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Incontinence Information

Incontinence in women

What is urinary incontinence? — "Urinary incontinence" is the medical term for when a person leaks urine or loses bladder control. Often it is called just "incontinence."

Incontinence is a very common problem. If you have this problem, there are treatments that can help. There are also things you can do on your own to stop or reduce urine leakage so you don't have to "just live with it."

What are the symptoms of incontinence? — There are different types of incontinence. Each causes different symptoms. The 3 most common types are:

  • Stress incontinence – People with stress incontinence leak urine when they laugh, cough, sneeze, or do anything that "stresses" the belly. Stress incontinence is most common in women, especially those who have had a baby.
  • Urgency incontinence – People with urgency incontinence feel a strong need to urinate all of a sudden. Often the "urge" is so strong that they can't make it to the bathroom in time. "Overactive bladder" is another term for having a sudden, frequent urge to urinate. People with overactive bladder might or might not actually leak urine.
  • Mixed incontinence – People with mixed incontinence have symptoms of both stress and urgency incontinence.

Is there anything I can do on my own to feel better? — Yes. Here are some steps that can help reduce urine leaks:

  • Reduce the amount of liquid you drink, especially a few hours before bed.
  • Cut down on any foods or drinks that make your symptoms worse. Some people find that alcohol, caffeine, or spicy or acidic foods irritate the bladder.
  • If you are overweight, lose weight.
  • If you have diabetes, keep your blood sugar as close to normal as possible.
  • If you take medicines called diuretics, plan ahead. These medicines increase the need to urinate. Take them when you know you will be near a bathroom for a few hours.

These techniques can also help improve bladder control:

  • Bladder retraining – During bladder retraining, you go to the bathroom at scheduled times. For instance, you might decide that you will go every hour. You would make yourself go every hour, even if you didn't feel like you needed to. And you would try to wait until a whole hour had passed if you needed to go sooner. Then, once you got used to going every hour, you would increase the amount of time you waited in between bathroom visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between bathroom visits.
  • Pelvic muscle exercises – Pelvic muscle exercises strengthen the muscles that control the flow of urine. These exercises can help, but people often do them wrong. Ask your doctor or nurse how to do them right.

Should I see my doctor or nurse? — Yes. Your doctor or nurse can find out what might be causing your incontinence. He or she can also suggest ways to relieve the problem.

When you speak to your doctor or nurse, ask if any of the medicines you take could be causing your symptoms. Some medicines can cause incontinence or make it worse.

How is incontinence treated? — The treatment options differ depending on what type of incontinence you have, and whether you are a man or a woman. Some of the treatment options include:

  • Medicines to relax the bladder
  • Surgery to repair the tissues that support the bladder or to improve the flow of urine
  • Electrical stimulation of the nerves that relax the bladder

What will my life be like? — Many people with incontinence can regain bladder control or at least reduce the amount of leakage they have. The key is to speak up about it to your doctor or nurse. Then work with him or her to find an approach that helps you.

Incontinence Men

What is urinary incontinence? — "Urinary incontinence" is the term doctors use when a person leaks urine or loses bladder control. Incontinence is a very common problem, but it is not a normal part of aging. If you have urinary incontinence, you do not have to "just live with it." There are treatments and things you can do on your own to stop or reduce urine leaks.

What are the symptoms of urinary incontinence? — There are different types of urinary incontinence. Each causes different symptoms. In men, the 4 main types are:

  • Stress incontinence – Men with stress incontinence leak urine when they laugh, cough, sneeze, or do anything that "stresses" the belly. Some men get this type of incontinence after having surgery for prostate disease.
  • Urgency incontinence – Men with urgency incontinence feel a strong need to urinate all of a sudden. Urgency incontinence is also known as urge incontinence. Often the "urge" is so strong that they can't make it to the bathroom in time. (If you have these sudden urges but do not leak urine, you might have an "overactive bladder." That can also be treated.)
  • Mixed incontinence – Men with mixed incontinence have symptoms of both stress and urgency incontinence.
  • Incontinence caused by incomplete bladder emptying – Some men cannot fully empty their bladder when they urinate. This can happen if they have a condition called "benign prostatic hyperplasia," which makes the prostate grow larger than normal. An enlarged prostate can block the flow of urine.

Is there anything I can do on my own to feel better? — Yes. Here are some steps that can help reduce urine leaks:

  • If you drink lots of liquids, ask your doctor or nurse if it is okay for you to reduce the amount you drink. This might help, especially in the hours before you go to bed.
  • Cut down on any foods or drinks that make your symptoms worse. Some people find that alcohol, caffeine, or spicy or acidic foods irritate the bladder.
  • Lose weight, if you are overweight.
  • If you have diabetes, keep your blood sugar as close to normal as possible.
  • If you take medicines called diuretics, keep in mind that these medicines increase the need to urinate. Try to plan ahead and take them when you know you will be near a bathroom for a few hours. If you keep having problems with leaking because of diuretics, ask your doctor if you can take a lower dose or switch to a different medicine.

These techniques can also help with bladder control:

  • Bladder retraining – During bladder retraining, you "train" yourself to go to the bathroom at scheduled times, even if you do not feel like you have to go. For instance, you might decide that you will go every hour while you are awake. In that case, you would go to the bathroom every hour, even if you don't feel the need to go. You would also try to wait until a whole hour had passed even if you need to go sooner. Once you get used to this, you try to increase the time between bathroom trips to an hour and 15 minutes. Over time, you might be able to "retrain" your bladder to wait up to 3 or 4 hours between bathroom visits. When you reach 3 or 4 hours, you can stop bladder training.
  • Pelvic muscle exercises – Pelvic muscle exercises strengthen the muscles that control the flow of urine. When done right, these exercises can help. But people often do them wrong. Ask your doctor or nurse how to do them right.

