Causes of Incontinence

“A quarter to a third of men and women in the U.S. suffer from urinary incontinence,” according to the  Urology Care Foundation. These numbers make it hard to believe most people are ashamed or confused about their experience of urinary incontinence.

In this article, we’re going to look at the various causes of female urinary incontinence - when small or large amounts of urine leak involuntarily. In some cases, the person affected may not be able to go to the bathroom in time.

We won’t spend time on male urinary incontinence or fecal incontinence. However, if you want to learn more about male urinary incontinence, check out this video from the Mayo Clinic.

What Happens When You Pee Normally?

Your brain and bladder work together to control urinary function. 

The bladder stores urine until you are ready to release it, and the muscles of your pelvis hold the bladder in place. The muscles of the bladder are usually relaxed and hold urine in the bladder, and the neck of the bladder is closed. 

The urethra is the tube that carries urine from the bladder to outside the body. The sphincter muscles are closed around the urethra. When those muscles do their job, urine does not leak outside the body by accident.

When you are ready to pee, your brain lets the bladder know. This causes the bladder muscles to contract, which forces urine out through the urethra. The sphincter also opens up when the bladder contracts, allowing the urine to pass through the urethra and leave the body.

Incontinence or bladder control problems happen when urine leaks outside your control and intention to pee. Urinary incontinence affects a quarter to a third of men and women in the U.S.

Ever wonder "Why do I pee when I cough"? We've got you covered.

What Causes Urinary Incontinence in Women?

Although urinary incontinence may be experienced by both men and women, it’s slightly more common in women. There are two main reasons for this:

• A woman’s urethra is shorter than a man’s
• If a woman has been through pregnancy and childbirth, she may have weakened pelvic muscles

Sometimes, urinary incontinence is temporary. Let’s look at those causes first…

Causes of Temporary Urinary Incontinence

Temporary urinary incontinence can be caused by many things. Causes of temporary urinary incontinence include:

• Certain medications and supplements
• Some foods and flavors
• Urinary Tract Infection (UTI):

Just because urinary incontinence may be temporary doesn’t mean you should dismiss it. Sure, if you know you just overate spicy food or drank too much alcohol, it should pass soon enough.

However, if you have any other symptoms that might indicate an infection, you should definitely seek medical advice as you may require treatment or antibiotics.

What if Urinary Incontinence Is Persistent?

If urinary incontinence is more persistent, you will need to understand what kind of incontinence you’re experiencing in order to find the cause of your incontinence.

So, let’s look at 5 different types of persistent urinary incontinence that can affect women...

5 Different Types of Urinary Incontinence & Their Causes

To understand the possible causes of urinary incontinence, you first need to understand the types of urinary incontinence.

1. Urge Incontinence

We all experience the urge to pee. And it can be urgent when we’ve been drinking a lot of fluid or have been stuck without access to a bathroom for too long. However, most of us can manage to ‘hold it’ until we find a washroom. 

For some people, though, that urgent urge to urinate comes out of nowhere. It can happen even if you’ve peed recently and or felt completely normal just a minute ago. And if they can’t get to a bathroom in time, an accident may happen. This is urge incontinence.

Urge incontinence can be difficult for those who experience it. It can happen without warning, and over time, you may find yourself constantly nervous about when and where it will strike.

Urge incontinence can be caused by a miscommunication between your brain and your bladder. There can be false messages that the bladder is full and needs emptying. Or “too late” nerve signals that you need to urinate.

There are many possible reasons this kind of urinary incontinence can occur: Because it also involves the brain, it can be linked to neurological conditions like Parkinson’s Disease and multiple sclerosis. But urge incontinence can also be caused by pregnancy (which puts pressure on the bladder), childbirth, menopause, or trauma from surgery.

Urge incontinence can also be caused by an overactive bladder (OAB) - though it’s important to note that an overactive bladder does not always cause incontinence and is not itself considered a disease. It can be caused when the muscles in your bladder are too active.

