7 causes of urinary incontinence and how to treat them
- You might find it difficult to bring up urinary incontinence with your doctor, but it's very common.
- Incontinence can begin after childbirth, in older adulthood, or with certain health conditions.
- Your doctor can help you identify the cause of incontinence and offer guidance on treatment options.
Urinary incontinence, or the loss of bladder control, is a fairly common concern. In fact, it affects about 25 million Americans.
The effects of incontinence can range from a minor leakage of urine when coughing or sneezing, to an urge so strong you find it difficult to make it to the bathroom in time.
Even mild incontinence can be frustrating and challenging to live with, but there's a lot you can do to address this concern. A good first step involves identifying the type of incontinence you experience, which can lead you to a more specific cause.
Types of incontinence
Urinary incontinence can be experienced in multiple ways, says Denicia Dwarica, MD, a urogynecologist at University of Missouri Health Care.
These types include:
- Stress incontinence, which happens when pressure on the bladder causes you to leak urine. This might happen when you laugh, cough, sneeze, or lift an object.
- Urge incontinence, or leakage that happens when your bladder involuntarily contracts. You'll generally feel a sudden urge to urinate before urine begins to leak.
- Mixed incontinence, the most common type, which is a combination of stress and urge incontinence.
- Overflow incontinence, which happens when your bladder becomes overly full and you involuntarily leak urine.
- Functional incontinence, which happens when you have normal bladder function but physical or mental health symptoms, like difficulty walking or impaired reasoning, prevent you from reaching a bathroom in time.
Anyone can experience urinary incontinence, but it's more common among:
- Women
- Older adults
- People who smoke
- People who have a family history of incontinence
- People living with medical conditions such as diabetes, multiple sclerosis, obesity, or dementia
Causes of incontinence
The main causes of urinary incontinence include:
1. Diuretics and foods that have a diuretic effect
Certain foods, drinks, and medications can contribute to urge incontinence because they irritate the bladder and act as diuretics by increasing the body's urine production, says Dwarica.
Food and drinks that have a diuretic effect include:
Diuretic medications include:
- Lasix (furosemide)
- HCTZ (Hydrochlorothiazide)
- Torsemide
- Spironolactone
If your incontinence is triggered by a food or drink that produces a diuretic effect, cutting back on that specific food or beverage could make a difference.
If you think one of your medications is causing urge incontinence, let your doctor know. They can discuss your options for alternate medications or offer more guidance on addressing the incontinence.
2. Pregnancy and childbirth
Up to 40% of people experience stress urinary incontinence during pregnancy due to the weight of the unborn baby putting pressure on the bladder and pelvic floor muscles.
Giving birth can also damage your pelvic floor muscles and, in some cases, lead to persistent urinary incontinence after labor. If you still experience incontinence six weeks after childbirth, it's a good idea to check in with your doctor.
Doing pelvic floor and Kegel exercises both before and after childbirth can help reduce incontinence, since these exercises strengthen the muscles that control the bladder.
3. Age-related changes
Two frequent causes of urinary incontinence associated with aging are:
- Weakening muscles of the bladder or pelvic floor
- An enlarged prostate
For weak pelvic floor muscles, your doctor may recommend pelvic floor physical therapy.
"Pelvic floor muscle strengthening is often the cornerstone of treatment, and a physical therapist can establish a comprehensive program to address muscle imbalances," says Angela Fishman, PT, owner of My Pelvic Therapy.
An enlarged prostate, or BPH, can contribute to urinary incontinence in two main ways:
- It can put pressure on the bladder and lead to urine leakage.
- It can partially obstruct urine flow, which can lead to overflow incontinence.
Your doctor may prescribe medication that:
- Helps relieve pressure on your bladder muscles, making urination more controllable.
- Allows your urethra to relax, helping urine pass through more easily
If medications aren't effective, your doctor may recommend considering surgical options for incontinence caused by BPH.