Should I see my doctor or nurse? — Yes. Your doctor or nurse can find out what might be causing your incontinence. He or she can also suggest ways to help the problem.

Ask your doctor or nurse if any of the medicines you take could be causing your symptoms. Some medicines can cause incontinence or make symptoms worse.

How is incontinence treated? — Your treatment options depend on what type of incontinence you have. Some of the treatment options include:

  • Medicines to relax the bladder – These medicines can help with urgency incontinence.
  • Medicines to improve urine flow – These medicines can help with incontinence related to an enlarged prostate.
  • Surgery to (figure 1):
    • Repair the tissues that support the bladder or hold it in place
    • Improve the flow of urine, for example by removing part of the prostate gland
    • Repair the muscles that control urine flow
  • Electrical stimulation of the nerves that relax the bladder
  • Devices, such as:
    • A "condom catheter," which fits over the penis like a condom and collects urine into a bag that is strapped to the leg.
    • A penis clamp, which squeezes the penis to keep urine from leaking out (this can be used only for a certain amount of time).

What will my life be like? — Many men with incontinence can recover bladder control or at least reduce the amount of leakage they have. The key is to speak up about it to your doctor or nurse. Then work with him or her to find a treatment or therapy that helps you. Sometimes it takes a few tries before you find a solution, but the effort is worth it.

Urgency Incontinence

What is urgency incontinence? — "Incontinence" is the medical term for leaking urine or losing control of your bladder. People with urgency incontinence feel a strong need or "urge" to urinate all of a sudden. Often it is so strong that they can't make it to the bathroom in time. "Overactive bladder" is another term for having a sudden, frequent urge to urinate. People with overactive bladder might or might not actually leak urine.

Urgency incontinence is common, especially in women. But there are treatments that can help. There are also things you can do on your own to stop or reduce urine leakage so you don't have to "just live with it."

Is there anything I can do on my own for urgency incontinence? — Yes. Here are some steps that can help reduce urine leaks or urges:

  • Cut down on any foods or drinks that make your symptoms worse. Alcohol, caffeine, spicy or acidic foods, or artificial sweeteners make some people urinate more often or cause sudden urges.
  • Try not to drink too much right before bed.
  • Prevent constipation – Constipation is a common problem that makes it hard to have bowel movements. It can make urgency incontinence worse.

You can also try some things to help with bladder control:

  • Bladder retraining – Bladder retraining helps your bladder hold more urine so you can urinate less often. During bladder retraining, you go to the bathroom at scheduled times. For example, you might decide to go every hour. Then you make yourself go every hour, even if you don't think you need to. If you need to go sooner, try to wait until the whole hour has passed. After you get used to waiting 1 hour, you can try waiting longer between bathroom visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between bathroom visits.
  • Relaxation can help manage the urge to go. When you get an urge, stand still or sit down. Take a deep breath, squeeze your pelvic muscles, and let the "wave" of needing to go pass. Then walk slowly to the bathroom to urinate.
  • Pelvic muscle exercises – Pelvic muscle exercises strengthen the muscles that control the flow of urine. These exercises can help, but people often do them wrong. Ask your doctor or nurse how to do them correctly.

How do doctors treat urgency incontinence in women? — In addition to bladder retraining, relaxation, and pelvic muscle exercises, treatment might include medicines and sometimes procedures. These are discussed in more detail below.

Medicines to relax the bladder – These can help get symptoms under control. Medicines include oxybutynin (brand name: Ditropan), tolterodine (brand name: Detrol), fesoterodine (brand name: Toviaz), solifenacin (brand name: VESIcare), darifenacin(brand name: Enablex), and mirabegron (brand name: Mirbetriq). They come in pills you take by mouth and patches or gels you put on your skin.

Medicines for urgency incontinence can cause side effects, including:

  • Very dry mouth
  • Constipation
  • Heartburn
  • Trouble thinking and remembering things
  • Blurry vision
  • Fast heart rate
  • Sleepiness

If you are older, ask your doctor if it is safe to take these medicines. If you have any trouble thinking or remembering things, some of these medicines could make these issues worse.

If you take medicine to help with urgency incontinence or overactive bladder, you might need to try several different medicines before you find a treatment that works for you.

Vaginal estrogen – If medicines that relax your bladder do not work for you or cause too many side effects, talk to your doctor about other treatments. For some women who have vaginal dryness after menopause, vaginal estrogen can help with this as well as your bladder problems.

Procedures to help relax the bladder – If medicines don't help your symptoms or you can't take medicines, your doctor might suggest a procedure such as:

  • An injection (shot) of botulinum toxin (Botox) into the bladder to help it relax – The injection needs to be given about once or twice a year. These injections can cause trouble urinating in about 1 out of 4 women who get them.
  • Treatment with electrical nerve stimulation – This is done with a device that goes under the skin, like a pacemaker. Electrical stimulation sends mild electrical signals to nerves that affect the bladder. The signals do not hurt. This treatment can reduce sudden urges or the need to urinate often. You might need follow-up procedures after getting the device put in.

How well do treatments for urgency incontinence in women work? — That depends on your symptoms and the cause of your urgency incontinence. For example, if you have another medical condition, such as diabetes, treating that condition might help.

Most women need to try several treatments and might use more than one at a time. For example, your doctor might suggest bladder retraining, medicine to relax your bladder, and vaginal estrogen. It can take a month or longer to know if a treatment is working. Try not to get discouraged if it feels like treatment is not working quickly enough.

What will my life be like? — Most women with urgency incontinence need some kind of treatment for a long time, or for life. Treatment for urgency incontinence in women can help symptoms, but does not cure the cause of the incontinence.

Even if treatment doesn't stop urgency incontinence completely, it can make life easier and help you feel a lot better.