Leaking Urine: Why It Happens and How to Treat It

There are a few types of urinary incontinence. Each affects people differently and happens for different reasons.

Maybe a little bit of pee squeaked out when you sneezed. Maybe it happened on your run—and this time, your shorts are kind of wet. Or maybe you have the sudden urge to go and don't quite make it to the toilet on time. There are different types of urinary incontinence that a person may suffer from.

Leaking urine happens. In fact, more than 25 million people in the US experience urine leakage every day, according to the National Association for Continence (NAFC). This loss of bladder control is known as urinary incontinence. Here's what you need to know about the condition—and how to get help.

Why Do People Experience Leaking Urine?

Urinary incontinence is considered any unintentional loss of urine. It can happen anywhere from a few drops once a month to leakage multiple times a day, David Sheyn, MD, an ob-gyn/urologist in the Division of Female Pelvic Medicine and Reconstructive Surgery at University Hospitals in Chardon, Ohio, tells Health. And the amount of urine you let out can be minor to moderate.

Stress Incontinence (SUI)

Your urine is stored in your bladder. When you need to urinate, your bladder muscles tighten, forcing your urine out of your bladder and through your urethra (the tube that lets out urine). So that your urine can be released out of your body, the sphincter muscles around the urethra relax.

You can experience SUI when your pelvic floor muscles—which support the urethra—and the sphincter muscles—which control the release of urine—weaken, according to the Mayo Clinic. When those muscles weaken, any everyday activity that uses abdominal and pelvic muscles, like laughing, coughing, exercising, and lifting, can put pressure on your bladder and cause urine leakage. Sudden movements can also cause urine to leak.

SUI is much more common for women than men. That's because events like pregnancy and childbirth can weaken pelvic floor muscles that play a key role in the coordination of urination, Kristin Sapienza, DPT, a pelvic floor physical therapist and founder of women's health physical therapy practice FemFirstHealth in New York City, tells Health. Scar tissue and pain may also affect muscles' ability to contract and relax as they should, she adds. SUI brought on by pregnancy can begin either during pregnancy or after delivery.

Among men, prostate surgery is the main cause of SUI, the NAFC reports.

Urge Incontinence

Urge incontinence is most often associated with overactive bladder (OAB). OAB is the frequent, sudden urge to urinate and is caused by bladder muscles that contract involuntarily, according to the Mayo Clinic.

If you make it to the bathroom in time, you might find that you don't actually urinate much when you get there. That's because the urgency of OAB can kick in even when you don't have a lot of urine in your bladder. But other times, you might not make it to the bathroom in time and leak urine, which is considered urge incontinence, per the Mayo Clinic.

Urge incontinence happens when there's a problem with the nervous system, pelvic floor muscles, or pelvic nerves that causes your bladder to empty without your permission, explains Dr. Sheyn.

Mood disorders, such as anxiety, can also play a role. That's because the part of the brain that controls anxiety also controls the bladder, and mood can affect your need to urinate, Dr. Sheyn says. A 2020 study showed that high levels of anxiety and depression were associated with incontinence, urge incontinence in particular, with the researchers writing that the conditions all "share hormonal and neurological pathways."

Overflow Incontinence

This happens when your bladder doesn't empty completely, causing too much urine to stay in your bladder, according to MedlinePlus. When your bladder gets too full, you experience frequent or constant dribbling of urine.

Overflow incontinence is most common among men and might be caused by tumors, kidney stones, diabetes, and certain medicines.

Functional Incontinence

You might have urine leakage if you have a physical or mental impairment that keeps you from making it to the toilet in time, says Mayo Clinic. MedlinePlus gives these two examples: If you have arthritis, you may have trouble unbuttoning your pants in time. If you have Alzheimer's disease, you may not realize that you need to plan to use the toilet.

