Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom. According to the National Association for Continence, approximately 25 million adult Americans experience temporary or chronic urinary incontinence. UI can strike at any age. Women over age 50 are the most likely to develop UI. Urinary incontinence may be a temporary condition, resulting from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.
The following are some of the different types of urinary incontinence:
Urge incontinence. The inability to hold urine long enough to reach a restroom. It is often found in people who have conditions, such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis, but may be an indication of other diseases or conditions that would also warrant medical attention.
Stress incontinence. The most common type of incontinence that involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder.
Functional incontinence. Leakage due to a difficulty reaching a restroom in time because of physical conditions such as arthritis.
Overflow incontinence. Leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold it.
The following are the most common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:
Inability to urinate
Pain related to filling the bladder and/or pain related to urination without a proven bladder infection
Progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying
An increased rate of urination without a proven bladder infection
Needing to rush to the restroom and/or losing urine if you do not get to restroom in time
Abnormal urination or changes in urination related to a nervous system
Abnormality, such as stroke, spinal cord injury, or multiple sclerosis that interferes with urination
Leakage of urine that prevents activities
Leakage of urine that began or continued after surgery
Leakage of urine that causes embarrassment
Frequent bladder infections
The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
For people with urinary incontinence, it is important to consult a health care provider for a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples. In many cases, patients will then be referred to a urologist, a doctor who specializes in diseases of the urinary tract.
Specific treatment for urinary incontinence will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include:
Behavioral therapies (to help people regain control of their bladder), including the following:
Bladder training. Teaches people to resist the urge to void and gradually expand the intervals between voiding.
Toileting assistance. Uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
Pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage), including the following:
Kegel exercises. Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. Should be performed 30-80 times daily for at least 8 weeks.
Biofeedback. Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
Vaginal weight training. Small weights are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes, twice daily, for four to six weeks.
Pelvic floor electrical stimulation. Mild electrical pulses stimulate muscle contractions; should be performed in conjunction with Kegel exercises.
Medication (including specific drugs for incontinence as well as estrogen therapy, which may be helpful in conjunction with other treatments for postmenopausal women with UI)
Surgery (if the incontinence is related to structural problems such as an abnormally positioned bladder or a blockage)
Diet modifications (i.e., eliminating caffeine in coffee, soda, and tea, and/or eliminating alcohol)
Specifically designed absorbent underclothing, which is no more bulky than normal underwear and can be worn easily under everyday clothing, is available. Also, incontinence may be managed by inserting a catheter into the urethra and collecting the urine into a container. Consult your doctor with your questions regarding the management and treatment of urinary incontinence.
Nearly one-third of American women have one or more pelvic floor disorders such as urinary incontinence, fecal incontinence or pelvic-organ prolapse. The Pelvic Floor Disorders Service at Mass General offers expert care and helps bring lasting relief to those suffering from a pelvic floor disorder.
Liliana G. Bordeianou, MD, a colorectal surgeon at the Massachusetts General Hospital Digestive Healthcare Center says incontinence is not just a normal part of getting older and explains the treatments that can dramatically improve your quality of life.
Milena Weinstein, MD, urogynecologist at the Mass General Department of Obstetrics and Gynecology says urinary incontinence or vaginal bulge can be related to pelvic floor disorders, which affect one out of three women. Learn more about the treatments available for pelvic floor disorders, from exercise to support devices to surgery.