Bladder Control Problems (Urinary Incontinence)Return to Overview Page
Definition & Facts
In this section:
- What are bladder control problems?
- Do bladder control problems have another name?
- What are the types of bladder control problems?
- How common are bladder control problems?
- Who is more likely to develop bladder control problems?
- What are the complications of bladder control problems?
What are bladder control problems?
Bladder control problems are conditions that affect the way a person holds or releases urine. Accidental loss or leaking of urine, called urinary incontinence (UI), is one of the most common bladder control problems. UI is not a disease, but a condition that may be related to another health problem or a life event, such as pregnancy in women or prostate problems in men.
Bladder control problems can be a small annoyance or can greatly affect a person’s quality of life. A person may be too embarrassed or afraid to participate in activities or may be unable to complete his or her normal routine. For example, a person may lose urine while running or coughing. Or, it may be hard to get to a toilet in time.
Bladder control problems are common, and a person’s life may get better with proper treatment. Talk with a health care professional about urine leaks. A doctor can help treat the problem or manage symptoms, including urine odor. Caregivers may find help from a health care professional or a support group. Gynecologists, urologists, and geriatricians—doctors who specialize in the health and care of older adults—often talk to people about bladder control problems. The sooner you get help, the sooner UI may improve.
Do bladder control problems have another name?
Urinary incontinence (UI), urine leakage, and urine loss are other names for a bladder control problem that causes urine to leak. Health care professionals may use the term LUTS, which stands for lower urinary tract symptoms, when speaking about other symptoms you may have with UI.
What are the types of bladder control problems?
The type of UI you have depends partly on the symptoms. The most common bladder control problems include
Stress incontinence occurs when movement—coughing, sneezing, laughing, or physical activity—puts pressure on the bladder and causes urine to leak.
Urgency incontinence occurs when someone has a strong urge, or need, to urinate and leaks before getting to a toilet. Health care professionals often refer to urgency incontinence as overactive bladder, which can happen when certain nerves and bladder muscles aren’t working together.
Sometimes a person can have urgency and stress incontinence at the same time, which is also called mixed incontinence.
Leaking urine without a warning or urge may be reflex incontinence. It often can happen when a person’s bladder nerves are damaged and don’t “talk” to the brain correctly. During reflex incontinence, the bladder can contract, or reflex, at the wrong time, causing urine to leak. Nerve damage from health conditions such as multiple sclerosis, or from trauma such as a spinal cord injury, are among the causes of reflex incontinence. Sometimes it’s also called “unaware” or “unconscious” incontinence.
Overflow incontinence occurs when the bladder doesn’t empty all the way, causing too much urine to stay in the bladder. With overflow incontinence, urine leaks because the bladder becomes too full.
Functional incontinence occurs when a physical disability or barrier, or a problem speaking or thinking, keeps someone from reaching the toilet in time. For example, a person in a wheelchair may not be able to get to a toilet in time, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer’s disease may not realize they need to plan to use the toilet.
Temporary, or transient, incontinence lasts a short time due to a passing situation, such as using a certain medicine or having an illness that causes leaking, such as a bad cough from a cold.
Bedwetting, also called nocturnal enuresis, doesn’t only occur in children. Some adults leak during their sleep for a variety of reasons. Certain medicines or drinking caffeine or alcohol at night can make it hard to sleep through the night without leaking urine. In some cases, the bladder can’t hold enough urine overnight. Lifestyle changes often can improve these symptoms.
Some people wet the bed because they don’t produce enough of a certain hormone at night, which could be a sign of diabetes insipidus. Other health problems, such as urinary tract infection, kidney stones, prostate enlargement, or obstructive sleep apnea can cause an adult to wet the bed or urinate frequently at night.
How common are bladder control problems?
Bladder control problems are common. Almost half of all women leak urine at some point in their lives.1 Women are more likely to develop UI during and after pregnancy, childbirth, and menopause. These events, and how the female urinary tract is built, make UI more common in women than men. Still, don’t accept UI as a routine part of being a woman or getting older.