Transient incontinence

The word 'transient' refers to something that isn't permanent. So transient incontinence is urine leakage that is caused by a temporary situation, such as an infection or new medicine, according to MedlinePlus. Once the cause is dealt with, the incontinence goes away.

Mixed Incontinence

You can also have a combination of incontinences, usually SUI and urge incontinence. Often, symptoms of one type of incontinence may be more severe than the other, according to the NAFC.

What Are Other Symptoms of Urinary Incontinence?

Besides the already-mentioned hallmark symptoms of each type of incontinence, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that other symptoms might include:

  • Leaking urine without any warning or urge
  • Wetting your bed while sleeping
  • Leaking urine while having sex

Another symptom of urinary incontinence is urinating often—more than seven times per day or more than once at night—says Dr. Sheyn.

What Are the Risk Factors for Leaking Urine?

Each type of incontinence can happen for different reasons, but there are some universal factors that can make incontinence more likely. According to MedlinePlus, adults are more likely to develop urinary incontinence if they:

  • Are female. This is especially true if you have experienced pregnancy, childbirth, and/or menopause. In fact, women are twice as likely than men to experience leaking urine, the Office on Women's Health reports. Again, pregnancy and childbirth can affect the muscles that keep urine in. When it comes to menopause, it's the change in hormones that are believed to lead to incontinence. Researchers think having low levels of the hormone estrogen after menopause may weaken the urethra.
  • Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine. Although, it's important to point out that urinary incontinence is not an inevitable part of aging.
  • Are a man with prostate problems. Enlargement of the prostate gland, which is right below the bladder and surrounds the top of the urethra, can lead to urinary incontinence, especially in older men. Incontinence can also be associated with untreated prostate cancer or be a side effect of treatments for prostate cancer.
  • Have certain health problems. Conditions such as diabetes, obesity, and long-lasting constipation can be risk factors for urinary incontinence. So can conditions involving the central nervous system, such as multiple sclerosis, stroke, or Parkinson's disease, because they can affect how the brain and bladder communicate, decreasing the ability to properly urinate, says Dr. Sheyn.
  • Are a smoker. Smoking irritates the bladder and can cause frequent urination. It can also cause coughing spasms that can lead to urine leakage.

Having a birth defect that affects the structure of your urinary tract can also raise your risk. Your risk is also higher if a close family member has urinary incontinence, especially urge incontinence, per the Mayo Clinic.

Many times, people with no risk factors can experience urinary incontinence. "Almost 70% of urge incontinence is idiopathic, meaning we don't know what causes it to happen in otherwise perfectly healthy people," says Dr. Sheyn.

When Should You See a Doctor for Leaking Urine?

Incontinence is common but not normal, says Sapienza. "I think [people] suffer in silence thinking that they can't get help, but it is treatable," she says.

Some patients aren't concerned with a few leaks here or there, and if it's truly not bothering you, then you likely don't need to see anyone, says Dr. Sheyn.

However, if you're altering your life in order to manage symptoms, then talk to a doctor. For instance, maybe when you go to a new place, you immediately scout out a bathroom to make sure you know where to dash off to if the time comes. Or maybe you decline invitations out because you can't be sure of the bathroom situation. Maybe you live in black leggings to hide urine leaks, something that patients often tell Sapienza they do.

You should also talk to your doctor if you're leaking urine frequently. Besides the impact it can have on your social, work, and personal relationships, regular urinary incontinence can also lead to physical complications like skin problems—rashes, skin infections, and sores can develop from constantly wet skin—and urinary tract infections. There's this too: Chronic incontinence might be a sign of a more serious underlying condition, and that's something you'd want to get checked out.

A place to start for getting your leaking urine addressed is your primary care provider. Or you can see a gynecologist or urologist. Any of these doctors might refer you to a pelvic floor physical therapist, if appropriate. Women may also be referred to a urologist specializing in female urology, or a urogynecologist, if one is available in your area, says Dr. Sheyn.

How Is Leaking Urine Diagnosed?

