Causes of Incontinence

TEAM KNIX / YOUR BODY

“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 happens when urine leaks outside your control and intention to pee.

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

Causes of Temporary Urinary Incontinence

Temporary 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 ate too much 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 kinds 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

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Urge Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

An impossible-to-ignore feeling that you need to go right this second or you’ll burst, even if you just went or felt fine just minutes before.

  • Neurological conditions like Parkinson’s or MS
  • Overactive bladder (OAB)
  • Pregnancy
  • Childbirth
  • Menopause
  • Trauma to the bladder and urethra from surgery
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Biofeedback therapy
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

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 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

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Stress Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

Urine loss during physical exertion, whether it be exercise or more physical reactions like coughing, sneezing, laughing etc.

  • Childbirth
  • Trauma from surgery (e.g. hysterectomy)
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Menopause
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

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, 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, trauma from surgery (e.g. hysterectomy). And weakened muscles can happen because of aging (menopause) and lack of exercise. This is one of the reasons why Kegel exercises (exercising the pelvic floor muscles) comes up so often.

3. Mixed Incontinence

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Mixed Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

A combination of stress and urge incontinence.

  • The same causes as stress and urge incontinence
  • Lifestyle changes
  • Medication
  • Bladder botox injections

Mixed 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 causes, which will give you a range of treatment options to help restore bladder control.

Those treatments can include lifestyle changes, medication and bladder botox injections.

4. Overflow Incontinence

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Overflow Incontinence At-a-Glance

How / When it Manifests

Some Possible Causes

Treatment May Include

If the flow of urine “dribbles” or is unsteady, you may have overflow incontinence. The inability to completely empty your bladder can lead it to overflow and cause unexpected urine leaks.

  • Weak bladder muscles
  • Underactive bladder
  • Blockages in the urinary tract
  • Lifestyle changes
  • Surgery to remove blockages
  • Use of catheter

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 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

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How / When it Manifests

Some Possible Causes

Treatment May Include

This is when you experience urine loss, but the cause is not associated with any problems with the urinary system.

  • Neurological or psychological causes
  • Physical impairments like spinal cord injuries
  • Nursing assistance
  • Changing physical settings
  • Medications and therapies to address underlying medical condition

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 judgement. 

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 Incontinence?

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 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, 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?
  • 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, you may be able to increase the time between bathroom breaks.

To help avoid the embarrassment of urine leakages, try leakproof underwear. Knix Leakproof Underwear can hold up to 8 teaspoons of liquid, whether it’s pee, period blood or sweat. They’re 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.