Controlling Incontinence: What Are My Treatment Options?

James Myhre & Dennis Sifris, MD
·15 min read

Why It Happens and Ways to Cope

Medically reviewed by Kumkum S. Patel MD, MPHMedically reviewed by Kumkum S. Patel MD, MPH

Urinary incontinence, which some refer to simply as incontinence, is the loss of bladder control, which causes mild to severe leakage of urine (pee). Incontinence is a common and frustrating condition affecting over 25 million people in the United States. It affects more females than males and has various causes, symptoms, and treatments.

This article describes the types, causes, and risk factors for incontinence in females and males. It also explains how incontinence can be treated and managed—with medications, devices, physical therapy, and surgery.

<p>Illustration by Julie Bang for Verywell Health</p>

Illustration by Julie Bang for Verywell Health



A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.



Different Types of Incontinence

The five types of urinary incontinence differ in their causes and symptoms. Categorizing them helps direct the appropriate course of treatment, as follows:

  • Urge incontinence is when you cannot hold the urine inside long enough to reach the bathroom. It is preceded or accompanied by a strong and uncontrollable urge to pee (urinary urgency).

  • Stress incontinence is when certain movements or actions (like laughing, coughing, sneezing, exercising, or lifting heavy objects) place stress on the bladder, causing pee to leak out.

  • Overflow incontinence is when the quantity of urine produced exceeds the bladder's capacity to hold it. It may be due to poor bladder contraction or the obstruction of the urine flow.

  • Functional incontinence is when you cannot reach the bathroom in time due to physical or mental limitations. It is sometimes referred to as "toileting difficulties."

  • Mixed incontinence involves features of two or more types of incontinence. Stress incontinence, for instance, commonly occurs with urge incontinence.



How Severe Is My Incontinence?

Incontinence treatment is partly based on results from the incontinence severity index (ISI). This scoring system grades the severity based on how often you have bladder leakage (e.g., never, monthly, several times monthly, several times weekly, daily) and how much urine you lose (e.g., none, drops, splashes, more).

Each answer is scored, and the total is added to determine whether your incontinence is "slight," "moderate," "severe," or "very severe."



What Conditions Are Linked to Incontinence?

The loss of bladder control may be temporary and caused by an underlying medical condition. Or, it may be an ongoing—or even permanent—concern related to the dysfunction of the bladder itself.

This includes structures like:

  • Detrusor muscle: The muscle in the bladder wall that contracts to squeeze urine out

  • Bladder neck: The passage between the bladder and urinary tube (called the urethra)

  • Urinary sphincters: Two muscular valves that help you hold urine in until you are ready to urinate

  • Pelvic parasympathetic nerves: The relay of nerves that controls the function of the bladder

Incontinence may also be due to the weakness or dysfunction of the pelvic floor muscles that assist with the voluntary control of urine flow.

Each type of incontinence involves a range of possible causes, both acute (sudden onset and short-lived) and chronic (persistent).

Urge Incontinence

Urge incontinence is associated with detrusor overactivity, also known as an overactive bladder (OAB). The overactivity, in turn, may be caused by bladder irritation or the dysfunction of nerves controlling the bladder (referred to as neurogenic bladder).

OAB affects roughly 1 in 8 people, mostly those over 40.

Causes of OAB and urge incontinence include:

Related: How Overactive Bladder Is Treated

Stress Incontinence

Stress incontinence is associated with the weakness of the pelvic floor muscles and/or the urinary sphincters. Laughing, coughing, exercising, lifting heavy weights, or having sex can all increase abdominal pressure, compressing the bladder and causing bladder leakage.

Unlike urge incontinence, which tends to affect older adults, stress incontinence can also affect younger people, also more female youths than male.

Conditions associated with stress incontinence include:

Overflow Incontinence

Overflow incontinence is due to the poor contraction of the detrusor muscle and/or the impaired urine flow out of the bladder (known as urinary retention). These things can cause the bladder to overfill until urine leaks out, persistently or with occasional dribbling.

