprogram bladder reflexes. In one technique, the provider inserts an stimulator through the skin near a nerve in the leg. This is done weekly in the provider's office. Another method uses battery-operated implanted device similar to a pacemaker that is placed under the skin in the lower back.

Botox injections. Urge incontinence can sometimes be treated with an injection of onabotulinum A toxin (also known as Botox). The injection relaxes the bladder muscle and storage capacity of the bladder. The injection is delivered through a thin tube with a camera on the end (cystoscope). In most cases, the procedure can be done in the provider's office.

When to Contact a Medical Professional

Talk to your provider about incontinence. Providers who treat incontinence are called gynecologists and urologists. They can find the cause and recommend treatments.

Call your local emergency number (such as 911) or go to an emergency room if you suddenly lose control over urine and you have:

Call your provider if you have:

References

Newman DK, Burgio KL. Conservative management of urinary incontinence: behavioral and pelvic floor therapy and urethral and pelvic devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 80.

Resnick NM. Incontinence. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 26.

Reynolds WS, Dmochowski R, Karram MM. Surgical management of detrusor compliance abnormalities. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2016:chap 93.

Vasavada SP, Rackley RR. Electrical stimulation and neuromodulation in storage and emptying failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 81.


Review Date: 11/13/2016
Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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