As many as 1 in 3 older men may lose urine by accident.1 A man is more likely to develop UI with age because prostate problems occur more often with age.
Who is more likely to develop bladder control problems?
Factors that make you more likely to develop UI include
- being female.
- being older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
- life events, such as pregnancy, childbirth, and menopause in women and prostate problems in men.
- health problems, such as diabetes, obesity, or long-lasting constipation.
- birth defects. You may have a problem with the structure of your urinary tract.
Your doctor can help find the cause of a bladder control problem and let you know your options for treatment.
You are more likely to have a particular type of UI if a family member has had it, too. For example, bedwetting often runs in families, and children may outgrow it at about the same age their parents did.
What are the complications of bladder control problems?
Leaking urine may cause a person to slow down or stop being physically active. For example, running, jumping, or brisk walking may make UI worse if someone has stress incontinence. Or, perhaps a woman feels that disposable pads or briefs are uncomfortable to move in, so being active may be less fun.
Staying active is important for a person’s overall health and may prevent further bladder control problems. UI may become worse for someone who is not physically active. Physical inactivity can lead to weight gain. People who are overweight or have obesity are more likely to have bladder problems. Getting active may lead to better bladder health.
Let a health care professional know if your bladder control problems are making it difficult for you to be active.
Untreated bladder problems can bring upsetting lifestyle changes. A person may avoid activities he or she once enjoyed. People might stop going to movies, meetings, or religious services because they don’t want to use the restroom in the middle of an activity or have an accident. These changes can lead to depression or social anxiety.
Bladder control problems sometimes cause people to avoid intimacy, because they are worried they may leak urine during sex. Talk with a health care professional if your bladder control problems are getting in the way of your sex life. Gynecologists and urologists regularly talk with people about health problems that interfere with sex. A healthy sex life is part of a healthy life.
Related bladder symptoms and problems
If you have UI, you are more likely to have other bladder symptoms or problems, such as
- urinary frequency
- getting up from sleep to urinate, called nocturia
- difficulty urinating
- trouble emptying your bladder fully, also called urinary retention
- dribbling urine after you think you’ve finished
Working with a health care professional to prevent and treat these related symptoms and problems is important for the health of your bladder and your overall health.
Symptoms & Causes
In this section:
- What are the symptoms of bladder control problems?
- When should I see a health care professional?
- What causes bladder control problems in women?
- What causes bladder control problems in men?
- What else causes bladder control problems in women and men?
What are the symptoms of bladder control problems?
Signs and symptoms of urinary incontinence can include
- leaking urine during everyday activities, such as lifting, bending, coughing, or exercising
- feeling a sudden, strong urge to urinate right away
- leaking urine without any warning or urge
- being unable to reach a toilet in time
- wetting your bed during sleep
When should I see a health care professional?
See a health care professional if you have symptoms of a bladder problem, such as trouble urinating, a loss of bladder control, waking to use the bathroom, pelvic pain, or leaking urine.
Bladder problems can affect your quality of life and cause other health problems. Your doctor may be able to help you treat your UI by recommending a lifestyle change or a change in how much medicine you normally take.
See a health care professional if you
- can’t pass urine or empty your bladder
- urinate too often—8 or more bathroom visits a day—also called frequency
- see blood in the urine, also called hematuria
- have bladder infection symptoms, including painful urination
What causes bladder control problems in women?
- pregnancy and childbirth
- trauma or injury, such as sexual assault
- cystocele and pelvic organ prolapse
Weak pelvic floor muscles can make it hard for your bladder to keep urine in during stress incontinence. Stress incontinence occurs when some of your movements—coughing, sneezing, laughing, or physical activity—put pressure on your bladder and cause urine to leak. A weak pelvic floor can also cause fecal incontinence, or bowel control problems.
What causes bladder control problems in men?
Men sometimes develop UI along with prostate problems.
