Urinary incontinence: symptoms, causes, and treatment

Urinary incontinence is a medical condition characterized by involuntary leakage of urine. It can happen when the muscles and nerves that control the bladder are weakened or damaged, causing the bladder to empty involuntarily. Urinary incontinence can affect people of all ages, but it is more common in older adults, particularly women who have gone through menopause. There are different types of urinary incontinence, including stress incontinence, urge incontinence, overflow incontinence, and mixed incontinence.

What are the symptoms of urinary incontinence?

• Urge incontinence: sudden, intense urges to urinate followed by involuntary urine leakage

• Stress incontinence: leakage of urine during physical activities such as coughing, sneezing, laughing, or exercise

• Overflow incontinence: frequent or constant dribbling of urine due to a full bladder that doesn't empty completely

• Mixed incontinence: a combination of two or more types of incontinence

Other symptoms may include frequent urination, difficulty starting urination, weak urine stream, and feeling like the bladder is not completely empty after urination. It is important to consult a St. Luke’s Health primary care provider if you are experiencing any of these symptoms.

What are the causes of urinary incontinence?

• Weak pelvic floor muscles due to aging, pregnancy, childbirth, or surgery

• Nerve damage or dysfunction due to conditions such as diabetes, multiple sclerosis, Parkinson's disease, or stroke

• Bladder muscle weakness or overactivity

• Obstruction in the urinary tract, such as an enlarged prostate or bladder stones

• Certain medications or medical treatments that affect bladder function

• Chronic coughing or sneezing that puts pressure on the bladder

• Excessive caffeine or alcohol consumption

• Infection or inflammation in the urinary tract

How do you diagnose urinary incontinence?

The diagnosis of urinary incontinence typically involves a physical examination and medical history review, including a discussion of symptoms, their duration, and potential contributing factors. Additional diagnostic tests may include:

• Urinalysis to check for signs of infection or other abnormalities

• Bladder diary to record how much fluid is consumed and how often urine is passed

• Post-void residual measurement to determine how much urine remains in the bladder after urination

• Urodynamic testing to measure bladder and urethral function during filling and emptying

• Cystoscopy to examine the bladder and urethra for abnormalities or blockages

In some cases, imaging tests such as an ultrasound, CT scan, or MRI may also be recommended to evaluate the urinary tract. Once the underlying cause of urinary incontinence is identified, a urologist can develop an appropriate treatment plan.

How do you treat urinary incontinence?

• Lifestyle changes, such as weight loss, dietary modifications, and fluid management

• Pelvic floor exercises, also known as Kegel exercises, to strengthen the muscles that control urination

• Bladder training, which involves gradually increasing the time between bathroom trips to improve bladder control

• Medications, such as anticholinergics or alpha blockers, to relax the bladder or improve urethral function

• Medical devices, such as a urethral insert or a pessary, to support the urethra or help hold urine in the bladder

• Nerve stimulation, such as electrical stimulation or acupuncture, to improve nerve function and bladder control

• Surgery, such as a sling procedure or bladder suspension, to support the bladder or urethra

What are Kegel exercises?

Kegel exercises are a type of pelvic floor muscle exercise that can help improve bladder control and reduce urinary incontinence. The exercises involve repeatedly contracting and relaxing the muscles that support the bladder, urethra, and other pelvic organs.

To perform Kegel exercises for urinary incontinence, follow these steps:

1. Identify the pelvic floor muscles by imagining you are trying to stop the flow of urine or trying to prevent passing gas.

2. Tighten and contract these muscles for 5-10 seconds, then relax for 5-10 seconds.

3. Repeat this cycle of contracting and relaxing for a total of 10-15 repetitions.

4. Try to do three sets of 10-15 repetitions each day.

It is important to note that Kegel exercises may not be effective for all types of urinary incontinence, and it may take several weeks or months of consistent practice to see improvement. It is recommended to consult with a primary care provider or physical therapist to ensure proper technique and individualized recommendations.

What lifestyle changes improve bladder control and reduce urinary incontinence? 

• Managing fluid intake: Drinking adequate fluids is important for overall health, but reducing fluid intake in the evening or before bedtime can reduce the frequency of nighttime urination. Avoiding caffeinated or alcoholic beverages can also be helpful.
• Losing weight: Carrying excess weight can put extra pressure on the bladder and pelvic floor muscles, making it more difficult to control urination. Losing weight can help reduce this pressure and improve bladder control.
• Quitting smoking: Smoking can contribute to chronic coughing, which can weaken the pelvic floor muscles and increase the risk of urinary incontinence. Quitting smoking can help reduce this risk.
• Dietary modifications: Certain foods and beverages, such as spicy or acidic foods, citrus fruits, and artificial sweeteners, can irritate the bladder and increase the risk of urinary incontinence. Modifying the diet to reduce or eliminate these items may be helpful.
• Regular exercise: Regular physical activity can help improve overall health and promote healthy weight management. It can also help strengthen the pelvic floor muscles and improve bladder control.
• Bowel regularity: Constipation can put extra pressure on the bladder and pelvic floor muscles, contributing to urinary incontinence. Ensuring regular bowel movements through dietary modifications and exercise can help reduce this pressure.