Your doctor will have to determine the type of urinary incontinence you have.

Starting a few days ahead of your appointment, your doctor might ask you to keep a bladder diary, MedlinePlus says. The diary would track how much and when you drink liquids, when and how much you urinate, and whether you leak urine.

During the appointment, your doctor will ask about your medical history and symptoms and perform a physical exam. This might include a rectal exam and, for women, a pelvic exam. They might also have you cough or do some other simple maneuver that can initiate the leaking.

To make a diagnosis, your doctor might also run some tests, including:

  • Urine and/or blood tests
  • Bladder function tests
  • Imaging tests

What Are the Treatment Options for Leaking Urine?

Here's some really great news: "Most patients can be cured or really well-managed with treatment," says Dr. Sheyn. "The most common thing I hear from patients is, 'I wish I would have done this sooner.'"

There are a lot of ways to treat leaking urine, but the best option for you will depend on which type of incontinence you have, how intrusive your symptoms are, what your treatment goals are, what your insurance covers, and whether you are interested in invasive or noninvasive treatment. Practical matters like time commitment and access to medical providers will also play a factor.

Here are some general treatment categories your doctor may discuss with you:

  • Medication: There are several types of medications that can be used to relax an overactive bladder, such as anticholinergics, beta-3 agonists, and tricyclic antidepressants, notes the NIDDK.
  • Pelvic floor physical therapy: Your pelvic floor is essentially the bottom of your core, says Sapienza. Pelvic floor physical therapy will help release muscles (if too tight), strengthen them (if too weak), or relax the pelvis with a range of techniques, such as exercises (kegels are one well-known option), dilator therapy, biofeedback, or yoga positions. She says that they usually see improvement in patients within six visits.
  • Devices: Stress incontinence devices can be used to assist with pelvic floor exercises to ensure you're performing them properly. These devices are equipped with motion sensors that are connected to an app to provide feedback and help you isolate the pelvic floor muscles, Dr. Sheyn explains. Then there are devices that have a direct role in preventing leaking. For example, there's a pessary, which is a soft, plastic device that is inserted into your vagina to help keep the urethra in place to diminish dribbles.
  • Lifestyle: Changing up your habits, such as avoiding fluids a few hours before bed and decreasing intake of known bladder irritants, such as alcohol and artificial sweeteners, may help manage symptoms, notes the NIDDK. And technology makes this even easier now. For example, some apps help patients with overactive bladder manage fluid intake, explains Dr. Sheyn.
  • Botox: Injections into your bladder can help relax the muscle, decreasing the chance of leakage if you have urge incontinence. It's generally prescribed only after other treatments haven't worked.
  • Surgery: Sling surgery is the most common surgery for stress incontinence in women. It involves inserting a strip of material between the vagina and urethra. Men with stress incontinence can also have sling surgery. Another surgical option is to implant an artificial urinary sphincter, a small, fluid-filled ring that's put around the bladder neck. The ring keeps the urinary sphincter shut until you need to urinate, at which point you press a valve that's under your skin to deflate the ring and allow urine to leave your bladder.

If treatment doesn't work, the Mayo Clinic points out that you can take measures to "ease the discomfort and inconvenience of leaking urine," including wearing pads and protective garments to collect any leakage or using a catheter to drain your bladder.

How Can You Prevent Leaking Urine?

Urinary incontinence isn't always preventable. But there are some things you can do to reduce your risk, including:

  • Maintaining a healthy weight
  • Practicing pelvic floor exercises
  • Avoiding bladder irritants, such as caffeine, alcohol, and acidic foods
  • Trying to maintain regular bowel movements, as constipation can cause urinary incontinence
  • Not smoking or, if you do smoke, quitting

If you are pregnant, schedule an assessment to evaluate pelvic floor health with your ob-gyn or midwife six weeks after having a baby, advises Sapienza. If you've already had your baby, it's never too late to make that visit.

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