“I laughed so hard I nearly peed my pants.” Incontinence is something many joke about. But that doesn’t mean we fully understand it: What is it, why does it happen, who will it affect and what can you do about it?
Understanding how your body can change over time, what you can do about it, and when you should talk to a doctor are important things. So we’re here to clear up what you need to know about urinary incontinence.
But first… let’s all get on the same page...
Urinary Incontinence Definition: What Is it?
Incontinence can mean many things. It’s not a “male” or “female” problem. But something that can impact any person at any time of their lives and for many different reasons. Indeed according to the Urology Care Foundation, “a quarter to a third of men and women in the U.S. suffer from urinary incontinence.”
Urinary incontinence affects women more for two main reasons:
- Women have a shorter urethra
- Those who have been through childbirth may have weakened muscle support in the bladder and urethra
“Incontinence” is also not a diagnosis but a symptom. Think of it like a tummy ache: We all get tummy aches at different points in our lives. Sometimes it’s a temporary thing with a fairly obvious cause (uhm, I stress-ate an entire pizza while watching the news). But it can also have many different causes with many different treatments (e.g. appendicitis, gallstones, menstrual cramps etc).
So, while you might experience incontinence, that alone won’t give you a clear picture of what’s happening, why or how to treat it. You need to understand the type of incontinence. And if it’s persistent, you’ll definitely want your doctor’s help investigating.
Incontinence is even more complicated because the term doesn’t just apply to peeing involuntarily (i.e. urinary incontinence). There also can be fecal incontinence. But all incontinence is characterized by a sudden loss of control over functions of eliminating waste.
Back to the pee jokes... They can create embarrassment, even stigma, around incontinence. Some feel it’s an inevitable fact of getting old (bring on the adult diapers jokes). Some are simply embarrassed by these sorts of bodily functions.
At Knix, we don’t believe bodies - or aging - are embarrassing or shameful. We want to have these conversations to empower you to understand your body, talk to your friends, discuss with your doctor, and ultimately feel like you have choices. We even created Leakproof Underwear to help you out.
More importantly, we want you to know how to advocate for your healthcare and if (on the rare occasion) symptoms have a more serious cause, not let shame hold you back from getting the care you need and deserve.
What We Will & Won’t Cover
In this article, we’re going to focus on urinary incontinence as experienced by women. Because of the unique anatomy of each gender, explanations for female urinary incontinence differ than those for men.
We’re not going to cover non-urinary incontinence, or male incontinence here. If you want to learn more about male urinary incontinence, check out this video from the Mayo Clinic.
5 Types of Urinary Incontinence
Remember when I said incontinence is a symptom not a diagnosis? It becomes a diagnosis when you’re able to understand the different kinds of incontinence and which type is being experienced. Only from there can you (and your doctor) move on and explore causes and treatments.
It’s worth mentioning that incontinence can also be temporary or persistent (we’ll explore that more in the causes of incontinence). While these aren’t “types” of incontinence they also impact your treatment plan as they point to different possible causes.
Type of Urinary Incontinence
How / When it Manifests
Some Possible Causes
Urine loss during physical exertion, whether it be exercise or more physical reactions like coughing, sneezing, laughing etc.
Pregnancy, childbirth, menopause, trauma from surgery.
An impossible-to-ignore feeling that you need to urinate right this second or you’ll burst, even if you just went or felt fine just minutes before.
Pregnancy which puts pressure on the bladder, childbirth, menopause, trauma from surgery. Overactive bladder (OAB). Also neurological diseases, like Parkinson’s disease and multiple sclerosis (MS).
A combination of stress and urge incontinence.
Any combination of the causes from stress and urge incontinence.
If pee “dribbles” or is unsteady, you may have overflow incontinence. The inability to completely empty the bladder can lead it to overflow and cause unexpected urine leaks.
More common in men (caused by an enlarged prostate). In women, it can indicate weak bladder muscles, nerve damage from diabetes, alcoholism or neurological damage or an underactive bladder.
This is when you experience urine loss, but the cause is not associated with any problems with the urinary system.
Physical or cognitive impairment, such as Alzeimher’s, immobility etc.
Let’s describe each with a little more detail.
1. Stress Incontinence
Stress urinary incontinence 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 is generally weakened muscles that become weaker when the body is experiencing the ‘stress’ of those exertions, so fails to hold in your pee.
When you sneeze for example, there’s a lot of exertion: Your abdominal muscles, diaphragm and intercostal muscles push the air out of your lungs and your vocal chords, your throat and even eyelids muscles play a role. In other words, your body is working! Same goes for laughing, crying, coughing and, of course, exercising. With all that bodily stress, weaker muscles can “falter” in those moments.
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.
2. Urge Incontinence
Have you ever needed to urinate 'right this second'? Of course, we’ve all experienced an urgent need to pee, whether we’ve been drinking a lot of fluid or have just been stuck without access to a bathroom for too long.
That urge to urinate is a normal experience and it usually comes on gradually… you could pee, you need to pee, okay you gotta go. But even then most of us can manage to ‘hold it’ until we find a washroom.
For some people, though, that sudden urge to urinate comes out of nowhere, but with the same urgency. They may even have peed recently and suddenly they need to pee again. Or one minute they’re absolutely fine and the next minute they’re in that “gotta go” panic. And if they can’t get there in time, an accident may happen.