Men have a prostate gland that surrounds the opening of the bladder. The prostate gets bigger as a man ages. When the prostate gets too big but isn’t cancerous, a man has a condition called prostate enlargement, or benign prostatic hyperplasia (BPH). Men with an enlarged prostate may have
- problems with starting to urinate
- a slow urine stream
- problems fully emptying the bladder
Men who have a history of prostate cancer may have short-term or long-term UI. The cancer can damage or block the urinary tract. Or, the surgery, radiation, or other prostate cancer treatments can lead to nerve damage, bladder spasms, or stress incontinence. Bladder control problems after prostate cancer can get better over time.
What else causes bladder control problems in women and men?
Other health problems, including those with your nervous system, and lifestyle factors can cause or contribute to urinary incontinence (UI) in women and men.
Health changes and problems
Certain health changes and problems can lead to urinary incontinence
- bladder infection
- birth defects
- blocked urinary tract—from a tumor or urinary stone
- chronic, or long-lasting, coughing
- overweight or obesity
Some health problems can be short-term, like coughing or constipation, and can cause temporary incontinence. When a disability or a problem speaking or thinking keeps you from reaching a toilet in time, you have functional incontinence.
Bladder nerves and muscles can be damaged or affected by
- Alzheimer’s disease
- Parkinson’s disease
- multiple sclerosis
- certain medicines
- spinal cord injury
Triggers of urinary incontinence can include drinking or touching water, hearing running water, or being in a cold environment, such as reaching into the freezer at the grocery store.
Lifestyle factors that make women and men more likely to develop UI include
- eating habits, such as eating foods that cause constipation
- drinking habits, such as drinking alcohol or caffeinated or carbonated beverages
- certain medicines
- physical inactivity
Temporary incontinence is usually a side effect of a medicine or short-term health condition. Temporary incontinence can also be a result of eating habits, including alcohol or caffeine use.
How do doctors find the cause of a bladder control problem?
A doctor uses your medical history and a physical exam to find the cause of your bladder control problem. Your doctor also may order lab and other diagnostic tests.
Even if you feel embarrassed, it’s important that you discuss your urinary incontinence (UI) with a health care professional. The types of health care professionals who can treat you include
- a family practice physician
- a nurse or nurse practitioner
- an internist or primary care provider
- a physical therapist
- an obstetrician-gynecologist (OB/GYN)
- a gynecologist who specializes in pelvic medicine and reconstructive surgery
- a urologist
A health care professional will record your medical history and may ask about your
- symptoms, also sometimes called lower urinary tract symptoms (LUTS)
- eating and drinking habits
- bowel habits
- over-the-counter and prescription medicines
- current and past medical problems and surgeries
- pregnancy and childbirth history, if you’re a woman
- prostate problems, if you’re a man
Your doctor may diagnose the type of UI you have based on your medical history and physical exam, or may use this information to decide if you need more testing.
To prepare for the doctor’s visit, you may want to keep a bladder diary (PDF, 487.59 KB) for 2 to 3 days beforehand. Each day, be sure to include
- what, when, and how much you drink
- when you urinate and the amount you urinate
- how often you leak
- whether you feel a strong urge to go before a urine leak
- what you were doing when the leaks happened
Your doctor will perform a physical exam, including a rectal exam. A doctor will also give a woman a pelvic exam. Doctors use these exams to look for medical problems that may lead to accidental urine loss.
You may be asked to cough while your bladder is full to see if you leak urine. This is called a stress test, and doctors use it to help diagnose stress incontinence.
Which tests help find the cause of a bladder control problem?
Your doctor may order lab tests, in addition to taking your medical history and completing a physical exam.
Urinalysis. You will collect a urine sample at the doctor’s office or lab, and a health care professional will test the sample. A health care professional may culture your urine by placing part of your urine sample in a tube or dish with a substance that encourages any bacteria present to grow. The test can show if you have a bladder infection, a kidney problem, or diabetes.
