What is urinary incontinence?
Urinary incontinence affects twice as many women as men. This is because reproductive health events unique to women, like pregnancy, childbirth, and menopause, affect the bladder, urethra, and other muscles that support these organs.
Urinary incontinence can happen to women at any age, but it is more common in older women. This is probably because of hormonal changes during menopause. More than 4 in 10 women 65 and older have urinary incontinence.
Adult Urinary incontinence
Urinary incontinence is the loss of bladder control.The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence, also called overactive bladder. Incontinence affects twice as many women as men. This may be because pregnancy, childbirth, and menopause may make urinary incontinence more likely. Urinary incontinence is not a normal part of aging, and it can be treated.
Who gets urinary incontinence?
Urinary incontinence is the loss of bladder control, or leaking urine.
Urine is made by the kidneys and stored in the bladder. The bladder has muscles that tighten when you need to urinate. When the bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body.
Incontinence can happen when the bladder muscles suddenly tighten and the sphincter muscles are not strong enough to pinch the urethra shut. This causes a sudden, strong urge to urinate that you may not be able to control. Pressure caused by laughing, sneezing, or exercising can cause you to leak urine. Urinary incontinence may also happen if there is a problem with the nerves that control the bladder muscles and urethra. Urinary incontinence can mean you leak a small amount of urine or release a lot of urine all at once.
Why does urinary incontinence affect more women than men?
Women have unique health events, such as pregnancy, childbirth, and menopause, that may affect the urinary tract and the surrounding muscles. The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker or damaged. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate. This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.
Also, the female urethra is shorter than the male urethra. Any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in until you are ready to urinate.
What are the types of urinary incontinence that affect women?
The two most common types of urinary incontinence in women are:
- Stress incontinence. This is the most common type of incontinence. It is also the most common type of incontinence that affects younger women. Stress incontinence happens when there is stress or pressure on the bladder. Stress incontinence can happen when weak pelvic floor muscles put pressure on the bladder and urethra by making them work harder. With stress incontinence, everyday actions that use the pelvic floor muscles, such as coughing, sneezing, or laughing, can cause you to leak urine. Sudden movements and physical activity can also cause you to leak urine.
- Urge incontinence. With urge incontinence, urine leakage usually happens after a strong, sudden urge to urinate and before you can get to a bathroom. Some women with urge incontinence are able to get to a bathroom in time but feel the urge to urinate more than eight times a day. They also do not urinate much once they get to the bathroom. Urge incontinence is sometimes called “overactive bladder.” Urge incontinence is more common in older women. It can happen when you don’t expect it, such as during sleep, after drinking water, or when you hear or touch running water.
Many women with urinary incontinence have both stress and urge incontinence. This is called “mixed” incontinence.
What are the symptoms of urinary incontinence?
Urinary incontinence is not a disease by itself. Urinary incontinence is a symptom of another health problem, usually weak pelvic floor muscles. In addition to urinary incontinence, some women have other urinary symptoms:
- Pressure or spasms in the pelvic area that causes a strong urge to urinate
- Going to the bathroom more than usual (more than eight times a day or more than twice at night)
- Urinating while sleeping (bedwetting)
What causes urinary incontinence?
Urinary incontinence is usually caused by problems with the muscles and nerves that help the bladder hold or pass urine. Certain health events unique to women, such as pregnancy, childbirth, and menopause, can cause problems with these muscles and nerves.
Other causes of urinary incontinence include:
- Overweight. Having overweight puts pressure on the bladder, which can weaken the muscles over time. A weak bladder cannot hold as much urine.
- Constipation. Problems with bladder control can happen to people with long-term (chronic) constipation. Constipation, or straining to have a bowel movement, can put stress or pressure on the bladder and pelvic floor muscles. This weakens the muscles and can cause urinary incontinence or leaking.
- Nerve damage. Damaged nerves may send signals to the bladder at the wrong time or not at all. Childbirth and health problems such as diabetes and multiple sclerosis can cause nerve damage in the bladder, urethra, or pelvic floor muscles.