This is urge incontinence. And because of its unpredictability it can be a very difficult form of incontinence to live with. The challenge here is often about how your brain and your bladder are communicating. There can be false messages that the bladder is full and needs emptying. Or “too late” messages that you need to urinate.
Urge incontinence has many possible causes, including a lot of the same causes we explored with stress incontinence. But because it also involves the brain, it can be linked to neurological conditions like Parkinson’s Disease and Multiple Sclerosis.
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. An overactive bladder 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. Exercises to strengthen the urinary 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.
3. Mixed Incontinence
Mixed incontinence is when a person is experiencing both urge and stress incontinence. While this sounds like a horrible double-whammy kind of 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 treatment options can include lifestyle changes, medication and botox injections—in your bladder — they won’t help your crow’s feet ;)
4. Overflow Incontinence
If you pee frequently but it has an unsteady, dribble-like flow, this could point to overflow incontinence. With this type of incontinence, the bladder doesn’t actually empty when you pee. 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. 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, it 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 changes, 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 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.
What Can Cause Urinary Incontinence?
As mentioned earlier, many of us experience incontinence at some point. In many instances, it can be temporary, versus the more persistent type we’ve been discussing so far.
Temporary Urinary Incontinence
What would cause temporary incontinence? Well, it can be brought on by consumption (or over-consumption) of certain foods and drinks, including alcohol, caffeine, carbonated drinks.
Hot and spicy foods or foods high in sugar or acid (like citrus fruits) can cause incontinence. If you notice consuming (or excess consumption) of certain foods or drinks causes incontinence, you may want to adjust your diet.
Temporary incontinence can also be caused by certain medications. Blood pressure medication, for example, can make you pee more often. Certain sedatives and muscle relaxants can also cause incontinence.
Always be aware of the risks and side effects of any medication you’re taking. With some, it may be a temporary effect while the body adjusts to the medication. If you’re taking a medication long term that causes incontinence, work with your doctor to explore alternatives.
Finally, there can be physical causes of incontinence. A urinary tract infection (UTI) may cause incontinence and certainly warrants a trip to the doctor. Other symptoms of a UTI include a burning sensation when you pee or blood in your pee.
Persistent Urinary Incontinence
If incontinence cannot be connected with any temporary cause and happens persistently, it’s definitely worth seeking medical advice.
As outlined in the previous section, the causes of persistent incontinence can vary depending on the type. Your doctor will work with you to help understand the kind of incontinence you’re experiencing, its cause and the treatment options you might explore.
Are There Risk Factors for Urinary Incontinence?
30-60% of women over the age of 40 experience urinary incontinence (Ian Milsom, Gothenburg Continence Research Center) so if you are among them, you shouldn’t blame yourself. Being a woman does put you at greater risk (though as we’ve discussed, men can be impacted too). Your age puts you at greater likelihood.
In addition to these factors, urinary incontinence risk factors include:
- Being overweight
- Family history
- Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
- Having been through pregnancy and childbirth
- Having undergone certain surgeries (e.g. hysterectomy)
Living with Urinary Incontinence: Lifestyle Changes and Solutions
Whether incontinence is temporary or persistent, there are lifestyle changes you can make to manage and have excellent quality of life while living with incontinence.
- Reduce risk factors: If you want another reason to quit smoking, reduce alcohol consumption or maintain a health weight, here it is. Of course, you can do these things for myriad medical reasons and while they don’t come with guaranteed health outcomes, the risk of many diseases and conditions will be lessened.
- Do Kegel exercises / pelvic floor exercises: These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. There’s no reason to wait to start doing pelvic muscle exercises. But they may help if begun at any stage.
- Try products like leakproof underwear: Experiencing incontinence can cause a great deal of embarrassment. It even prevents some people from participating in events and outings, leading to isolation, depression and shame. While you explore treatment options with your doctor, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels, that can hold up to 8 tsp of pee.
- Time your bathroom breaks: Taking bathroom breaks on a schedule may help you manage urge and overflow incontinence. Over time, you can increase the time between bathroom breaks.
50% of people who experience incontinence do not seek help. So while lifestyle changes are easy to make, we’re not at all suggesting they replace medical advice.
Don’t Be Afraid to Talk to Seek Medical Advice
If there’s one message that carries across every single article we’ve written, it’s that seeking medical advice should not be something you avoid. Your doctor is your health care partner and if you’re worried about anything going on with your body, you should share that with them.
Whether it’s embarrassment or fear of “wasting their time” that’s holding you back, understand they’re there to help you navigate what’s happening, and whether it’s something you may need to act on. We all can be bad judges of our own bodies at times… we normalize and dismiss our own concerns because we’re too busy, or ashamed, afraid of bad news, or just don’t want the inconvenience.
When you do make the time to talk to your doctor, it helps to be prepared. Write down the questions you want to ask and anticipate the questions they might ask you!
Urinary Incontinence: Question Prep
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
- 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?
Incontinence is not an easy thing to experience, but there are treatment options and lifestyle changes that can make it easier to live with incontinence. Hopefully this article has empowered you to have the conversations you need to!