4. Menopause
During menopause, your estrogen levels begin to drop. Changing hormone levels can cause changes in functionality and strength of the pelvic floor muscles and bladder, which can lead to incontinence.
Just as in pregnancy and childbirth, pelvic floor exercises can help improve menopausal incontinence.
A 2018 review of 31 studies concluded that pelvic floor muscle training was effective in reducing symptoms of urinary incontinence and improving quality of life for study participants.
5. Urinary tract infections
UTIs often cause frequent, strong urges to urinate, and they can lead to temporary urinary incontinence. Other signs of a UTI include:
- Pain or pressure in the pelvic area
- Pain and burning during urination
- Bloody or cloudy urine
- Fever
Your doctor can diagnose a UTI and prescribe antibiotics. These will generally start to clear your symptoms within a day or two, though symptoms can last up to a week. As the infection clears, incontinence should also improve.
6. Prostate cancer surgery
Between 6 and 8% of people experience lasting incontinence after surgery for prostate cancer. The surgery can affect muscles and nerves in the pelvic and bladder region, causing stress and urge incontinence.
Potential treatments include:
- Limiting fluid intake
- Avoiding bladder irritants
- Pelvic floor physical therapy
Your doctor may recommend surgery if incontinence persists. Two common procedures are:
- A sling procedure, which moves the position of the urethra to decrease incontinence.
- An artificial urinary sphincter, which allows you to control urine outflow by squeezing a pump.
7. Constipation
Constipation can also lead to urinary incontinence. "A full bowel pushes against the bladder and can affect control, and chronic straining can overstretch the pelvic floor muscles, making them less effective" says Fishman.
If constipation is causing incontinence, remedying the constipation could also help stop urine leakage.
To get relief from chronic constipation, try:
- Increasing fiber intake by adding more fresh fruits and vegetables to your diet
- Drinking plenty of water
- Trying an over-the-counter laxative or stool softener
- Cutting back on refined grains and heavily processed or fried foods
When to connect with your doctor
If urinary incontinence happens regularly, to the point where you find yourself adjusting your daily life and avoiding your usual activities because of it, contacting your doctor is a good next step.
In the meantime, pads or adult diapers can help manage leakage.
Your doctor will most likely ask you to keep a diary for three to four days to track:
- Liquid consumed
- How often you urinate
- When leakage usually tends to happen
They may also recommend tests, such as:
- Post-void residual urine testing to help determine whether your bladder empties completely when you urinate.
- Urinalysis to help rule out infections.
- Blood tests to test kidney function.
- Urodynamic testing to make sure your bladder is functioning properly.
- Cystoscopy to examine the urinary tract for signs of inflammation, blockage or narrowing, or cancer leading to incontinence.
Your doctor can also offer more guidance on potential treatments for urinary incontinence, such as:
- Bladder training, a behavior therapy that aims to prevent leakage by delaying urination, managing urges, and increasing time between using the bathroom.
- Biofeedback, which places sensors on the body to create a graph showing the muscles you use while doing pelvic floor exercises. The visual feedback helps make sure you strengthen the correct muscles to control your bladder
- Electrical stimulation, which sends an electric current to nerves in your lower back and muscles in your pelvis. The electric current can help strengthen bladder and pelvic floor muscles and decrease incontinence.
- Botox, which can decrease spasms in the bladder that cause urge incontinence. Botox is usually used only when other treatments haven't been effective.
- Nerve stimulation, which involves a device inserted into your back that stimulates sacral nerves which control the pelvic floor and bladder.
- Urethral bulking, which involves injections of collagen into your urethra to help retain urine.
Insider's takeaway
Urinary incontinence is a common issue, but it's one that can have a major impact on quality of life.
If you live with incontinence, you might have a hard time bringing this concern up with your doctor or clinician. Know, though, that it's nothing to be ashamed of, and you have a range of options to manage it, including lifestyle changes, exercises you can do at home, and treatment from your doctor.