Unlike other forms of urinary incontinence, overflow incontinence is slightly more common in males than females (due mainly to prostate problems).

Conditions associated with overflow incontinence include:

  • Bladder outlet obstruction (a blockage of urine flow due to kidney stones, UTIs, tumors, pelvic organ prolapse, or scarring caused by medical procedures like cystoscopy or urinary catheters)

  • Hypotonic neurogenic bladder (an underactive bladder caused by bladder trauma, bladder surgery, or neurological conditions like stroke, brain tumors, Parkinson's disease, MS, and diabetes)

  • Bladder compression (caused by external pressure exerted by an enlarged prostate, pelvic organ prolapse, prostate cancer, or other pelvic masses)

  • Drugs that cause urinary retention, including opioid painkillers, lithium, and certain antidepressants or antipsychotics

Functional Incontinence

Functional incontinence is when your bladder and urinary tract are functioning normally, but you have physical or mental limitations that prevent you from getting to the bathroom in time.

Functional incontinence can affect anyone of any sex but is more common in older adults and people with disabilities.

Conditions associated with functional incontinence include:

Who Develops Incontinence?

Incontinence can affect anyone, but certain groups are more vulnerable to bladder due to risk factors. Some of these factors are non-modifiable, meaning that you cannot change them, while others are modifiable and can be changed.

Some of the major risk factors for incontinence are:

  • Being female: According to a 2021 study in the Journal of Urology, 53% of females 20 and over in the United States experience urinary incontinence (26% stress, 10% urge, 16% mixed). Among males, the rate runs closer to 19% (10% urge, 5% overflow, 4% mixed).

  • Older age: The risk of incontinence increases with age. Between the ages of 65 and 75, 22% of males and 28% of females report incontinence. By age 85, the number jumps to 45% and 58%, respectively.

  • Having obesity: Obesity, defined as a body mass index (BMI) of 30 or over, is linked to a fivefold increased risk of incontinence compared to people with a BMI indicating normal weight.

  • Pregnancy: Roughly 41% of people experience incontinence during pregnancy (predominantly stress incontinence). The condition can continue well after childbirth in 31% of cases, lasting anywhere from three months to a year or more. For some, the condition may become permanent.

  • Smoking: Cigarette smoking can irritate the bladder, contributing to and worsening OAB symptoms. Current smoking increases the risk of urge incontinence by roughly 2.5-fold. Younger people are more affected than older adults.

  • Menopause: The drop in estrogen during menopause weakens the pelvic floor muscles, increasing the risk of stress incontinence. This accounts in part for the ever-increasing rate of incontinence among women after age 42 when menopause typically starts.

  • Estrogen replacement therapy: Hormones used to prevent osteoporosis and menopause symptoms can lead to incontinence by thickening the walls of the urethra. Studies suggest that oral estrogen replacement therapy during menopause increases the risk of overflow incontinence by nearly fourfold.

Related: What Is Pelvic Floor Dysfunction?

How to Deal With Public Incontinence

Incontinence can be frustrating on its own but can be even more challenging when you are out with friends, at work, or participating in sports. The stress may be further amplified when you are traveling or in a sexual relationship.

You can do several things before and during a public outing to reduce stress.

Before going out:

  • Plan ahead: Before an outing, find out where the nearest bathrooms are. You can search for public restrooms, gas stations, and rest stops on Google or Apple Maps and schedule when and where to take a bathroom break. If you are flying, book a seat next to the toilet.

  • Wear bladder protection products: If you are prone to minor dribbling, place an absorbent pad in your underwear before heading out. If your condition is more severe, try disposable protective underwear like Always Discreet or washable protective underwear like Knix or Thinx.

  • Dress strategically: Bladder leakage is harder to see if you wear dark colors like black, gray, or navy. White and light colors are far less forgiving if you have an accident.

  • Reach out to friends: Let people you trust know about your condition. This often makes it easier to slip out when you need to pee. It may stop people from pushing problematic food and drink on you. Talking with a sex partner beforehand can also ease nerves.