- Surgery.Any surgery that involves a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed. If the pelvic floor muscles are damaged, a woman’s bladder muscles may not work like they should. This can cause urinary incontinence.
Sometimes urinary incontinence lasts only for a short time and happens because of other reasons, including:
- Certain medicines. Urinary incontinence may be a side effect of medicines such as diuretics (“water pills” used to treat heart failure, liver cirrhosis, hypertension, and certain kidney diseases). The incontinence often goes away when you stop taking the medicine.
- Caffeine. Drinks with caffeine can cause the bladder to fill quickly, which can cause you to leak urine. Studies suggest that women who drink more than two cups of drinks with caffeine per day may be more likely to have problems with incontinence. Limiting caffeine may help with incontinence because there is less strain on your bladder.
- Infection. Infections of the urinary tract and bladder may cause incontinence for a short time. Bladder control often returns when the infection goes away.
How does pregnancy cause urinary incontinence?
As many as 4 in 10 women get urinary incontinence during pregnancy. During pregnancy, as your unborn baby grows, he or she pushes down on your bladder, urethra, and pelvic floor muscles. Over time, this pressure may weaken the pelvic floor muscles and lead to leaks or problems passing urine.
Most problems with bladder control during pregnancy go away after childbirth when the muscles have had some time to heal. If you’re still having bladder problems 6 weeks after childbirth, talk to your doctor, nurse, or midwife.
How does childbirth cause urinary incontinence?
Problems during labor and childbirth, especially vaginal birth, can weaken pelvic floor muscles and damage the nerves that control the bladder. Most problems with bladder control that happen as a result of labor and delivery go away after the muscles have had some time to heal. If you’re still having bladder problems 6 weeks after childbirth, talk to your doctor, nurse, or midwife.
How does menopause cause urinary incontinence?
Some women have bladder control problems after they stop having periods. Researchers think having low levels of the hormone estrogen after menopause may weaken the urethra The urethra helps keep urine in the bladder until you are ready to urinate.
Also, like all muscles, the bladder and urethra muscles lose some of their strength as you get older. This means you may not be able to hold as much urine as you get older.
What steps can I take at home to treat urinary incontinence?
Some things you can do at home to help treat urinary incontinence. Some people do not think that such simple actions can treat urinary incontinence. But for many women, these steps make urinary incontinence go away entirely, or help leak less urine. These steps may include:
- Doing Kegel exercises. If you have stress incontinence, Kegel exercises to strengthen your pelvic floor muscles may help. Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
- Training your bladder. You can help control overactive bladder or urge incontinence by going to the bathroom at set times. Start by tracking how often you go to the bathroom each day in a bladder diary. Then slowly add about 15 minutes between bathroom visits. Urinate each time, even if you do not feel the urge to go. By gradually increasing the amount of time between visits, your bladder learns to hold more urine before it signals the need to go again.
- Losing weight. Extra weight puts more pressure on your bladder and nearby muscles, which can lead to problems with bladder control. If you have overweight, your doctor or nurse can help you create a plan to lose weight by choosing healthy foods and getting regular physical activity. Your doctor or nurse may refer you to a dietitian or physical therapist to create a healthy eating and exercise plan.
- Changing your eating habits. Drinks with caffeine, carbonation (such as sodas), or alcohol may make bladder leakage or urinary incontinence worse. Your doctor might suggest that you stop drinking these drinks for a while to see if that helps.
- Quitting smoking. Smoking can make many health problems, including urinary incontinence, worse.
- Treating constipation. Your doctor might recommend that you eat more fiber, since constipation can make urinary incontinence worse. Eating foods with a lot of fiber can make you less constipated.
You can also buy pads or protective underwear while you take other steps to treat urinary incontinence. These are sold in many stores that also sell feminine hygiene products like tampons and pads.
Should I drink less water or other fluids if I have urinary incontinence?
No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health. (But alcohol and caffeine can irritate or stress the bladder and make urinary incontinence worse.)
Women need 91 ounces (about 11 cups) of fluids a day from food and drinks. Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.
After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.