Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or chronic (lasts for a long time). Incontinence is a symptom, not a condition in and of itself.

Temporary incontinence can be caused by:

• Medicines
• Constipation
• Infection
• Muscle weakness
• Restricted mobility
• Obesity
• Endocrinological disorders (for example, diabetes )

More permanent urinary incontinence may be one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. The cause may also be unclear.

This results when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects , or exercise. This is the most common type of incontinence. It may be caused by:

• Weakening of the muscles that suspend the bladder
• Weakening of muscles that control urine flow
• Obesity

Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is not able to hold urine long enough to make it to a restroom. This is also known as overactive bladder. It may be caused or worsened by:

• Urinary tract infection
• Diabetes type 1 and 2
• Bladder irritation (stone, tumor)
• Drugs (eg, hypnotics, diuretics)
• Caffeine
• Alcohol
• Nerve damage due to:
  • Spinal cord injury
  • Stroke
  • Multiple sclerosis
  • Parkinson's disease
• Constipation

This occurs when the bladder will not empty. Urine builds up, and this causes an overflow and leaking of urine. It may be caused by:

• A bladder that is blocked, such as by a scar in the urethra (stricture)
• Fecal impaction
• Drugs (eg, antidepressants, hypnotics, antipsychotics, antihistamines, calcium channel blockers)
• Vitamin B12 deficiency
• Weak bladder muscles
• Nerve damage due to:
  • Surgery
  • Diabetes
  • Spinal cord injuries
  • Other factors

This occurs when there is normal bladder control, but an inability to reach the toilet in time. An example would be severe arthritis . Drugs that cause confusion or sedation can also cause functional incontinence.

These risk factors increase your chance of developing urinary incontinence. Tell your doctor if you have any of these risk factors:

• Age: older than 65
• Having been pregnant multiple times
• Urinary tract infection
• Obesity
• Chronic lung disease
• Urethritis
• Previous hysterectomy or urethral surgery
• Pelvic organ prolapse
• Depression
• Dementia including Alzheimer’s disease
• Menopause
• Diabetes
• Stroke
• Multiple sclerosis
• Spinal cord injury or disease
• Use of certain substances/medicines:
  • Caffeine
  • Alcohol
  • Alpha-agonists
  • Cholinergic agents
  • Cyclophosphamide

Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

The doctor will ask about your symptoms and medical history. You will be asked how often you empty your bladder and patterns of urine leakage. Your doctor will perform a physical exam to look for any physical causes, such as blockages or nerve problems. You will keep a diary of your bladder habits. You may be referred to a urologist or a urogynecologist.

Tests may include:

• Stress test—You relax then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.
• Urine tests
• Blood tests to detect diabetes
• Ultrasound —a test that uses sound waves to examine structures inside the body to determine the residual urine volume after voiding
• Cystoscopy—a thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder
• Urodynamic tests—tests used to measure the flow of urine and pressure in the bladder

Treatments may include:

Behavioral therapy includes:

• Making muscles stronger by doing Kegel exercises
  • This strengthens the muscles that hold the bladder in place and those that control urine flow.
  • Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence.
• Bladder training
  • This can be done by setting a regular, timed schedule for emptying your bladder and by drinking fewer liquids.

If you are a woman who is overweight or obese, losing weight may help to reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.

Medicines may be prescribed to relax the bladder muscles.

Nerve stimulation is effective for urge urinary incontinence. It can be done by stimulating a nerve in your ankle. Or, it can be done by implanting a device that stimulates the bladder nerves.

In women, surgery can repair weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra. The bladder sphincter can be repaired or implants can be inserted.

Absorbent diapers are often used with incontinence.

Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases. Alternatively, pessaries may be used in women. Pessaries are devices that raise the uterus or the prolapsed bladder. This decreases pressure on the bladder.