Treatment options can include biofeedback therapy, which seeks to give you greater awareness of your body’s physiological responses and help control the bladder muscle. Exercises to strengthen the pelvic floor muscles (i.e., Kegels) can help, too - while they won’t eliminate the urge, they can help ensure it doesn’t lead to a leak.

2. Stress Incontinence

Stress urinary incontinence (SUI) has nothing to do with emotional stress, but is about physical exertion. This can be the obvious physical exertion of doing exercise. But it can also include bodily functions and involuntary reactions like coughing, sneezing, and even laughing.

When any of those exertions cause an involuntary loss of bladder control, we’re talking about stress incontinence. And the cause of stress incontinence is generally weakened muscles that become weaker when the body is experiencing the ‘stress’ of those exertions, so fails to hold in your pee.

But why would the muscles in your urethra and bladder be weakened in the first place? Well, they’re just like any other muscle: They can be injured or damaged. And they can also be weak if not exercised. Or a combination of both!

Damage to the muscles of the bladder and urethra can happen to women due to childbirth, or trauma from surgery (e.g., hysterectomy). And weakened muscles can happen because of aging (menopause) and lack of exercise. Both can cause female stress urinary incontinence. This is one of the reasons why Kegel exercises (exercising the pelvic floor muscles) comes up so often when discussing treatments for stress incontinence.

You may also want to read our article on stress vs urge incontinence 

3. Mixed Incontinence

Mixed urinary incontinence is when a person experiences both urge and stress incontinence. It’s not uncommon to experience both issues with bladder control.

If you have mixed incontinence, you likely have weakened pelvic floor muscles in combination with other possible health concerns. Working with your doctor will help pinpoint the causes of urine leakage, which will give you a range of treatment options to help restore bladder control.

The treatments for mixed incontinence can include lifestyle changes, medication, and bladder botox injections.

4. Overflow Incontinence

If you pee frequently but it has an unsteady, dribble-like flow of urine, this could point to overflow incontinence. With this type of incontinence, the bladder cannot actually empty when you pee and the amount of urine you eliminate may be small. And because your kidneys continually produce urine, this can lead your bladder to overflow later, without warning.

In addition to the distress this kind of sudden incontinence can cause, it also puts you at risk for urinary tract infections (UTI). This is because urine should be expelled from the body, but if the bladder isn’t emptying, the urine that remains can become a breeding ground for bacteria.

Overflow urinary incontinence is more common in men and is often caused by an enlarged prostate. 

In women, overflow incontinence can be caused by weak bladder muscles, an underactive bladder, or a blockage in the urinary tract. An underactive bladder can be caused by certain medications, diabetes, alcoholism, and other medical conditions. Blockages in the urinary tract are sometimes caused by other surgeries or unusual growths.

Treatment for overflow incontinence varies from case to case but may include surgery to remove urinary tract blockages, review of medications and lifestyle adjustments, or the use of a catheter.

5. Functional Incontinence

Functional incontinence is probably the easiest form of incontinence to understand, because it isn’t caused by any damage to the urinary system but usually by another medical condition.

This kind of incontinence can have neurological or psychological causes. It might be a mental health issue that causes a person to ignore their urge to pee, or a disease like Alzheimer’s disease that can impact a person’s self-awareness or judgment. 

But it can also be caused by physical impairments which prevent a person from acting on their need to urinate. These can include physical obstacles, such as spinal cord injuries and mobility issues.

Functional incontinence most often affects the elderly, and treatment often includes nursing assistance that includes bathroom reminders. Changing physical settings to ensure easy access to bathrooms may also help. Other treatments can involve medications and therapies to improve the person’s physical and mental wellbeing.

Are There Factors That Increase Your Risk of Urinary Incontinence?

Urinary incontinence can happen to anybody, whether it’s temporary or persistent. So if it happens to you, don’t blame yourself or think it’s something you should be able to solve for yourself.

