Managing Incontinence

When you have incontinence, you’re sure to have a lot of questions and may not know where to go for answers and advice. Working with your doctor is the first step. Here, you’ll also learn more about incontinence, the treatments available, and lifestyle changes you can make so you can understand your condition and continue do to the things you enjoy.

Urinary Incontinence

What is urinary incontinence?

Incontinence is a common condition and happens because of problems with the muscles and nerves that help the bladder hold or release urine. You may leak urine when you cough or sneeze. Or you may have a sudden urge to go but can’t get to the bathroom in time.

What are the different kinds of urinary incontinence?

There are five basic types.

  1. Stress incontinence causes you to leak urine when you sneeze, cough, laugh, lift heavy objects, exercise, or do other things that put pressure on your bladder.
  2. Urge incontinence, also known as overactive bladder (OAB), is when you leak urine after feeling a sudden, strong urge to go. You may have OAB if you have to go eight or more times a day and more than once at night. Or you may feel the urge to go when you touch or hear running water. There’s also a dry form of OAB: You get the urge to go even if your bladder is empty.
  3. Mixed incontinence is when you have stress and urge incontinence at the same time. This is more common in women.
  4. Overflow incontinence , which is more common in men, is when you are not able to empty your bladder completely, so you may leak urine once your bladder is full.
  5. Functional incontinence happens when a medical condition, like arthritis, keeps you from getting to the bathroom in time.

What causes urinary incontinence?

Some causes include:

  • Urinary tract infection. This infection can irritate your bladder, leaving you with a strong urge to urinate and, sometimes, incontinence.
  • Pregnancy and childbirth. The strain from carrying a baby and giving birth can weaken muscles, ligaments, and nerves in the pelvis, bringing on incontinence.
  • Menopause. Stress incontinence and OAB are more common in menopause when estrogen levels drop. Estrogen helps keep the bladder, pelvic muscles, and urethra healthy.
  • Prostate problems. Men who’ve had prostate surgery or have an enlarged prostate are more likely to have incontinence.
  • Smoking. Experts aren’t sure why, but smokers are at a higher risk for incontinence than nonsmokers.
  • Being overweight. Excess pounds can put pressure on your bladder, causing it to leak urine.
  • Medical conditions. Some conditions damage nerves or muscles, such as diabetes, multiple sclerosis, and Parkinson’s disease. Anxiety can also trigger incontinence in some people.
  • Medications. Some medications, such as diuretics (“water pills”), sedatives, sleeping pills, and some drugs to treat depression can cause incontinence or make it worse. Ask your doctor if your incontinence might be a side effect of your medication and whether there are other treatment options for you.
  • Hysterectomy. The muscles and ligaments that support the bladder may be damaged when you have surgery to remove your uterus.

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How is urinary incontinence treated?

Your doctor can create a treatment plan that addresses your symptoms and any conditions that might be causing the problem. Some options include:

  • Medication. Over-the-counter and prescription drugs can calm muscles and nerves and prevent bladder spasms. Botox injections can also help calm the bladder when other medications don’t work. Botox is done in your doctor’s office and usually takes less than 5 minutes. It may keep your symptoms under control for as long as 6 months.
  • Surgery. Your doctor may suggest surgery if your symptoms are severe and other treatments don’t help. One common type of surgery, called a sling procedure, uses a small ribbon of mesh to support the bladder.
  • Devices. A pessary is a ring that’s inserted into a woman’s vagina to reposition the urethra to prevent leaks.
  • Bladder training. By using the restroom at set times instead of waiting for the urge, you can slowly get control over your bladder and increase the time between bathroom trips.
  • Kegel exercises. Squeezing your pelvic floor muscles, which hold up your bladder, can make them stronger and help stop leaks. Here’s how to do them:
    1. To get a feel for the muscles you're targeting, stop the stream of urine when you’re going to the bathroom. If you feel a sense of pulling, you’re squeezing the right muscles.
    2. When your bladder is empty, squeeze your pelvic floor muscles for a count of five, then relax them for 5 seconds. That’s one rep.
    3. Aim for three sets of 10 reps per day.
  • Biofeedback. An electrical patch is placed on your skin over your bladder and urethra. The patch is connected to a monitor so you can see when the muscles contract. This will help you learn to control them to prevent leaks.
  • Nerve stimulation. Sends quick pulses of electricity to muscles around the bladder, which may help strengthen them.

