Incontinence (Involuntary Urine Leakage)
More than 12 million Americans suffer from urinary incontinence. The condition affects all ages, both sexes and people of every social and economic level. There are three basic forms of incontinence:
- Stress incontinence: occurs when sneezing, coughing or during other activities that put pressure on your bladder.
- Urge incontinence: a sudden and urgent need to urinate due to involuntary bladder contraction
- Overflow incontinence: (more common among men) develops when your bladder doesn’t empty as it should and then leaks urine later.
Urinary incontinence can be caused from muscle weakness in the bladder or pelvic floor, or problems in the nerves that control urination. Pregnancy, smoking, obesity, diabetes, bladder disease, certain medications, constipation or an enlarged prostate can contribute to incontinence. Congenital problems or neurologic disease (for example: stroke, Parkinson’s disease, Multiple Sclerosis or a spinal cord injury) can also contribute to incontinence.
But specifically, different types of incontinence have different causes:
- Stress incontinence can occur in men when the prostate is removed. Also, if there has been damage to the nerves or to the sphincter, the urethra won’t close enough to keep urine from leaking.
- Urge incontinence is caused by bladder muscles that are too strong or that squeeze at the wrong time, pushing urine out past the sphincter. This often leads to a strong urge to urinate. Urge incontinence can be the result of long-standing blockage of the bladder, neurologic conditions or idiopathic (unknown) reasons.
- Overflow incontinence is usually caused by blockage of the urethra, making it difficult for the bladder to empty completely. Over time, the bladder gets so full that pressure builds up and forces urine out past the sphincter.
The main symptom of incontinence is the accidental release of urine.
- If you have stress incontinence, you may leak urine when you cough, laugh, exercise or move suddenly.
- If you have urge incontinence, you may leak when you get the urge to urinate. You will often urinate frequently and have trouble reaching the toilet in time.
- If you have overflow incontinence you may have the constant urge to urinate, but often just dribble urine continuously.
A urologist will perform a detailed history and physical exam to categorize the incontinence. It is helpful if the patient keeps a diary for a few days before examination to record times of urination, how much urine is passed, leakage and the foods and beverages consumed. The physician may also perform one of several tests:
- Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
- Postvoid residual volume: A test that measures the amount of urine left in the bladder after urination.
- Urinalysis: An examination of the composition of the patient’s urine.
- Bladder scan: An ultrasound of the kidneys, bladder and urethra, to see if the bladder empties completely.
- Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
- Urodynamics: A special technique that measures pressure in the bladder and urine flow.
Both stress and urge incontinence may be managed by lifestyle changes, including modifications to the diet and Kegel exercises. The physician may also recommend the following treatments:
- Medications: Anticholinergics, estrogens, tricyclic antidepressants or alpha-adrenergic drugs.
- Injection therapy: The physician injects collagen, body fat or synthetic compounds around the urethra to improve the function of the urethral sphincter and compress the urethra near the bladder outlet.
- Sling: In this procedure support material is placed directly under the urethra and attaches it up to the connective tissue of the abdominal muscles. It is usually a small outpatient procedure.
- Sacral nerve stimulation: A pacemaker-like device for the bladder, implanted through a tiny incision near the tailbone, to stimulate the sacral nerves.
- Artificial sphincter: The insertion of a pump, a balloon reservoir and a cuff that encircles and closes the urethra.
- Bladder augmentation: A rare procedure that enlarges the bladder with a patch made from the patient’s own tissue.
To learn more about Urinary Incontinence (Involuntary Urine Leakage), visit WebMD's Incontinence & Overactive Bladder Health Center.
To learn more about female incontinence, visit our women's health section on Female Incontinence.
To learn more about male incontinence, visit our men's health section on Male Incontinence.