However, as with any medical condition, here are some risk factors that can increase your chances of experiencing urinary incontinence. They include:

• Being overweight
• Smoking
• A family history of urinary incontinence
• Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
• Having been through pregnancy and childbirth
• Having undergone certain surgeries (e.g. hysterectomy)
• Dementia 

Of course, not all of these risk factors are under your control. But where possible, maintaining a healthy diet and weight and avoiding smoking or overconsumption of alcohol is medically advised for better all-round wellbeing.

When to Seek Medical Advice

If you experience incontinence, it’s something you should consider bringing up at your next medical checkup or even booking an appointment for. You may be shocked to learn that 50% of people ignore their experience of incontinence.

But there are treatments for urine leakage, medications, and lifestyle changes that can improve your experience. So, why wouldn’t you seek medical advice? If it’s because you’re embarrassed, don’t be. This is the work that doctors do daily. They’ve seen it all, as the adage goes. 

But ignoring incontinence is not just foolhardy, it can also mean you’re ignoring something that could be more serious than it appears. While we don’t want to scare you into going to see a doctor, any time your body experiences pain, discomfort, or unusual reactions, it’s worth trying to get to the bottom of what’s going on.

If you’ve very nervous, a little preparation can help. Write down your questions and anticipate the questions your doctor may ask and come with answers ready. Below, we’re unpacking some of the things that might come up during your appointment.

These are some of the questions your doctor may ask about your experiences of urinary incontinence:

• How long have you been experiencing these symptoms?
• Have your symptoms been continuous or occasional, have they worsened over time?
• How often do you need to urinate?
• When (time of day or night) do you leak urine/experience bladder control issues?
• Is it difficult for you to empty your bladder?
• Have you noticed any blood in your urine?
• General lifestyle questions: Smoking, diet, alcohol, and caffeine consumption, etc.

And here are some questions you might ask your doctor:

• What type of incontinence do I have?
• What is causing my urinary incontinence
• What tests should I expect?
• Should I make lifestyle changes, like:
• Bladder diary
• Kegel exercises to strengthen pelvic floor muscles
• Timed bathroom breaks
• Diet changes, etc.
• What treatment(s) do you suggest for me and why?
• Without treatment, what will happen?
• What are the side effects or risks associated with this treatment plan?

Your doctor will likely review your medical history and administer a physical exam.

Other Things You Can Do to Help Control Urinary Incontinence

While you and your doctor work together to explore options for whichever kind of incontinence you experience, there are some options you can explore to help manage your incontinence. 

Many people find success with timing their bathroom breaks so that they follow a schedule may help avoid leaking urine and, thereby, managing incontinence. Over time, as bladder control improves, you may be able to increase the time between bathroom breaks.

To help avoid the embarrassment of urine leakages, try incontinence underwear. Knix Leakproof Underwear  are machine-washable and come in a variety of styles and colors, from thongs, bikini, boyshort and high rise. Basically, they feel just like regular underwear.

Exercises for Pelvic Floor Muscles (Kegels)

Doctors will often start talking to women about Kegel exercises during pregnancy or later in life. This is because these events are most associated with an increased risk of incontinence and prolapse.

However, women of all ages can benefit from doing Kegel exercises. They don’t just help prevent (or manage) urinary incontinence, they also are good for your general wellbeing.

Kegel exercises can also enhance your sexual health by helping you control your vaginal muscles, which allows your vagina to be more open (this is also helpful during pelvic exams). Moreover, the exercises increase blood circulation in the pelvic area, which can increase arousal.

So, don’t think of Kegel exercises just as something to do if/when incontinence occurs. Doing them when healthy can have myriad benefits, both present and preventative:

• Helps prevent urinary incontinence
• Preventing involuntary gas or fecal incontinence
• Improve symptoms of prolapse
• Orgasm improvement
• Maintaining overall pelvic floor strength

The good news about Kegel exercises is that you don’t need to set aside workout time or buy any special gear to do them. You can do them when you’re sitting at your desk, on the couch, or even in your car. 

Want to learn more? Click here

Written by Jane Flanagan — Updated on April 5, 2022.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.