What is urinary incontinence?

Urinary incontinence is the act of urinating involuntarily. It means that someone cannot control when they pee. The amount of urine released can vary from a few drops to an entire bladder’s worth.

Typically, when we are ready to urinate, our brain sends a signal to the bladder. The bladder muscles contract to move urine into the urethra. The muscles around the urethra relax to open the sphincter and let urine out of the body. If these muscles do not work properly, they can cause incontinence.

Although it is more frequent in older adults, urinary incontinence affects many people at different stages of life. The Urology Care Foundation estimates that 25% to 30% of Americans experience incontinence. Those Americans are twice as likely to be women as they are to be men.

There are multiple types of incontinence, and they can be categorized in different ways. Some are forms of incontinence are temporary while others persist, which we explain below. Incontinence types are also categorized by how the bladder functions during the incontinence event. We review those categorizations below as well.

TEMPORARY INCONTINENCE

Some incontinence can be temporary, so if you think you have just leaked urine or if you have a strong urge to “go,” don’t worry. Incontinence can occur simply based on the foods that you eat or the beverages you drink. Eating or drinking foods that are diuretics (that cause an increase in urine) can cause incontinence. These foods include:

• Alcohol
• Caffeine
• Carbonated beverages
• Foods with a lot of spice, sugar or acid such as chili peppers, chocolate, or citrus

Temporary incontinence can also be due to a urinary tract infection (UTI) or constipation.

PERSISTENT INCONTINENCE

Incontinence can also be a consequence of a medical condition or changes in the body. Some possible causes of incontinence include:

• Pregnancy and childbirth
• Menopause
• Hysterectomy
• Enlarged prostate
• Prostate cancer
• Aging
• Obstruction
• Neurological disorders

STRESS URINARY INCONTINENCE (SUI)

Stress incontnence is due to weak pelvic muscles. The muscles are no longer strong enough to keep urine in the bladder, so urine leaks out. This could be any amount, from a teaspoon to the entire contents of the bladder.

Stress incontinence is most common in women, whose pelvic floors are weaker after childbirth.

There isn’t any medication available to help stress incontinence, though many people claim that doing kegels can strengthen the pelvic floor.

OVERACTIVE BLADDER (OAB)

Having an overactive bladder leads to urge incontinence. In this case, the brain tells the bladder to empty, even if it is not full. Alternatively, the bladder contracts to pass urine, even if it is not full. This leads to an unexpected urge to urinate.

OAB could be caused by cystitis, an inflammation of the bladder lining.

OAB is common among postmenopausal women and men with enlarged prostates or prostate cancer.

MIXED INCONTINENCE: SUI AND OAB

Some people experience both types of incontinence.

OVERFLOW INCONTINENCE

Overflow incontinence occurs when the bladder is full but the body makes more urine. This causes the bladder to leak. This type of incontinence occurs most commonly among men.

Two times as many women have incontinence as men do, and some of that can be traced back to pregnancy and childbirth.

During pregnancy, the uterus places pressure on the bladder. Combined with hormonal changes, this can weaken the bladder muscles and cause stress incontinence. Similarly, vaginal birth puts pressure on vaginal muscles, bladder muscles, and bladder tissue. This can cause temporary incontinence or persistent incontinence. While incontinence might not immediately manifest after childbirth, the experience means women have a higher likelihood of developing it later in life.

Menopause is another point at which incontinence can appear. At menopause, women stop producing the hormone estrogen. Estrogen also helps keep the bladder and urethra healthy, so this dip can lead to incontinence.

Undergoing a hysterectomy can lead to incontinence. The uterus and bladder are supported by the same muscle groups, so any procedure that affects the uterus can affect the bladder as well.

Finally, as we age, our bladder’s capacity shrinks. The bladder also undergoes involuntary contractions more frequently, leading to incontinence. Women between the ages of 70 and 80 are twice as likely as men to have incontinence.

A leading cause of incontinence in men is an enlarged prostate. Untreated prostate cancer can also lead to incontinence. On the flip side, getting treated for prostate cancer is often accompanied by incontinence.