Urinary incontinence

Definition

Urinary (or bladder) incontinence happens when you are not able to keep urine from leaking out of your urethra, the tube that carries urine out of your body from your bladder. You may leak urine from time to time. Or, you may not be able to hold any urine.

The three main types of urinary incontinence are:

Bowel incontinence is when you are unable to control the passage of stool. It is not covered in this article.

Alternative Names

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

Considerations

NORMAL URINATION

Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine.

You should feel the first urge to urinate when there is around 200 mL (just under 1 cup) of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. At the same time, the bladder should keep filling.

The average person can hold around 350 to 550 mL (more than 2 cups) of urine in the bladder. 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 your body.

To control urination, you must have:

Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.

Infants and children are not incontinent before they have been toilet trained. Children up to age 6 may still have accidents sometimes. Young (and sometimes teenage) girls may leak a little bit of urine when they laugh.

It is normal for children to wet the bed until age 5 or 6.

Bladder function - neurological control

Causes

Causes of urinary incontinence include:

Incontinence may be sudden and go away after a short period of time. Or, it may continue long-term. Causes of sudden or temporary incontinence include:

Causes that may be more long-term:

Home Care

See your health care provider for tests and a treatment plan. What type of treatment you get depends on what caused your incontinence and what type you have.

The following methods are used to strengthen the muscles of your pelvic floor:

For urine leaks, wear absorbent pads or undergarments. There are many well-designed products that no one else will notice.

Other treatments include:

For more information about treating urinary incontinence, see also:

If you have overflow incontinence or cannot empty your bladder completely, you may need to use a catheter. For more information on catheter use, see also:

When to Contact a Medical Professional

Talk to your health care provider about incontinence. Health care providers who treat incontinence are called gynecologists and urologists. They can find the cause and recommend treatments.

Call your local emergency number (such as 911) or go to an emergency room if you suddenly lose control over urine and you have:

Call your health care provider if:

What to Expect at Your Office Visit

Your health care provider will ask about your medical history. You will have a physical exam focusing on your abdomen, genitals, pelvis, rectum, and nervous system.

Your health care provider may ask questions such as:

Tests that may be performed include:

References

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.

Resnick NM. Incontinence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.

Deng DY. Urinary incontinence in women. Med Clin North Am. 2011;95:101-109.