What is Urinary Incontinence?

Urinary incontinence is leaking of urine that you can't control. Many American men and women suffer from urinary incontinence. We don't know for sure exactly how many. That's because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.

Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don't want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.

Many people think urinary incontinence is just part of getting older. But it's not. And it can be managed or treated. Learn more here. Talk to your doctor. Find out what treatment is best for you.

Key Statistics

A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.

Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery.

Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence.

Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked.

Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms.

What happens normally?

Female Urinary Tract
Female Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Male Urinary Tract
Male Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn't leak.

Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the bladder contracts.

What are the types of urinary incontinence?

Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:

Stress Urinary Incontinence (SUI)

With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.

SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.

Nerves carry signals from the brain to the bladder and sphincter
Nerves carry signals from the
brain to the bladder and sphincter
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include "Kegel" exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.

To learn more about SUI risk factors, diagnosis and treatments visit our SUI article page.

Overactive Bladder (OAB)

OAB is another common type of urinary incontinence. It is also called "urgency" incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people's lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren't near a bathroom. They may not even be able to get a good night's sleep. Some people have both SUI and OAB and this is known as mixed incontinence.

With OAB, your brain tells your bladder to empty - even when it isn't full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.

The main symptom of OAB is the sudden urge to urinate. You can't control or ignore this "gotta go" feeling. Another symptom is having to urinate many times during the day and night.

OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.

To learn more about OAB risk factors, causes and treatments visit our OAB page.

Mixed Incontinence (SUI and OAB)

Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.

Overflow Incontinence

With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.

One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called "dribbling."

This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.



How Do I Tell What Kind of Incontinence I Have?

The symptoms tell you what kind of urinary incontinence you have.

Not all incontinence is long term. Some causes are temporary so that the incontinence ends when the cause goes away. Vaginal infections can cause temporary incontinence. Irritation, medications, constipation and restricted mobility can cause it.  Urinary tract infections (UTIs) are a common cause of temporary incontinence and should be addressed.

It remains important that if the cause isn't temporary or easily treated, the leakage is probably one of the four types described above. With SUI, the pelvis or sphincter muscles (or both) aren't strong enough to hold the urine by closing the bladder and urethra. With OAB, the bladder muscles contract too much, pushing urine out even when you are not ready to release it. Mixed incontinence is usually both SUI and OAB. With overflow incontinence, the bladder gets too full without releasing.

These are the symptoms for each:

SUI

The key symptom of SUI is leaking when you are active. The activity and amount of leaking depends on how severe the SUI is. To learn more about SUI, visit our SUI article page and www.UrologyHealth.org/SUI.

OAB

Normal vs. Overactive Bladder
Normal vs. Overactive Bladder
Image © 2003 Fairman Studios, LLC.

The main symptom of OAB is a sudden, strong urge to urinate that you can't control. The urge may or may not cause your bladder to leak urine. To learn more about OAB, visit our OAB article page and www.UrologyHealth.org/OAB.

You can also take this quiz "Think You Have an Overactive Bladder?" Print the questions and answer them. Use your answers talk to your doctor about your symptoms. The quiz will help you and your doctor know which OAB symptoms you have. It will help your doctor figure out how best to treat you.

Mixed incontinence (SUI and OAB)

The symptoms of mixed incontinence include leaking and a sudden, strong urge to urinate. Mixed incontinence is when you have more than one type of incontinence. Most often, people with mixed incontinence have SUI and OAB.

To find out more about SUI, visit our SUI article page and www.UrologyHealth.org/SUI.
To find out more about OAB, visit our OAB article page and www.UrologyHealth.org/OAB.

Overflow Incontinence

Frequent small urinations and constant dribbling are the main symptoms of overflow incontinence. The bladder is unable to empty. Symptoms happen when the bladder is full. This type is less often in women however, dropped bladders, prior bladder surgeries or diabetes may affect this. It is more common in men with a history of prostate problems or surgery.



Managing with Products and Devices

There are many devices and products that collect and hold urine. They help manage urinary retention and urinary incontinence. With urinary retention, your bladder does not completely empty. With urinary incontinence (UI), you have urine leakage that you cannot control.

Products and devices can help men and women of all ages. For some people, they are the only way to manage bladder problems. These devices can also give older and disabled persons more freedom.

Indwelling Catheters

Foley Catheter
Foley Catheter
Image: Blamb/Shutterstock.com

Suprapubic Catheter
Suprapubic Catheter
Image: Blamb/Shutterstock.com

A catheter is a flexible tube placed in your bladder. An "indwelling" catheter stays in your bladder all day and night. There are two types of indwelling catheters. Indwelling "Foley" catheters are placed in your urethra. Indwelling "suprapubic" catheters go above your pubic bone through a small surgical cut in the belly. With both types, a balloon holds the tube in your bladder. They both also drain urine into a bag outside the body.

A health care provider will place the Foley catheter in your urethra. The catheter can be managed by home care nurses when used long term. A urologist places the suprapubic catheter with minor surgery.

A Foley catheter should only be used for less than 2 years. If you need an indwelling catheter for a longer period of time, you should consider a suprapubic catheter. Because the suprapubic catheter is only in the bladder, there is less risk of bacteria growing (because it is away from the vagina and rectum). That means less risk of urinary tract infections, especially in women.

Both Foley and suprapubic catheters need to be replaced with a new catheter at least once every month. This also lowers the risk of infection. Both catheters can cause complications if used for a long time. Bladder, testicle (males), and kidney infections, bladder stones and bladder cancer can occur. Foley catheters can cause permanent damage to the urethra.

Foley and suprapubic catheters should be taped or strapped to the upper thigh or lower belly. This lowers the chance of injury if the catheter is tugged accidentally.

