What is urinary incontinence and what causes it?

When you are not able to hold your urine until you can get to a bathroom, you have what's called urinary incontinence (also called loss of bladder control). In contrast, bladder control means you urinate only when you want to. Incontinence can often be temporary, and it always caused by an underlying medical condition. Millions of Americans experience loss of bladder control. However, women suffer from incontinence twice as often as men do. Both women and men can have trouble with bladder control from neurological (nerve) injury, birth defects, strokes, multiple sclerosis (MS), and physical problems associated with aging. Older women have more bladder control problems than younger women do.

The loss of bladder control, however, is not something that has to happen as you grow older. It can be treated and often cured, whatever your age. Don't let any embarrassment about incontinence prevent you from talking to your health care provider about your condition. Find out if you have a medical condition that needs treatment.

Different Types of Urinary Incontinence

Stress incontinence - Leaking small amounts of urine during physical movement (coughing, sneezing, exercising). Stress incontinence is the most common form of incontinence in women. It is treatable.

Urge incontinence - Leaking large amounts of urine at unexpected times, including during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes).

Functional incontinence - Not being able to reach a toilet in time because of physical disability, obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet. For example, a person with Alzheimer's disease may not think well enough to plan a trip to the bathroom in time to urinate or a person in a wheelchair may be blocked from getting to a toilet in time.

Overflow incontinence - Leaking small amounts of urine because the bladder is always full. With this condition, the bladder never empties completely. Overflow incontinence is rare in women.

Mixed incontinence - A combination of incontinence, most often when stress and urge incontinence occur together.

Transient incontinence - Leaking urine on a temporary basis due to a medical condition or infection that will go away once the condition or infection is treated. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation).

Read More about Treatments
For Female Urinary Incontinence

How is urinary incontinence diagnosed?

To diagnose the problem, our Urogynecology Team  will first ask you about your symptoms and for a complete medical history. We'll ask about your overall health, any problems you are having, medications you are taking, surgeries you have had, pregnancy history, and past illnesses. You will also be asked about your bladder habits: how often you empty your bladder, how and when you leak urine, or when you have accidents. A physical exam will be performed to look for signs of any medical conditions that can cause incontinence, such as tumors that block the urinary tract, impacted stool, and poor reflexes that may be nerve-related. A test may be done to figure out how much your bladder can hold and how well your bladder muscles function.

For this test, you will be asked to drink plenty of fluids and urinate into a measuring pan, after which your provider will measure any urine that remains in the bladder. Your provider may also recommend other tests, including:

The Stress test - You relax, then cough hard as the provider watches for loss of urine.
Urinalysis - You give a urine sample that is then tested for signs of infection or other causes of incontinence.
Blood tests - You give a blood sample, which is sent to a laboratory to test for substances related to the causes of incontinence.
Cystoscopy - A thin tube with a tiny camera is placed inside the urethra to view the inside of the urethra and bladder.
Urodynamics - Pressure in the bladder and the flow of urine are measured using special techniques.

You may be asked to keep a diary for a day or a week in order to record when you empty your bladder. This diary should include the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. These pans are available at drug stores or surgical supply stores.

Does pregnancy, childbirth and menopause affect urinary incontinence?

Yes. During pregnancy, the added weight and pressure of the unborn baby can weaken pelvic floor muscles, which affects your ability to control your bladder. Sometimes the position of your bladder and urethra can change because of the position of the baby, which can cause problems. Vaginal delivery and an episiotomy (the cut in the muscle that makes it easier for the baby to come out) can weaken bladder control muscles. And, pregnancy and childbirth can cause damage to bladder control nerves. After delivery, the problem of urinary incontinence often goes away by itself. But if you are still having problems 6 weeks after delivery, talk to us.

Bladder control problems don't always show up right after childbirth. Some women do not have problems with incontinence until they reach their 40's. Menopause (when your periods stop completely) can cause bladder control problems for some women. During menopause, the amount of the female hormone estrogen in your body starts decreasing. The lack of estrogen causes the bladder control muscles to weaken. Estrogen controls how your body matures, your monthly periods, and body changes during pregnancy and breastfeeding. Estrogen also helps keep the lining of the bladder and urethra plump and healthy.

Talk with us about whether taking estrogen to prevent further bladder control problems is best for you. Tell us if you or your family has a history of cancer. If you face a high risk of breast cancer or uterine cancer, your health care provider may not prescribe estrogen for you.