- Bladder leaks from physical stress, limitations, and
health conditions are common for men and women. - Treatments range from training your bladder to addressing underlying conditions.
- Underlying causes can include UTI, an enlarged prostate, and diabetes.
If you can't hold your pee, you probably have some form of urinary incontinence, which affects up to 36% of people worldwide.
Incontinence can have a big impact on your quality of life, but "there are things that can be done to fix it," says Karyn Eilber, MD, a urologist with Cedars Sinai in Los Angeles.
Bladder leaks are common
Defined as any involuntary loss of urine, urinary incontinence can be embarrassing, but it's extremely common, says Brian Norouzi, MD, a urologist with Providence St. Joseph Hospital.
It's twice as common in women than men, and increases with age, although it can affect anyone, says Norouzi.
"Likely you don't know it but your friends and relatives have had to deal with one form or another," he says.
Working with a doctor to identify the type of incontinence you have can help inform treatment, says Eilber.
Types of incontinence
There are four main types of incontinence.
1. Stress incontinence
Stress incontinence is a bladder leak caused by physical stress put on the bladder. Most often the physical stress is abdominal pressure from common movements like coughing, sneezing, laughing, or exercising, says Eilber.
Stress incontinence will affect one-quarter of women, but is most common in people who have had vaginal childbirths. That's because vaginal delivery can damage the pelvic floor muscles and ligaments that help with bladder control.
Stress incontinence can also occur in men due to an enlarged prostate, but that's less common, says Norouzi.
What to do about it: Kegel exercises can help treat stress incontinence, but they're not a cure-all, Eilber says. Bladder training and lifestyle changes like using absorbent underwear can alleviate and control symptoms, but some people will need surgical treatment.
2. Overflow incontinence
Overflow incontinence occurs when a person can't empty their bladder entirely or they don't feel a need to urinate even when their bladder is full, says Eilber. Over time, this leads to the bladder becoming very full, which can cause involuntary leaks.
This can happen in both men and women, but is a more rare type of incontinence, says Eilber. It's linked to having weakened bladder muscles, nerve damage that affects your ability to feel the urge to pee, or a blockage that impacts your ability to empty your bladder completely.
Overflow incontinence is more common in people who have health conditions including diabetes, multiple sclerosis, or enlarged prostate, and those on certain medications.
What to do about it: The treatment for overflow incontinence involves treating the underlying condition. If other treatments fail and the incontinence is having a severe impact on a person's life, a catheter may also be used to periodically empty the bladder.
3. Urge incontinence
Urge incontinence is characterized by a sudden severe need to urinate and the inability to get to a toilet in time.
It happens most commonly in post-menopausal women. But it can occur in men as well and is more likely in people who have neurological conditions, including nerve damage associated with diabetes.
What to do about it: The first line of treatment for urge incontinence is to use the bathroom at regular intervals to avoid your bladder becoming too full. This is known as timed voiding, says Norouzi.
Botox injections, medications, and nerve stimulation treatments that stimulate the bladder in the same way that a pacemaker stimulates the heart can also treat urge incontinence.
4. Functional incontinence
Functional incontinence is when a person cannot make it to the bathroom due to physical or cognitive limitations or disabilities. It might occur in people who have limited mobility or those with dementia or other cognitive conditions, says Eilber.
What to do about it: The treatments for functional incontinence are management and behavioral and lifestyle changes. It may involve wearing absorbent underwear and making changes to the home or to habits that make it easier for someone to get to the bathroom in time.
Some medical conditions can contribute to incontinence
Certain medical conditions can cause or contribute to incontinence. Often, these make symptoms more noticeable in people who might otherwise have had mild incontinence, says Eilber.
Poor muscle control, nerve damage, or excessive urine production, known as polyuria, can all make it difficult to hold your pee. These can be symptoms of underlying conditions like diabetes or kidney disease, or the side effects of medications.
UTI
Having a urinary tract infection (UTI) can contribute to incontinence, particularly in older adults. This is most common in people who already have some incontinence, says Eilber. To prevent symptoms, empty your bladder regularly during and after your UTI.
Constipation or an enlarged prostate
The pelvic area is tightly packed, so the enlargement of other organs can press on your bladder, contributing to incontinence, says Eilber. A full rectum from constipation or an enlarged prostate due to aging can put pressure on your bladder, she says.
An overactive bladder
Overactive bladder is a separate medical condition closely linked with incontinence. It's extremely common, affecting up to 43% of people and becoming more prevalent with age. To be diagnosed with overactive bladder, you must have at least two of these three symptoms:
- Urinate 8 times a day, or two times overnight
- Have sudden, strong urges to pee
- Leak urine after those urges
Overactive bladder isn't necessarily dangerous, but it can be embarrassing and isolating, says Norouzi.
"People feel they cannot be far from restrooms, which can limit public appearances," he says.
Overactive bladder can be caused by muscle or nerve disorders, but oftentimes the cause is unknown.
How to treat it: It can be treated and controlled with behavioral modifications — like timed voiding — and medications.
What is bladder training?
The bladder is a muscle, and like other muscles in the body it can be trained for better performance, says Eilber. She recommends bladder training for all her incontinence patients.
Bladder training involves going pee at set time intervals. For example, you might start by peeing every hour. If you need to urinate before the hour is up, you try to wait, using techniques like deep breathing to help. If you can't wait, use the bathroom.
Gradually, you increase the time between bathroom trips, making your bladder more accustomed to holding a greater amount of urine. Eilber recommends increasing the time between urination by five minutes every week.
A small 2013 study found that bladder training led to decreased symptoms of overactive bladder and improved quality of life in adults with overactive bladder.
You should discuss your bladder training goal with your doctor, says Eilber.
How long should I be able to hold my pee?
Most healthy adults can hold their urine for about 3 hours during the day, and longer at night. If you have urge incontinence, bladder training can be difficult, so you should talk with your doctor before starting, Eilber says.
Insider's takeaway
Although bladder control issues affect many people throughout their lifetime, talking about it can be uncomfortable.
Still, having open and honest conversations with your healthcare providers is important, since incontinence can be treated and is not an inevitable part of aging or of life after vaginal childbirth, says Eilber.
She says too many people live in fear of having bladder accidents, when there are effective treatments available if they just reach out for help.
"It's a quality of life issue," Eilber says.