sign in sign up
<<
Home , Urinary incontinence

F r e q u e n t l y As k e d Qu e s t i o n s

Urinary Incontinence

Q: What is (UI)? A: UI is also known as ‘loss of bladder http://www.womenshealth.gov control’ or ‘urinary leakage.’ UI is when 1-800-994-9662 urine leaks out before you can get to a TDD: 1-888-220-5446 bathroom. If you have UI, you are not this process works. alone. Millions of women have this prob- Muscles in the wall of the bladder con- lem, especially as they get older. tract to force urine out through the Some women may lose a few drops . At the same time, sphincter (ss- of urine when they cough or laugh. FINK-ter) muscles around the urethra Others may feel a sudden urge to uri- relax to let the urine pass out of the body. nate and cannot control it. Urine loss Incontinence happens if the blad- can also occur during sexual activity der muscles suddenly contract or and can cause great emotional distress. the sphincter muscles are not strong enough to hold back urine. Q: What causes UI? UI is twice as common in women as in A: It is usually caused by problems with men. , , and meno- muscles and nerves that help to hold or pause are major reasons why. But both pass urine. women and men can become incon- Urine is stored in the bladder. It leaves tinent from brain injury, birth defects, the body through a tube that is con- , , , and nected to the bladder called the urethra. physical changes associated with aging. Look at the images below to see how • Pregnancy — Unborn babies push down on the bladder, urethra (tube that you urinate from), and muscles. This pressure may weaken the pelvic floor sup- port and lead to leaks or problems passing urine. Fetus Pressing on Bladder

page 1

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y As k e d Qu e s t i o n s

• Childbirth — Many women leak nerve damage. Nerves may also urine after giving birth. Labor and become damaged during childbirth. vaginal birth can weaken pelvic floor • Excess weight — Being over- support and damage nerves that con- weight is also known to put pressure trol the bladder. Most problems with on the bladder and make inconti- bladder control during pregnancy nence worse. and childbirth go away after the muscles have time to heal. Talk to your doctor if you still have bladder Q: What are the types of UI? problems 6 weeks after childbirth. A: • — Leakage http://www.womenshealth.gov • — Some women have happens with coughing, sneezing, exercising, laughing, lifting heavy 1-800-994-9662 bladder control problems after they stop having periods. After meno- things, and other movements that TDD: 1-888-220-5446 pause, the body stops making the put pressure on the bladder. This is female hormone . Some the most common type of inconti- experts think this loss of estrogen nence in women. It is often caused weakens the urethral tissue. by physical changes from pregnancy, childbirth, and menopause. It can be Other causes of UI that can affect treated and sometimes cured. women and men are: • Urge incontinence —This is • Constipation — Problems with sometimes called "overactive blad- bladder control can happen to peo- der." Leakage usually happens after a ple with long-term (chronic) consti- strong, sudden urge to urinate. This pation. may occur when you don't expect it, • Medicines — UI may be a side such as during sleep, after drinking effect of medicines such as diuret- water, or when you hear or touch ics (“water pills” used to treat heart running water. failure, liver cirrhosis, hyperten- • Functional incontinence — sion, and certain kidney diseases). People with this type of inconti- Hormone replacement has been nence may have problems thinking, shown to cause worsening UI. moving, or speaking that keep them • Caffeine and alcohol — Drinks from reaching a toilet. For example, with caffeine, such as coffee or soda, a person with Alzheimer's disease cause the bladder to fill quickly and may not plan a trip to the bathroom sometimes leak. in time to urinate. A person in a • — of the uri- wheelchair may be unable to get to a nary tract and bladder may cause toilet in time. incontinence for a short time. • — Urine Bladder control returns when the ill- leakage happens because the bladder ness goes away. doesn't empty completely. Overflow • Nerve damage — Damaged incontinence is less common in nerves may send signals to the blad- women. der at the wrong time, or not at all. • Mixed incontinence —This is 2 or page 2 Trauma or diseases such as diabetes more types of incontinence together and multiple sclerosis can cause (usually stress and urge incontinence).

