Adult Incontinence: What You Should Know

Adult incontinence isn’t a condition — it’s a symptom of another problem. There are five types of incontinence, and each manifests a little bit differently:

• Urge incontinence, also called overactive bladder: You often feel a sudden, intense urge to urinate. Sometimes you leak.
• Stress incontinence: A cough, sneeze, or laugh can make you leak urine.
• Overflow incontinence: Urine often dribbles out. You can’t fully empty your bladder when you use the bathroom.
• Functional incontinence: You leak because a condition like arthritis or Alzheimer’s disease prevents you from getting to the bathroom in time.
• Mixed incontinence: You experience a combination of stress and urge incontinence.

In children, incontinence often stems from a health issue such as a urinary tract infection, kidney problem, or defect in the urinary tract. Sometimes kids continue to have accidents during the day and wet the bed at night after they’re toilet trained. Childhood incontinence often goes away on its own.

Normally, the muscles in your bladder wall relax while the bladder fills with urine. Once it’s full, the bladder sends your brain a signal that it’s time to go. Muscles in and around your bladder hold the urine inside until you can make it to a bathroom.

Incontinence happens when the muscles that hold in urine or that support your bladder weaken enough to let urine leak out.

Nerve damage can also prevent your brain from getting the message that it’s time to go.

Here are some causes of incontinence:

• pregnancy
• childbirth
• age
• menopause
• enlarged prostate
• prostate cancer
• blockage in the urinary tract
• conditions that damage nerves, such as multiple sclerosis, Parkinson’s disease, and stroke
• structural problems with the urinary tract

Learn more: Multiple sclerosis and incontinence »

Women are more likely to develop stress incontinence than men, in part because pregnancy and childbirth can weaken the muscles that support the bladder.

Female hormones also play a role in incontinence. The loss of estrogen after menopause can weaken and thin the pelvic muscles, leading to less control over bladder function.

As you get older, your likelihood of getting incontinence increases. Age weakens your bladder, preventing it from holding as much urine as it once did.

Check out: Menopause and urinary incontinence »

If you’re experiencing symptoms of incontinence, you should consult your doctor. Your primary care doctor may be able to make a diagnosis.

Your doctor may refer you to a urologist. Women may be referred to a urogynecologist if initial treatments are unsuccessful.

Your doctor will start by asking about your symptoms: How often you feel the urge to go, what seems to trigger the problem, and whether you leak urine. Keeping a diary of your symptoms can help you answer your doctor’s questions more easily.

After assessing your symptoms, your doctor may perform one of the following tests to help determine the cause of your incontinence:

• Urine tests: These can detect bacteria in your urine. Bacteria in the urine may be a sign of infection.
• Urodynamic study: You arrive to this test with a full bladder. The volume and rate of emptying your bladder is then measured. A post-void residual volume test is performed as part of this study. This shows how much urine is left in your bladder after you go to the bathroom. This test can determine if there’s a blockage in your urinary tract or problems with your bladder’s nerves and muscles.
• Cystoscopy: Your doctor will place a thin scope into your urethra, which is the tube that carries urine out of your bladder. This allows your doctor to look for any structural problems.
• Cystogram: Your doctor will take X-rays of your bladder after it’s filled with a contrast material. A voiding cystogram is a similar procedure where the doctor continues to take X-rays while you urinate. Both tests can help in the investigation of bladder problems that may cause incontinence.

Treatments for urinary incontinence are based on the cause of the problem.

First-line treatments typically include:

• Medication: Options such as mirabegron (Myrbetriq), Oxybutynin (Ditropan), and tamsulosin (Flomax) relax overactive bladder muscles. They’re often used to treat urge incontinence.
• Estrogen cream: This can strengthen weakened tissues in the urethra and vagina. It’s often prescribed for women who are postmenopausal.

Other treatments include:

• Pessaries and urethral inserts: Pessaries are placed inside the vagina to prop up the bladder and treat stress incontinence. Urethral inserts act like plugs to prevent leaking.
• Bulking material: Material, such as collagen, is injected around the urethra. This helps the urethra stay closed so that urine doesn’t leak out or build up the wall of the urethra. This procedure is primarily performed in women, but may also be used to treat stress incontinence in men.
• Botulinum toxin type A (Botox): This is injected into the bladder muscle, causing it to relax. This increases the bladder’s storage capacity for urine. This may decrease your episodes of incontinence.
• Nerve stimulator: This device is primarily recommended for people with severe urge incontinence. After being implanted under your skin, it sends electrical pulses to the muscles that regulate your bladder.

If these treatments don’t work, your doctor might recommend one of these surgeries to treat your incontinence:

• Bladder neck suspension: This raises the neck of the bladder where it attaches to the urethra. Supporting the bladder neck helps prevent leakage in stress incontinence.
• Prolapse surgery: If your bladder has dropped out of its normal position, this may help raise it.
• Sling procedures: These are done if the pelvic floor muscles that support your bladder have weakened. The surgeon will use pieces of your own body’s tissue or man-made materials to create a sling that holds up your bladder neck and keeps your urethra closed.

Certain products can help manage leakage and prevent urine odor:

• Absorbent pads: These pads are similar to the ones used for menstrual periods, except they can hold more fluid. Incontinence pads stick to your underwear and absorb urine and odors. They cost about $12 for a package of 60 pads.
• Incontinence panties and briefs: These products have an absorbent pad built into a pair of briefs. Some types of bladder control underwear are disposable. Others are washable and look like typical cotton underwear. Incontinence briefs cost around $15 a pair for reusable options. Disposable options are often around $20 a package.
• Plastic pants: These plastic briefs slip on over your underwear to prevent leaks. Plastic pants sell for about $20 a pair.
• Protective pads: You can place these bed pads over your sheets to prevent you from having to change the bed if you leak during the night. They cost about $20 each.
• Catheters: A catheter is a thin, flexible tube that goes into your urethra to drain your bladder. Men can wear a condom-like catheter device that fits over the penis. The catheter drains urine into a bag. Each catheter costs $1 to $3.

Most of these products are available at your local drugstore or supermarket, or online.

Keep reading: Kegel exercises for incontinence »

Urinary incontinence can affect your work, social interactions, and just about every part of your life. If you’re experiencing symptoms, talk with your doctor. They can help you develop an appropriate treatment plan to reduce your symptoms and improve your quality of life.

Incontinence isn’t always preventable, but a few lifestyle changes can make you less likely to deal with urinary urgency and leakage. You can:

• Limit fluids. Avoid drinking large amounts of water, fruit juice, and other fluids at once. Instead, drink small amounts at regular intervals during the day. If you have problems holding in your urine at night, don’t drink any fluids just before bed. You should also avoid diuretics like caffeinated soda, alcohol, and coffee—they make you go more often.
• Get on a bathroom schedule. Go to the bathroom at regular time intervals, such as once every hour. Try to gradually increase the amount of time between bathroom visits. Waiting to go will train your bladder to hold urine longer.
• Eat more fiber. Constipation can contribute to incontinence. Eating more fresh fruits, vegetables, and whole grains can prevent constipation. You should aim to get 30 grams of fiber each day.
• Maintain a healthy weight. Being overweight can put extra pressure on your bladder, making you go more.