When you are out in public:

  • Schedule bathroom breaks: It is easy to lose track of time when socializing, only to find yourself rushing to the bathroom when the urge to pee strikes. Regular bathroom breaks can reduce the risk of "surprise" leakages even if you don't feel like going.

  • Drink water: Although it seems counterintuitive, avoiding water for prolonged periods can irritate the bladder and increase the risk of bladder leakage. Instead, take small sips of water throughout the day. Bring a water bottle if you plan to be outdoors or at a sporting event.

  • Eat and drink right: Avoid caffeine and alcohol, which promote urination and can be irritating to the bladder. Sweetened drinks and carbonated sodas are also irritating. Acidic drinks and foods (like citrus and tomatoes), spicy foods, and artificial sweeteners should also be limited.

  • Cover seats and surfaces: Avoid the embarrassment of staining a fabric seat by placing an absorbent pad on it. This does not have to be obvious; an absorbent, washable jacket can do just fine. Before sex, strip off the bedspread and cover the sheets with a terry cloth towel.

Incontinence Care Supplies

The best way to reduce the stress of incontinence is to prepare an emergency kit for any possible mishap while out in public.

The emergency kit might include:

  • A change of clothing and underwear (maybe even something that matches what you are wearing)

  • Additional absorbent pads

  • Moist wipes for when soap or cleansers are not available

  • Disposable "pee bags" that can be sealed, such as TravelJohn, which can be purchased online

  • Disposable absorbent bed pads or mattress covers for overnight stays

  • Travel-sized odor eliminator sprays such as Fresh Spray or Medi-aire

  • Ziplock bags to place soiled clothing or disposables in to avoid smells

Treating What Is Causing Incontinence

The best way to avoid the frustration of urinary incontinence is to seek the appropriate care. Your primary care provider or gynecologist (a specialist in female reproductive health) may be able to help. But a specialist called a urologist is usually best suited to diagnose and treat the different types of incontinence.

Depending on the cause and severity of your incontinence, the urologist may recommend lifestyle and behavior therapies, prescription medications, and specialist procedures (including surgery).

Lifestyle and Behavioral Therapies

Lifestyle and behavioral therapies teach you how to reduce bladder leakage by strengthening key muscles and routinely voiding (emptying) the bladder before leakage is an issue.

This may involve:

  • Bladder training: This teaches you how to hold it in rather than rushing to the bathroom. By consciously forcing yourself to hold it in for 10, 15, 20 minutes, and progressively, you may be able to increase the time between bathroom breaks.

  • Double voiding: This means waiting for several minutes after urinating and going again to get rid of any remaining urine that might accidentally leak out.

  • Scheduled voiding: This means going to the bathroom regularly, even if you have no urge to urinate. This can help avoid accidents with all four types of incontinence.

  • Kegel exercises: Also known as pelvic floor exercises, this involves tightening and releasing the perineum (the area between the anus and genitals) to better control the muscles involved with urinating. This can be done several times a day and benefits people of all sexes.

  • Dietary management: In addition to managing fluids and avoiding problematic foods, a nutritionist might also guide you on ways to lose weight with diet and exercise.

Related: 6 Pelvic Floor Exercises to Try at Home

Prescription Medications

When conservative treatment is not enough to prevent dribbling or leakage, medications may be prescribed to treat the different kinds of urinary incontinence.

Medications commonly used include:

  • Anticholinergic drugs: These act on the parasympathetic nervous system to prevent spasms that lead to incontinence. Examples include Detrol (tolterodine), Ditropan (oxybutynin), Enablex (darifenacin), Toviaz (fesoterodine), and Vesicare (solifenacin).

  • Alpha-blockers: These are used in males with overflow and urge incontinence to relax the bladder neck and make urination easier. Cardura (doxazosin), Flomax (tamsulosin), Rapaflo (silodosin), and Uroxatral (alfuzosin) are some of the more commonly prescribed.