Catheters are made from latex with Teflon coating or silicone. The choice depends on a person's allergies and the health care provider's preference. Some catheters are coated with antibiotics to prevent infection. There is debate about whether this works.

Indwelling catheters vary in shape, tube size and tip. They are sized using the French (Fr) scale. Size 14 Fr is the most common size. A balloon is inflated once the catheter is inserted. This keeps the catheter from falling out. The balloon is usually filled with about 2 teaspoons of sterile water.

External Collecting Systems

Condom Catheter
Condom Catheter

For men, there are external collecting systems called condom or Texas catheters. These special condoms are rolled over the penis. They are kept in place by adhesive or straps. The condoms have holes at the tip. A tube goes from the hole to a drainage bag. Urine from incontinence collects in the drainage bag. Newer condoms are usually silicone. They come in sizes, with a sizing guide.

This device may be hard to use if you have problems with finger dexterity. A caregiver or family member would need to apply the condom catheter. Adhesive pouches may be better for men whose penis has retracted (drawn back).

An external collection device for women funnels urine from a pouch through a tube to a collecting device. These must be stuck to the outside of the labia. They are rarely used as the labia do not form a good water tight seal, so urine leaks.

Urine Drainage Bags

Both indwelling and external collecting devices are connected to drainage bags. They collect urine coming out of the bladder. Drainage bags come in different sizes. Overnight bags hold 1500 to 2000 milliliters (1.5 to 2.0 liters) of urine. These are large and cannot be hidden.

A leg bag is a smaller drainage bag. It holds 500 to 800 milliliters. It allows more freedom of movement. It can be hidden under clothing. It can be strapped to the thigh or calf. A new type, called the Belly Bag, is strapped to the belly. Drainage bags work by gravity. So they should be strapped somewhere below the bladder.

When choosing a bag, make sure the strap is not too restrictive or tight. The valve that drains urine from the bag should be easy to open.

Drainage bags can be cleaned and deodorized. Soak 20 minutes in a solution of two parts vinegar and three parts water.

Catheters for Intermittent Catheterization (IC)

Catheter for Clean Intermittent Catheterization
Catheter for Clean Intermittent Catheterization

Intermittent catheterization is also called "in and out" catheterization. It is also called "clean intermittent catheterization" (CIC). Because it is clean you don't need gloves and sterile preparation.

A catheter is inserted in the urethra 3 to 5 times a day. After you empty your bladder, you remove the catheter and throw it away. You or a caretaker can insert the catheter. You don't have to wear it all the time. This lowers the chance of infection. And these devices don't have a balloon like the indwelling catheter.

Older men and women can perform CIC and should be on a routine schedule. The amount of urine in the bladder should be 15 ounces or less. Catheterization may be needed four to five times a day. Most healthcare insurances and Medicare will pay for 4 catheters a day (120 a month).

Most IC catheters are straight. Some (called Coudé catheters) have a curved tip. It may be easier for a man to advance a curved tip past the prostate gland. Catheter lengths are 6 inches for women and 12 inches for men.

You can get catheters and other supplies, such as lubricant, packaged together. These packages are helpful if you need to use the catheter at work. Catheter supply companies deliver catheters and other supplies by mail.

Absorbent Products

Absorbent products such as pads and adult diapers are available for incontinence. There are many designs. Some pads or panty liners have adhesive strips that attach to underwear. There are also undergarments, adult briefs and protective underwear. There are guards and drip collection pouches for men.

These products all absorb urine leakage and they help protect the skin from urine accordingly, they keep urine from wetting clothing. Pads can be disposable or reusable.

Absorbent incontinence products are designed to absorb and hold urine. Feminine hygiene pads are designed to absorb blood, not urine. The advantage of using incontinence products is that the surface area is closest to the urethral opening, which is above the vaginal opening. The pads are super absorbent and they cause less skin irritation and fewer rashes. Reusable pads are made of cloth with a rayon or polyester core and helps urine absorb.

When choosing a product, consider ease of use. Consider whether you need to remove outer clothing to change the device. Also consider absorbency, the liner, and the materials. For example, outside coverings made of plastic may irritate skin. Cost is also a concern for many people.

Toilet Substitutes

Portable devices can be very helpful if you cannot get to a regular toilet. These devices include commode seats or bedside commodes. There are also bedpans and urinals.

A bedside commode is placed close to the bed. It is easy to use at night or on a floor of the house with no bathroom. When choosing a commode you should consider its height and weight, how easy it is to empty, seat type, and cost. A soft surface may be more comfortable.

There are also raised seats (toilet raisers) that can help you get up and down from a regular toilet on your own.

Bedpans are usually not very effective or comfortable. Special fracture pans can help if you are recovering from surgery and can't get out of bed.

Urinals (plastic jug-type devices) are useful if you cannot move easily. You urinate into these devices directly. They can help when restrooms are not accessible. They are also useful when traveling. And they are an option if you are confined to a bed or chair. Most urinals, such as the newer spill proof ones, are easier for men to use. Urinals for women are not as easy to use.

Skin Care Products

If you are using incontinence devices or products, you may need skin care. Over time, urine leakage can cause skin breakdown, rash and redness. Urine on your skin can lead to bacteria growth and infection.

Soaps, skin products, topical antimicrobials, cleansers and skin barrier products can all help if used properly. Frequent washing with soap and water can dry out your skin. Rinses or cleansers made to remove urine may be better for washing the skin around the urethra.

Disposable wipes or wash clothes rather than toilet tissue may help keep your skin healthy. Moisturizing creams, lotions or pastes keep the skin moist. They seal in or add moisture. Barrier products protect the skin from contact with moisture. They lower friction from absorbent incontinence products.