Urinary Incontinence: Types, Causes, and When to See a Doctor

Urinary incontinence is involuntary leakage of urine. Urine comes out without the person's control: when coughing, laughing, with a sudden urge, or constantly. Millions of people live with this problem, and it is not a sentence — the condition can often be improved if the cause is identified; there is no need to be ashamed of it, it is a common problem.

What urinary incontinence is

Urinary incontinence (uncontrolled urination, loss of bladder control) is a condition in which urine is released involuntarily. Manifestations vary: from a few drops under exertion to constant leakage. Incontinence is a common problem: millions of people face it. At the same time, incontinence is not an inevitable part of aging.

Types of incontinence: stress, urge, and mixed

Stress urinary incontinence is leakage at the moment when the bladder is under pressure: when coughing, laughing, sneezing, lifting heavy objects, or any physical activity. Urge urinary incontinence is when urine is released with a sudden strong urge or immediately after it, before the person can reach the toilet. Mixed incontinence is a combination of stress and urge.

In addition to these three, several other variants are distinguished. Overflow incontinence — the bladder does not empty completely, and urine leaks frequently; it is more common in men. Total incontinence — the bladder does not hold urine at all, and urination is constant or frequent. Functional incontinence — the person cannot reach the toilet in time due to physical or cognitive limitations. Transient incontinence — temporary, caused by an infection or a new medication. Nocturnal — enuresis, leakage during sleep.

Why urine is released when coughing and during physical exertion

Stress incontinence usually occurs due to weakening or damage to the muscles that hold urine: the pelvic floor muscles and the urethral sphincter. The second cause is displacement of the bladder from its normal position. Coughing, laughing, and lifting heavy objects sharply increase pressure in the abdomen, and weakened muscles do not hold urine. Thus, involuntary urination when coughing becomes regular.

Main causes of involuntary urination

The cause of urinary incontinence depends on the type. The main mechanisms:

• weakening or damage to the pelvic floor muscles and sphincter — the basis of stress incontinence;
• overactivity of the detrusor — the muscle that controls the bladder — the basis of urge incontinence;
• obstruction or blockage in the bladder, due to which it does not empty completely — the cause of overflow incontinence;
• a congenital feature of the bladder, spinal cord injury, or a fistula between the bladder and an adjacent area — possible causes of total incontinence.

Factors that increase the likelihood of the problem: pregnancy and vaginal childbirth, obesity, a family history of incontinence, age. Urge incontinence is more common in older people and is sometimes a sign of a urinary tract infection or a neurological disease — for example, multiple sclerosis or spinal cord injury. Overflow incontinence is associated with tumors, kidney stones, diabetes, and certain medications.

How urinary incontinence is diagnosed

The diagnosis is usually made after a consultation: the doctor asks about symptoms and may perform an examination — vaginal or rectal. You are asked to keep a diary: how much fluid was drunk, when and how much urine is released, and in what situations leakage occurs. Next, urine and blood tests, bladder function tests, and imaging studies are used. If necessary, the patient is referred to a specialist.

When to see a doctor

You should see a doctor for any type of incontinence — from rare drops when coughing to constant leakage. This is the first step toward finding an effective way to control it. Incontinence may be associated with a urinary tract infection or with an obstruction to urine outflow. The doctor will refer you to a specialist if necessary.

Urinary incontinence by itself is not a reason to call an ambulance. 103 or 112 — if signs of a life-threatening condition appear: for example, a stroke or heart attack.

This article is for reference. It does not replace a doctor's consultation: the cause of leakage and the method of control are discussed at an appointment.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer