Urinary incontinence: types, causes and ways to regain control

Leaking urine can be upsetting, and people may feel embarrassed to mention it. This article explains the types of urinary incontinence, why it happens and what can help, using information from the NHS, MedlinePlus and the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

1. Introduction

Urinary incontinence means passing urine without meaning to ^{[1, 3]}. MedlinePlus describes it as a loss of bladder control that can range from minor to severely disruptive, and says it often improves with treatment ^[2]. The NHS says it is common and affects millions of people ^[1]. It is not an inevitable part of ageing ^[1]. Because the causes differ, the right approach depends on the type, so it helps to understand the pattern of your leaks before you see a doctor. Noting when leaks happen, for example during exercise, at night or on the way to the toilet, gives your doctor useful clues. This article is general information and does not replace a medical assessment.

2. Types and causes

The NHS and MedlinePlus describe these main types ^{[1, 2]}:

• Stress incontinence: urine leaks when the bladder is under pressure, for example when coughing, laughing or lifting. It is linked to weakened or damaged pelvic floor muscles, the muscles that support the bladder, and to the muscle that closes the urethra.
• Urge incontinence: urine leaks with a sudden, strong need to pass urine. It is linked to an overactive bladder muscle, and MedlinePlus says it can signal a urinary tract infection or a nerve condition.
• Overflow incontinence: the bladder cannot empty fully, so it overfills and leaks. The NHS links it to a blockage, and MedlinePlus says it is more common in men and can be linked to tumours, kidney stones, diabetes or certain medicines.
• Mixed incontinence: a combination, usually stress and urge together.
• Total incontinence: the NHS describes this as the bladder being unable to store any urine at all, so urine is passed constantly or leaks often.

MedlinePlus also describes functional incontinence, where a physical or mental disability prevents getting to the toilet in time, and transient incontinence, which is temporary and caused by something such as an infection or a new medicine ^[2].

3. Risk factors

The NHS lists pregnancy and vaginal birth, obesity, a family history and older age ^[1]. MedlinePlus adds menopause, prostate problems in men, diabetes, long-term constipation and smoking ^[2]. The NIDDK notes that in women childbirth, menopause and ageing can contribute, and in men ageing and prostate problems may be a cause ^[3].

4. Diagnosis and tests

The NHS says diagnosis usually involves a consultation and may include a pelvic examination or, for people with a penis, a rectal examination. A GP may ask you to keep a diary of fluid intake and how often you pass urine, and may refer you to a specialist for more tests ^[1]. MedlinePlus says providers may also use urine and blood tests, bladder function tests and imaging ^[2]. The NIDDK lists urodynamic testing and cystoscopy, a look inside the bladder with a small camera, among related tests ^[3].

5. Treatment and management

Treatment depends on the type ^[3]. The NHS and MedlinePlus say the first steps are usually self-care ^{[1, 2]}:

• Pelvic floor exercises: squeezing these muscles to strengthen them. The NHS lists this as a first step and says it may help prevent leaks during pregnancy ^[1].
• Bladder training: gradually learning to wait longer between feeling the need to pass urine and going ^{[1, 2]}.
• Lifestyle changes: losing weight if needed, cutting back on caffeine and alcohol, and drinking less in the hours before bed while keeping up fluids in the day ^[1]. The NHS explains that caffeine and alcohol can make the kidneys produce more urine and irritate the bladder, and that a GP can advise how much to drink.

If these are not enough, a doctor may discuss other options. The NHS lists absorbent pads, medicines and surgery such as a sling procedure for stress incontinence, and for urge incontinence surgery to enlarge the bladder or implant a device that stimulates the nerve controlling the bladder muscle ^[1]. MedlinePlus adds medicines to relax the bladder, devices such as catheters or a vaginal ring, injections that help the urethra close more tightly and electrical nerve stimulation ^[2].

6. Prevention and self-care

The NIDDK says incontinence cannot always be prevented, but habits that may help keep the bladder healthy include eating well, drinking enough fluids and keeping a healthy weight ^[3]. MedlinePlus also lists staying physically active, avoiding constipation and not smoking ^[2]. The NHS notes that pelvic floor exercises can help prevention ^[1].

7. Special groups

Women may notice leaks after pregnancy, childbirth or menopause ^{[2, 3]}. In men, prostate problems can be linked to leaking ^[3]. MedlinePlus says bedwetting is most common in children but can also occur in adults, with causes such as certain medicines, caffeine, alcohol, infections, kidney stones, an enlarged prostate and sleep apnea, a condition where breathing pauses during sleep ^[2].

8. When to see a doctor

The NHS says to see a GP for any type of urinary incontinence, because it is common and you should not feel embarrassed ^[1]. The NIDDK advises seeking care if you often feel a sudden urge to pass urine or leak during normal activities ^[3]. MedlinePlus says new leaking can be caused by a temporary problem such as an infection or a new medicine, so tell a health care professional right away about any sudden change ^{[2, 3]}.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Urinary incontinence is common, has several types and often improves with treatment. Pelvic floor exercises, bladder training and lifestyle changes are usual first steps, and a doctor can arrange tests and other options if needed. Do not let embarrassment delay getting advice.