Which lifestyle changes can help me?

  • Drink plenty of water. You might think cutting back on water would make you have to go less, but not drinking enough can make the problem worse. Aim for six to eight 8-ounce glasses a day.
  • Watch what you eat. Cutting back on alcohol, carbonated drinks, coffee, tea, and spicy and acidic foods may improve your symptoms.
  • Lose weight. Taking off extra pounds can make incontinence better. Losing just 5% percent of your body weight can help. That's 10 pounds for a 200-pound person.
  • Quit smoking. You’ll raise your chances of leaking less if you stop smoking.

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Bowel Incontinence

What is bowel incontinence?

Bowel incontinence, also called fecal incontinence, happens when you’re not able to control your bowel movements, leading you to leak solid or liquid stool. It’s more common in older people, but anyone can get bowel incontinence. Nearly 18 million adults in the U.S. have bowel incontinence.

What causes bowel incontinence?

Some common causes are:

  • Diarrhea. Loose stools are more difficult to hold than solid stools and may leak.
  • Constipation. Watery stools may build up behind large, hard stools and leak around them, causing incontinence.
  • Muscle damage or weakness. Childbirth injuries, cancer surgery, and hemorrhoid surgery may damage or weaken the muscles that keep your anus closed, leading to leakage.
  • Nerve damage. Some conditions, like diabetes and MS, can affect the nerves around the rectum.
  • Being physically inactive. People who spend many hours sitting or lying down are at risk, such as an older adult who can’t move around well.
  • Childbirth. Injuries to muscles and nerves in the pelvic floor can lead to bowel incontinence, especially when forceps are used or if an episiotomy (a cut in the vaginal area to prevent tearing during delivery) is performed.
  • Hemorrhoids can prevent the muscles around the anus from working properly, leading to incontinence.
  • Medical conditions. People with lactose intolerance or intestinal disorders, like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), may get bowel incontinence.
  • Medications. Some medications, like laxatives, can lead to incontinence.

How is bowel incontinence treated?

Some common treatments include:

  • Medication. Over-the-counter and prescription drugs may help. Anti-diarrhea medicines can reduce the number of bowel movements and the urge to go, while bulking agents, like fiber supplements, can make the stool more firm and easier to control.
  • Bowel training. Getting your body used to going at scheduled times, like after every meal, can cut down on incontinence.
  • Surgery. Several different procedures are available that can repair injuries (like a muscle torn during childbirth) that cause incontinence. A colostomy is another surgery that provides a way to collect stool in a bag outside of your body.
  • Kegel exercises and biofeedback. They’re not just for urinary incontinence. Having strong pelvic floor muscles and an understanding of which muscles to squeeze can improve bowel control.
  • Diet changes. Eating more (or less) fiber and avoiding caffeine, alcohol, dairy, and spicy foods may help. Keeping a food diary can help you understand what foods might be playing a role in your incontinence. Your doctor can suggest diet changes based on your situation.
  • Anal electrical stimulation. A small probe is inserted into the rectum for a few minutes every day for 8 to 12 weeks. It sends a mild electrical current to the muscles around the rectum, causing them to contract, which helps make them stronger.

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What kinds of aids can help me manage urinary or bowel incontinence?

There are many aids to help you manage your incontinence and live an active life. They come in a variety of styles and sizes. Look for one that fits your body well, wicks moisture, and offers the level of protection you need. Here’s an overview of what’s available.