  • Myrbetriq (mirabegron): This drug has a similar action to anticholinergics and is specifically licensed for the treatment of OAB and urge incontinence.

  • Topical estrogen cream: This topical hormone may improve pelvic floor muscles in females when combined with Kegel exercises. It may also reduce the risk of stress incontinence that might otherwise occur with oral estrogen.

Related: What Are the Best Medications for Overactive Bladder?

Specialist Procedures and Surgery

Chronic or severe incontinence may require aggressive treatment when your health or quality of life is compromised. Some procedures work better than others, and some may be better suited for one type of incontinence but not another.

Options include:

  • Vaginal pessary: This is a soft silicone ring placed inside the vagina to support tissues displaced by pelvic organ prolapse. Doing so can reduce bladder leakage.

  • Urethral insert: This soft silicone plug is inserted into the opening of the urethra to prevent leakage during sports or other situations where the risk of leakage is high.

  • Electrical stimulation: This involves the placement of electrodes on the perineum to stimulate the pelvic floor muscles with gentle electrical currents. Over time, the stimulation may help strengthen the muscles and improve stress and urge incontinence.

  • Transcutaneous electrical nerve stimulation (TENS): For this approach, electricity is delivered through a thin needle inserted just beneath the skin of the lower back and pelvis. TENS is thought to stimulate the nerves involved in bladder control, reducing spasms and OAB symptoms.

  • Urethral bulking agents: This involves an injection of a synthetic material (like collagen or a water-based gel) around the urethra to help keep the opening shut, reducing bladder leakage.

  • Botox (onabotulinumtoxinA): Botox injections are less commonly prescribed but may be useful if other methods for easing bladder spasms have failed.

  • Surgery: Surgical options include sacrocolpopexy (prolapse repair surgery), retropubic suspension (which supports a displaced bladder neck with sutures), and a midurethral sling (which supports a displaced urethra with mesh fabric or grafted tissues).

  • Artificial urethral sphincter (AUS): An AUS is an implanted device used in males. It allows you to control the urine flow by opening and closing a fluid-filled ring around the bladder neck with a pump implanted in your scrotum.



Do I Need Surgery?

Surgery is typically pursued in people with moderate to severe incontinence when all other treatment options have failed. Even then, it may not be appropriate for everyone.

For instance, while surgery can be beneficial for females with stress or urge incontinence, studies suggest that it may increase the severity of urge incontinence in those with mixed incontinence.

Surgery, like sling procedures and AUS, is generally limited to males with moderate to severe stress incontinence.



Long-Term Management and Confidence

Although some cases of incontinence are transient (passing quickly), others may be a lifelong condition that needs to be managed. Even if there is no "cure" to your condition, there are things you can do to better cope.

This includes:

  • Quitting cigarettes

  • Achieving and maintaining a healthy weight with diet and exercise

  • Drinking water regularly in modest amounts to keep well-hydrated

  • Eating a diet rich in fiber to prevent constipation and straining

  • Reducing your caffeine and alcohol intake

  • Managing underlying medical conditions, like diabetes or enlarged prostate

  • Avoid UTIs (such as by drinking plenty of water, peeing after sex, and wiping from front to back)

It may also help your peace of mind to discuss your condition with others you trust, including friends and family. This can help reduce the stigma surrounding incontinence.

If you are not ready to open up to people you know, try connecting with an online support group like that offered by the nonprofit Simon Foundation for Continence.

Summary

Urinary incontinence is the loss of bladder control ranging in severity from mild to severe. There are different types of incontinence (stress, urge, overflow, functional, and mixed) with different causes and treatments.

Urinary incontinence affects over 25 million people in the United States, predominantly females and older adults. Treatment includes bladder training, medications, devices like pessaries, Botox, electrical stimulation, and surgery.

You can better manage incontinence by losing weight, quitting cigarettes, limiting alcohol and caffeine, eating a healthy diet, and keeping well-hydrated with a controlled intake of fluids.

Read the original article on Verywell Health.