Urinary (or bladder) incontinence is when you are not able to keep urine from leaking from your urethra, the tube that carries urine out of your body from your bladder. It can range from an occasional leakage of urine, to a complete inability to hold any urine.
The three main types of urinary incontinence are:
Bowel incontinence, a separate topic, is the inability to control the passage of stool.
Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary
Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.
Nighttime urination in children is normal until the age of 5 or 6.
Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow increasing amounts of urine.
The first urge to urinate occurs when around 200 mL (just under 1 cup) of urine is stored in the bladder. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.
The average person can hold around 350 to 550 mL (more than 2 cups) of urine. Two muscles help control the flow of urine:
When it is time to empty the bladder, the bladder wall (detrusor) muscle contracts or squeezes to force urine out of the bladder. Before this muscle squeezes, your body must be able to relax the sphincter to allow the urine to pass out of the body.
The ability to control urination depends on having normal anatomy, a normally functioning nervous system, and the ability to recognize and respond to the urge to urinate.
Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:
Causes that may be more long-term:
See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic floor:
To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. Do NOT contract your abdominal, thigh, or buttocks muscles. And Do NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.
Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 - 4 days.
Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.
Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.
For leakage, wear absorbent pads or undergarments. There are many well designed products that go completely unnoticed by anyone but you.
See also: Urinary incontinence products
Other measures include:
Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.
Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra.
If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.
Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.
Call your local emergency number (such as 911) or go to an emergency room if any of the following accompany a sudden loss of urine control:
Call your doctor if:
Your doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.
Medical history questions may include:
Diagnostic tests that may be performed include:
Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the Q-tip test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles that support the bladder.
Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 3.
Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.
Rogers RG. Clinical practice: urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.
Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148:459-473.