  • Liners. These thin, throwaway pads are for light to moderate urinary incontinence in women.
  • Pads. For heavier leaks, disposable absorbent pads can be worn with your regular underwear.
  • Male guards. For light to medium protection, these disposable guards fit in briefs and have a sticky backing to keep them in place.
  • Protective underwear. These look similar to regular underwear, but they are designed with extra padding in the crotch for women and a leak-proof panel in the front for men for moderate to heavy incontinence. There are both disposable and reusable varieties. Some can be worn with a liner or pad.
  • Underpads. You place these cloth-like waterproof pads on your bed to protect your mattress and the sheets when you sleep. You can also use them while you’re sitting in a chair or on a sofa to absorb any wetness. There are washable and disposable varieties.

Can I use a sanitary pad to manage my incontinence?

Sanitary pads are designed to absorb slow menstrual flow, not full urination or liquid stools. If you have very light urinary incontinence, sanitary pads may be enough. Otherwise, incontinence aids will provide more protection against leaks, odor, and will keep moisture away from your skin.

What do I need to know about incontinence and skin care?

When you have incontinence, you’re more likely to have skin problems around your hips, pelvis, rectum, or genitals. You may develop redness, peeling, and yeast infections because of too much moisture in those areas.

Here are steps you can take to protect your skin:

  • Clean and dry yourself after urinating or having a bowel movement. Consider a premoistened wipe to keep your skin clean and dry.
  • Use soap-free, fragrance-free cleansers.
  • Apply a moisturizer that doesn’t contain alcohol.
  • Create a moisture barrier by applying creams or ointments that contain zinc oxide, lanolin, or petrolatum. Reapply after each time you urinate or have a bowel movement.
  • Treat yeast infections (itchy red rashes) with an over-the-counter antifungal medication.
  • Talk to your doctor if you have a serious skin problem, or if the irritation or yeast infection won’t go away.

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Don’t Go It Alone

Discussing incontinence with anyone, including your doctor, can feel awkward. But incontinence is treatable, so getting your doctor’s advice is the first step.

Getting advice from others who also have incontinence can help, too. You can find out what they’re doing and ask what treatments and lifestyle changes have worked for them. Blogs and message boards can be convenient places for you to get ideas and talk openly with others. The National Association for Continence has an active online community. The right support can make all the difference.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on March 12, 2019

Sources

SOURCES:

Elizabeth Mueller, MD, associate professor and division director, Female Pelvic Medicine and Reconstructive Surgery, departments of urology and obstetrics/gynecology, Loyola University.

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U.S. Department of Health and Human Services: “Urinary incontinence fact sheet.”

Urology Care Foundation: “Loss of Bladder Control.”

National Kidney and Urologic Diseases Information Clearinghouse: “Kegel Exercise Tips.”

Urology Care Foundation: “Get the facts about SUI.”

Cleveland Clinic: “What are Kegel Exercises?”

National Association for Continence: “Kegel Exercises.”

Weill Cornell Medical College James Buchanan Brady Foundation Department of Urology: “Overactive Bladder.”

CDC: “Nutrition Information for Fruits and Vegetables.”

CDC: “Quitting Smoking.”

National Association for Continence: “You Are What You Eat And Drink!”

FDA: “FDA approves Botox to treat overactive bladder.”

National Institute on Aging: “Urinary Incontinence.”

National Institutes of Health: “Overactive Bladder.”

National Kidney and Urologic Diseases Information Clearinghouse: “Urinary Incontinence in Women.”

New York Presbyterian: “Digestive Diseases: Fecal Incontinence.”

University of Maryland Medical Center: “Urinary Incontinence.”

U.S. Department of Health and Human Services, Office on Women’s Health: “Urinary Incontinence.”

Leslee, S. Journal of Urology, 2010.

Healthywomen.org: “Urinary Tract Conditions.”

Herbison, G. Cochrane Database of Systematic Reviews, 2013.

American Heart Association: “Understanding Food Nutrition Labels.”

University of Maryland Medical Center: “Skin care and incontinence.”

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