Urinary Incontinence

Sarah loves to spend time with her friends talking about grandchildren and visiting with neighbors. But lately she's been having a big problem that keeps her from enjoying life. Because she can't get to the bathroom in time, she's starting to wet her pants. Sarah doesn't know what's happening, but the problem keeps her at home.

Sarah may have a problem with bladder control called urinary incontinence. While it may happen to anyone, urinary incontinence is more common in older people. Women are more likely than men to have incontinence. If this problem is happening to you, there is help. Incontinence can often be cured or controlled. Talk to your doctor about what you can do.

Causes of Incontinence

Incontinence is often seen as part of aging. But it can occur for many other reasons. For example, urinary tract infections, vaginal infection or irritation, constipation, and some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

• weak bladder muscles
• overactive bladder muscles
• damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson's disease
• diseases such as arthritis that may make it difficult to get to the bathroom in time
• blockage from an enlarged prostate in men

Bladder Control

The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. Incontinence occurs if the muscles tighten or relax without warning.

Diagnosis

The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

• urine and blood tests
• tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine.

Types of Incontinence

There are different types of urinary incontinence:

• Stress incontinence happens when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It's the most common type of bladder control problem in younger and middle-age women. It may also begin around the time of menopause.
• Urge incontinence happens when people have a sudden need to urinate and aren't able to hold their urine long enough to get to the toilet in time. It is often, but not only, a problem for people who have diabetes, Alzheimer's disease, Parkinson's disease, multiple sclerosis, or stroke.
• Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of incontinence.
• Functional incontinence happens in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treatment

Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

Bladder Control Training

Your doctor may suggest bladder training to help you get better control of your bladder. With bladder training, you can change how your body stores and releases urine. There are several ways to do this:

• Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.
• Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
• Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
• Lifestyle changes that may help with incontinence include losing weight, quitting smoking, avoiding alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation, and not lifting heavy objects.

Management

Besides bladder control training, you may want to talk to your doctor about other ways to help manage incontinence:

• Some drugs can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage. Talk with your doctor about the benefits and side effects of using these medicines.
• A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This reduces stress incontinence in women. This treatment may have to be repeated.
• Special devices for both men and women could help control incontinence.
• Surgery can sometimes improve or cure incontinence if it's caused by a change in the position of the bladder or blockage due to an enlarged prostate.
• You can buy special absorbent underclothing that can be worn under everyday clothing.

If you suffer from urinary incontinence, tell your doctor. Remember, under a doctor's care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help you feel more relaxed and confident.

For More Information

Here are some helpful Federal and Non-Federal resources:

National Association for Continence
P.O. Box 1019
Charleston, SC 29402-1019
800-252-3337 (toll-free)
www.nafc.org

National Institute of Diabetes and Digestive and Kidney Diseases
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
800-891-5390 (toll-free)
http://kidney.niddk.nih.gov

National Library of Medicine
Medline Plus
www.medlineplus.gov

Simon Foundation for Continence
P.O. Box 815
Wilmette, IL 60091
800-237-4666 (toll-free)
www.simonfoundation.org

For more information on health and aging, contact:

National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
800-222-2225 (toll-free)
800-222-4225 (TTY/toll-free)
www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.

Visit NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.

National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services