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y As k e d Qu e s t i o n s

• Transient incontinence — Urine leak urine. Be sure to note what you leakage happens for a short time were doing at the time, such as sneez- due to an illness (such as a bladder ing, coughing, laughing, stepping off infection or pregnancy). The leaking a curb, or sleeping. Take this log with stops when the illness is treated. you when you visit your doctor.

Q: How do I talk to my doctor Q: How do I find out if I have UI? about UI? A: Schedule a visit with your doctor. Your A: Many women do not want to talk to doctor will ask you about your symptoms their doctor about such a personal and take a medical history, including: http://www.womenshealth.gov topic. But UI is a common medical • How often you empty your bladder 1-800-994-9662 problem. Millions of women have the • How and when you leak urine TDD: 1-888-220-5446 same problem. Many have been treated successfully. Your doctor has probably • How much urine you leak heard many stories like yours. Your doctor will do a physical exam to Even if you feel shy, it is up to you to take look for signs of health problems that the first step. Some doctors don't treat can cause incontinence. Your doctor bladder control problems, so they may also will do a test to figure out how not think to ask about it. They might well your bladder works and how much expect you to bring up the subject. it can hold. For this test, you will drink Family practitioners and internists can water and urinate into a measuring pan. treat bladder problems. If your doctor The doctor will then measure any urine does not treat such problems, ask for help still in the bladder. Your doctor also finding a doctor who does, such as a urol- may order other tests such as: ogist, OB/GYN, or urogynecologist. • Bladder stress test — During this Here are some questions to ask your test, you will cough or bear down as doctor: the doctor watches for loss of urine. • Could what I eat or drink cause • Urinalysis — A urinalysis tests your bladder problems? urine for signs of infection or other causes of incontinence. • Could my medicines (prescription and over-the-counter) cause bladder • Ultrasound — Sound waves are problems? used to take a picture of the kidneys, bladder, and urethra. • Could other medical conditions cause loss of bladder control? • — A doctor places a thin tube connected to a tiny camera • What are the treatments to regain in the urethra to look at the inside of bladder control? Which one is best the urethra and bladder. for me? • Urodynamics — A doctor places a • What can I do about the odor and thin tube into your bladder and your rash caused by urine? bladder is filled with water. The It also helps to keep a bladder diary. doctor then measures the pressure in This means you write down when you the bladder. page 3

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y As k e d Qu e s t i o n s

Your doctor may ask you to write to tighten your stomach, legs, or down when you empty your bladder buttocks. and how much urine you produce for a 3. Relax. Squeeze the muscles again day or a week. and hold for 3 seconds. Then relax for 3 seconds. Work up to 3 sets of Q: How is UI treated? 10 repeats. A: There are many ways to treat UI. Your 4. When your muscles get stronger, try doctor will work with you to find the doing your exercises while sitting or best treatment for you. standing. You can do these exercises Types of treatments include: any time, while sitting at your desk, http://www.womenshealth.gov • Behavioral treatments in the car, waiting in line, doing the 1-800-994-9662 dishes, etc. • Medicines for bladder control TDD: 1-888-220-5446 See your doctor, nurse, or physical • Devices therapist to learn how to do these exer- • Nerve stimulation cises correctly. Kegel exercises are most effective when the patient has received • proper instruction from a health care • Surgery professional. Simply trying to stop your • Catheterization urine flow or trying to do the exer- cises hundreds of times a day without Behavioral treatments instruction from a health professional By changing some basic behaviors, will not help. you may be able to improve your UI. Bladder retraining Behavioral treatments include: You may regain bladder control by Pelvic muscle exercises (Kegel exercises) going to the bathroom at set times, Exercising your pelvic floor muscles before you get the urge to urinate. You regularly can help reduce or cure stress can slowly increase the time between leakage. A doctor or nurse can teach set bathroom trips as you gain control. you the right way to do the exercises if Weight loss needed. A pelvic floor physical therapist may be available in your area to help Extra weight puts more pressure on teach you how to strengthen these mus- your bladder and nearby muscles. This cles or help you with other treatments. can cause bladder control problems. To do Kegel exercises: Work with your doctor to plan a diet and exercise program if you are over- 1. First, try practicing these exercises weight. while lying down. Dietary changes 2. Squeeze the muscles in your genital Some foods and beverages are thought area as if you were trying to stop the to contribute to bladder leakage. While flow of urine or trying to stop from doctors do not know if these foods passing gas. Try not to squeeze the really do cause UI, it is reasonable to muscles in your belly or legs at the see if stopping one or all of these items same time. Try to squeeze only the is helpful: page 4 pelvic muscles. Be extra careful not

