(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)
DefinitionUrinary incontinence is the loss of voluntary bladder control that can lead to urine leakage. Incontinence can be temporary or long-lasting.
CausesThe causes may vary with the type of incontinence.
Stress IncontinenceThe accidental loss of urine during physical activity or coughing, sneezing, and laughingThe leakage may be caused by:
- Weakening of the muscles that suspend the bladder
- Weakening of the muscles that control urine flow
- Damage to the muscles that control urine flow following prostate surgery
Urge IncontinenceThis is also known as overactive bladder and is the accidental loss of urine when the bladder spasms for no reason. It may be caused by:
- Urinary tract infection
- Diabetes type 1 and type 2
- Bladder irritation, such as a kidney stone or tumor
- Drugs, such as hypnotics or diuretics
- Nerve damage due to:
Overflow IncontinenceThis occurs when the bladder will not empty. The urine builds up and overflows. This leads to leaking of urine. It may be caused by:
- Prostate enlargement
- Bladder that is blocked, such as by a scar in the urethra (stricture)
- Fecal impaction putting pressure on the urethra
- Drugs, such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, and calcium channel blockers
- Vitamin B12 deficiency
- Weak bladder muscles
- Nerve damage
Functional IncontinenceThis is when you have normal bladder control, but you are physically unable to reach the toilet in time. It may be a result of a condition like severe arthritis. Drugs that cause confusion or sedation can also lead to functional incontinence.There may be several different causes for incontinence. In some cases, the cause may also be unclear.
Risk FactorsMen who are older than 65 are most affected.Factors that may increase your risk of incontinence include:
- History of prostate surgery
- Prostate enlargement due to benign prostatic hyperplasia (BPH), infection, or prostate cancer
- Urinary tract infection
- Chronic lung disease
- Dementia , including Alzheimer’s disease
- Multiple sclerosis
- Spinal cord injury or disease
- Use of certain substances or medications:
- Cholinergic agents
SymptomsUrinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.With stress incontinence, leakage may happen when there is extra pressure on your bladder. This can happen when you laugh, sneeze, lift heavy objects, or exercise.With urge incontinence, you may have a loss of bladder control following a strong urge to urinate. You may not be able to hold urine long enough to make it to a toilet.
When Should I Call My Doctor?Call your doctor if you have any loss of urine control. Your doctor can help you determine the underlying cause.
DiagnosisYou will be asked about your symptoms and medical history. You will be asked about your urine leakage and how often you empty your bladder. A physical exam will be done to look for any physical causes. These include blockages or nerve problems. You may be asked to to keep a diary of your urinary habits.You may be referred to a specialist. Urologists are doctors who focus on urinary issues.Tests to help find the cause of the incontinence may include:
- Stress test—you relax, and then cough as your doctor watches for loss of urine (this will confirm if you have stress incontinence)
- Urine tests
- Tests to explore problems with your prostate, such as a prostate exam or blood tests
- Blood tests to detect diabetes
- Ultrasound—uses sound waves to examine structures inside the body to determine if any urine remains in your bladder after urinating
- Cystoscopy —a thin tube with a tiny camera is inserted into the urethra to view the urethra and bladder
- Urodynamic tests—used to measure the flow of urine and the pressure in the bladder
TreatmentTreatments may include:
Behavioral TherapyBehavioral therapy includes:
- Making muscles stronger by doing Kegel exercises
- These strengthen the muscles that hold the bladder in place and control urine flow.
- Painless electrical stimulation is sometimes used. It can strengthen the muscles more quickly. It is helpful for stress incontinence.
- Creating a regular schedule to empty your bladder (called bladder training). This training may also involve drinking fewer liquids
Weight LossLosing weight may help reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.
MedicationMedications may be prescribed to relax the bladder muscles. These types of medications are called anticholinergics. They are often used in treating urge incontinence. Examples include: Your doctor may also recommend botulinum toxin injections to help ease symptoms.
DevicesAbsorbent diapers are often used by men with incontinence.Catheters are sometimes used to treat more severe cases. External (condom) or internal (Foley) catheters may be used. Another option is a penile clamp. These clamps are padded and have a sleeve to absorb leakage.
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- Take care of your skin by gently cleaning yourself after an episode of incontinence. Let the skin air dry.
- Make it easier to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night-lights in the hallway and in the bathroom.
- If needed, keep a bedpan or urine canister handy in your bedroom.
Nerve StimulationDevices like Urgent PC and Inter-Stim may be used to stimulate the nerves. This may involve implanting a thin lead wire with a small electrode tip. This electronic stimulation therapy can be done as a series of treatments in your doctor's office and can help strengthen muscles that control voiding.
SurgeryIn men, surgery may be done to relieve a physical blockage due to an enlarged prostate.Other procedures involve surgical repair or implants into the bladder sphincter. The sphincter is the gate that allows the urine to flow through.
PreventionIncontinence is really a symptom of another condition. There are several ways to prevent incontinence:
- Reduce your intake of substances that lead to incontinence. These include caffeine, alcohol, and certain drugs.
- Lose weight.
- Avoid and treat constipation.
National Institute of Diabetes and Digestive and Kidney Diseases
Urology Care Foundation
Canadian Nurse Continence Advisors Association
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Urinary incontinence in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2014. Accessed October 28, 2014.
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12/3/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK.Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.
7/28/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mangera A, Apostolidis A, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981-990.
- Reviewer: Adrienne Carmack, MD
- Review Date: 12/2014
- Update Date: 12/20/2014
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