Urinary Incontinence

Types

Urinary incontinence comprises seven types:

• Stress incontinence
• Urge incontinence
• Overflow incontinence
• Functional incontinence
• Mixed incontinence
• Anatomic or developmental abnormalities
• Temporary incontinence

In addition, some children over age 5 wet their beds, either because they can't control their bladder during the night or as a result of increased production of a specific hormone. This type of incontinence is called nocturnal enuresis, and pediatric urologists at Mayo Clinic have specific strategies for the problem. Read more about the treatment of bed-wetting.

Stress incontinence (anatomic incontinence)

Pressure on bladder causes leaking.

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People with stress incontinence involuntarily leak urine while exercising, coughing, sneezing, laughing or lifting. These activities apply sudden pressure to the bladder, causing urine to leak out. Stress incontinence is the most common type of incontinence among women, and may be due to weakened pelvic muscles, weakening in the wall between the bladder and vagina, or from a change in the position of the bladder. In many cases, the condition develops as a result of pregnancy and childbirth. Other causes of stress incontinence include:

• Weakening of muscles that hold the bladder in place, or of the bladder itself
• Weakening of the urethral sphincter muscles
• In men, benign prostatic hyperplasia (a noncancerous overgrowth of the prostate gland) prostate cancer or from prostate surgery
• In women, a hormone imbalance or a decrease in estrogen following menopause, which can weaken the sphincter muscle
• Damage to the nerves controlling the bladder resulting from diseases such as diabetes, stroke, Parkinson's disease and/or multiple sclerosis, or from treatment of gynecologic or pelvic cancers with surgery, radiation or chemotherapy

Urge incontinence (overactive bladder)

Problems caused by oversensitive bladder.

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Urge incontinence describes the experience of a frequent, sudden urge to urinate with little control of the bladder (especially when sleeping, drinking, or listening to running water). Urge incontinence is also known as spastic bladder, overactive bladder or reflex incontinence. Marked by a need to urinate more than seven times daily or more than twice nightly, urge incontinence is most common in the elderly. It also may be a symptom of a urinary infection in the bladder or kidneys, or may result from injury, illness or surgery, such as:

• Stroke
• Diseases of the nervous system, such as multiple sclerosis, Alzheimer's or Parkinson's
• Tumors or cancer in the uterus, bladder or prostate
• Interstitial cystitis (inflamed bladder wall)
• Prostatitis (inflamed prostate)
• Prostate removal, cesarean section, hysterectomy, or surgery involving the lower intestine or rectum

Overflow incontinence

Bladder doesn't empty completely, leading to frequent urination or dribbling.

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Patients with overflow incontinence cannot completely empty their bladders, causing either a constantly full bladder requiring frequent urination or a constant dribbling of urine, or both. This type of incontinence is generally caused by weakened bladder muscles as a result of nerve damage from diabetes or other diseases. It can also result from the urethra being blocked due to kidney or urinary stones, tumors, an enlarged prostate in men, or a birth defect.

Functional incontinence

Functional incontinence is the most common type of incontinence among elderly patients with arthritis, Parkinson's disease or Alzheimer's disease. Often, these patients are unable to control their bladder before reaching the bathroom due to limitations in moving, thinking or communicating.

Mixed incontinence

Some patients have two types of incontinence simultaneously, typically stress incontinence and urge incontinence. Mixed incontinence is the most common type in women, and what causes the two forms may or may not be related.

Anatomic or developmental abnormalities

Incontinence is sometimes caused by a physical or neurologic abnormality. An abnormal opening between the bladder and another structure (fistula) can cause incontinence, as can a leak in the urinary system.

Some patients lose normal bladder function because of damage to part of the nervous system due to dysfunction, trauma, disease or injury. Called neurogenic bladder, the damage can cause the bladder to be underactive, in which it is unable to contract and empty completely, or overactive, contracting too quickly or frequently.

Temporary incontinence

Temporary incontinence may be caused by:

• Severe constipation
• Infections in the urinary tract or vagina
• Certain medications, such as diuretics (water pills); sleeping pills or muscle relaxants; narcotics, such as morphine; antihistamines; antidepressants; antipsychotic drugs; or calcium channel blockers

Mayo Clinic specialists have developed effective strategies to treat each type of urinary incontinence, and are experts in determining the best treatment for each patient's needs. See Treatment Options for more details.