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y As k e d Qu e s t i o n s

• Alcoholic beverages ments or medicine. In this case, electri- • Carbonated beverages (with or with- cal stimulation of the nerves that con- out caffeine) trol the bladder may help. You will be tested to see if this treat- • Coffee or tea (with or without caf- ment, called neuromodulation (ner- feine) roh-mod-yoo-LAY-shun), can work for Other changes include drinking fewer you. The doctor will first place a device fluids after dinner and eating enough outside your body to deliver a pulse. If fiber to avoid constipation. Also, avoid it works well, a surgeon will drinking too much. Six 8-ounce glasses the device. http://www.womenshealth.gov of fluid a day is enough for most people. Biofeedback 1-800-994-9662 Quitting Biofeedback helps you learn how your TDD: 1-888-220-5446 Researchers are still looking at the link body works. A therapist puts an electri- between incontinence and cigarette cal patch over your bladder and urethral smoking. Studies show that smokers muscles. A wire connected to the patch have more frequent and severe urine is linked to a TV screen. You and your leaks. therapist watch the screen to see when Medicines for bladder control these muscles contract, so you can learn to control these muscles. Medications can reduce some types of leakage. Some medicines, for example, Biofeedback can be used with pelvic help relax the bladder muscles and pre- muscle exercises and electrical stimula- vent bladder spasms. Talk to your doc- tion to help control stress incontinence tor to see if medication is right for you. and urge incontinence. It is always important to take your med- Surgery icine exactly as your doctor tells you to. Surgery is most effective for people Also, all drugs have side effects and may with stress UI who have not been affect people differently. Always tell helped by other treatments. Talk to your doctor about any over-the-counter your doctor about whether surgery medicines you are taking. would help you, and what type of sur- Devices gery is best for you. A (PESS-uh-ree) is the most Catheterization common device used to treat stress The doctor may suggest a if incontinence. It is a stiff ring that a you are incontinent because your blad- doctor or nurse inserts into the vagina. der never empties completely (overflow The device pushes up against the wall incontinence). This is also an option if of the vagina and the urethra. This your bladder cannot empty because of helps reposition the urethra to reduce poor muscle tone, past surgery, or a spi- stress leakage. See your doctor regularly nal cord injury. A catheter is a thin tube if you use a pessary. that is placed in the bladder by a doctor Nerve stimulation or by you. It drains the bladder into a bag that you can attach to your leg. n Some people with urge incontinence may not respond to behavioral treat- page 5

U.S. Department of Health and Human Services, Office on Women’s Health F r e q u e n t l y As k e d Qu e s t i o n s

For more information

For more information about urinary incontinence, call womenshealth.gov at 1-800-994- 9662 or contact the following organizations:

National Kidney and Urologic Diseases National Association for Continence Information Clearinghouse Phone Number: (800) BLADDER (252- Phone Number: (800) 891-5390 3337) Internet Address: http://kidney.niddk.nih. Internet Address: http://www.nafc.org/ http://www.womenshealth.gov gov/ American Urogynecologic Society 1-800-994-9662 National Institute on Aging Phone Number: (202) 367-1167 TDD: 1-888-220-5446 Phone Number: 301-496-1752; Toll-Free: Internet Address: http://www.augs.org (800) 222-2225 Internet Address: http://www.nia.nih.gov American Urological Association Foundation Food and Drug Administration Phone Number: (800) 828-7866 Phone Number: (888) INFO-FDA Internet Address: http://www. (1-888-463-6332) urologyhealth.org/ Internet Address: http://www.fda.gov/

This FAQ was reviewed by: Magda Barini-García, MD, MPH Office of Minority Health and Health Disparities Health Resources and Services Administration (HRSA)

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.

Content last updated March 18, 2010.

page 6

U.S. Department of Health and Human Services, Office on Women’s Health