Urinary Incontinence

by Food and Drug Administration (FDA)

Leslie Behanna can describe every rest stop, gas station, and even a few bushes in the greater Pittsburgh area where she lives. "I got to know all the bathrooms," says Behanna, adding that by the time she got the bathroom door open, it was often too late. "I've peed in every bush too."

Just the act of standing up after sitting awhile was enough to make Behanna, 53, leak urine, she says. And hearing water running was a trigger, too. "I'd go to do laundry and as soon as the washer started filling up, I'd have to run to the bathroom."

But her worst moment, she says, came during one of her son's soccer games. She was sitting on a picnic table and when she got up, she left a puddle on the table. Her son and his friends realized what had happened and tried to help her out. "The kids washed it off with their squirt guns. I was so embarrassed for myself and my kid."

The National Association For Continence (NAFC) estimates that about 25 million adults in the United States experience urinary incontinence, the involuntary leakage of urine. Women experience it twice as often as men. For Behanna and others, incontinence is frustrating, embarrassing, and debilitating. It wakes them up at night, restricts their time away from home, irritates their skin, forces them to wear bulky pads or diapers, and makes them self-consciously wonder whether others know. "I was always afraid I'd smell," says Behanna.

Despite its prevalence and its effect on quality of life, many people are reluctant to talk about incontinence or to seek treatment. A 2001 survey of U.S. adults sponsored by the NAFC indicated that only one-quarter of those who had symptoms had discussed them with a doctor. And a 2004 survey showed that women live with their symptoms for an average of six and a half years before seeking treatment; men wait an average of about four years.

A number of treatment options are available, ranging from behavioral therapies, to medications and medical devices approved by the Food and Drug Administration, to surgical remedies. About 80 percent of people with urinary incontinence can be cured or improved, says the NAFC.

Although incontinence can occur at any age, age-related changes in the body make older people more likely to experience it. "But no matter what your age, if you feel that bladder symptoms are so burdensome that they affect your quality of life, it's time to do something," says Wendy W. Leng, M.D., assistant professor of urology at the University of Pittsburgh School of Medicine.

Water Works

Certain organs, muscles, nerves, and the brain all work together to control the process of urination. The kidneys filter the blood to remove waste and water, producing urine. From the kidneys, urine travels down tubes called ureters to the bladder. The bladder expands to store urine. Urine leaves the bladder through another tube, the urethra, from which urine passes out of the body. A muscle at the top of the urethra, the sphincter, acts as a shut-off valve, opening and shutting the urethra to allow or stop the flow of urine.

During normal urination, the brain sends a signal to nerves in the spinal cord that trigger the bladder to contract, forcing urine into the urethra. The nerves also send a message to the sphincter to relax, allowing the urine to pass.

Experts say that incontinence can occur for many reasons. It is often temporary, and it always results from an underlying medical condition, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Urinary tract or vaginal infections, constipation, and certain medications can cause temporary incontinence.

A variety of other problems, such as weakness of the bladder or of the muscles that support it, overactive bladder muscles, or a blockage of the urinary tract, can cause persistent incontinence. Damaged nerves that control the bladder can also cause incontinence. Nerve damage may occur with multiple sclerosis, Parkinson's disease, stroke, and other diseases. Birth defects, pelvic surgery, and spinal cord injury may cause incontinence, too.

The NIDDK lists several types of incontinence:

Stress incontinence occurs when urine leaks during such activities as laughing, sneezing, coughing, and bending. These acts increase pressure on the abdomen, which pushes on the bladder. This is the most common type of incontinence in women. It is usually caused by a weakening of the muscles that control the bladder, which often occurs after pregnancy, childbirth, or menopause.

Urge incontinence, also called overactive bladder, is characterized by frequent urination; a strong, sudden need to urinate; and inability to get to the bathroom in time after the urge. Nerve damage that results from certain diseases or surgeries often causes overactive bladder. The NAFC estimates that 1 in 5 adults over age 40 has symptoms of overactive bladder.

Mixed incontinence is a combination of several types of incontinence, usually stress and urge.

Overflow incontinence occurs when the bladder never empties completely. It becomes so full that it just overflows. This type of incontinence is more common in men, often because of an obstruction such as an enlarged prostate, the male gland that sits just below the bladder.

Functional incontinence is leakage in a person who has difficulty reaching a bathroom in time because of a physical disability, such as arthritis, or a mental disorder, such as Alzheimer's disease.

About the Author

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