Blood test. A health care professional may take a blood sample from you and send the sample to a lab to test. A blood test can show problems with kidney function or a chemical imbalance in your body.
Bladder function tests
Doctors use urinary tract imaging to diagnose other conditions that may cause LUTS.
How can I treat my bladder control problem?
Treatment depends on the type of UI you have. Your doctor may recommend you first try self-care treatments.
Make lifestyle changes
You may be able to reduce leaks by making lifestyle changes.
Drink the right amount of liquid at the right time. Ask your doctor whether you should drink less liquid during the day. However, don’t limit liquids to the point of becoming dehydrated. Your doctor can tell you how much and when to drink based on your health, activities, and local climate.
To limit nighttime trips to the bathroom, you may want to stop drinking liquids a few hours before bedtime, but only if your doctor suggests it. Limiting foods and drinks with caffeine, such as chocolate, tea, coffee, and carbonated beverages, may help to reduce leaks. You should also limit alcoholic drinks, which can increase how much urine your body makes.
The amount of urine a person should make is different for everyone, based on how much liquid you drink, how much you sweat, how much liquid you use by breathing, and the medicines you take.
Be physically active. Although you may not feel like being physically active when you have UI, regular physical activity is important for weight management and good overall health. Even something like walking can improve your health. If you’re concerned about not having a bathroom nearby during physical activity, find a place with nearby restrooms, such as a shopping mall, community park, or local gym.
Keep a healthy weight. Your chances of developing UI and other diseases, like diabetes, are higher if you’re overweight or have obesity. Losing weight can help you have fewer leaks, and avoiding weight gain may prevent UI. Studies suggest that, as your body mass index (BMI) increases, you’re more likely to leak.2 If you’re overweight or have obesity, talk with your doctor about how to lose weight.
Avoid constipation. Constipation, can make urinary tract health worse and can lead to UI. Talk with your doctor about drinking more liquids and eating enough fiber to help avoid constipation. Doctors use medicines called antimuscarinics, such as oxybutynin and tolterodine, tricyclic antidepressants, and beta-3 agonists to treat UI, but they can cause constipation.
Stop smoking. If you smoke, get help to stop smoking. Quitting smoking at any age is good for your bladder health and overall health. Smoking raises your chances of developing stress incontinence, because smoking causes chronic, or long-lasting, coughing. You might improve your UI if you’re able to stop coughing.3
Smoking also causes most cases of bladder cancer. Some people say smoking makes their bladder more irritated.
Train your bladder
Bladder training is when you urinate on a schedule to help reduce leaking. Based on a bladder diary (PDF, 487.59 KB) , your doctor may suggest using the bathroom on a regular schedule, called timed voiding. Gradually lengthening the time between trips to the bathroom can help stretch your bladder so it can hold more urine. Record your daily bathroom habits so you and your doctor can review your diary.
Do pelvic floor muscle exercises
Strong pelvic floor muscles hold in urine better than weak muscles. You can make your pelvic floor muscles stronger by doing Kegel exercises. These exercises involve tightening and relaxing the muscles that control urine flow. A review of studies showed that women who received pelvic floor muscle training were much more likely to have improvement in their leaking than those women who didn’t get training.4 You should not do pelvic floor exercises while you’re urinating.
Men can also benefit from pelvic floor muscle exercises. Strengthening these muscles may help a man leak urine less often, especially dribbling after urination.
A health care professional, such a physical therapist trained in pelvic floor therapy, can help you get the most out of your Kegel exercises by helping you improve your core muscle strength. Your core includes your torso muscles, especially the lower back, pelvic floor muscles, and abdomen. These muscles all keep your pelvis lined up with your spine, which helps with good posture and balance. Your physical therapist can show you how to do some exercises during daily activities, such as riding in a car or sitting at a desk.
You don’t need special equipment for Kegel exercises. However, you can learn how to perform Kegel exercises properly by using biofeedback. Biofeedback uses special sensors to measure muscle contractions that control urination.
Control your urge to urinate
You may be able to suppress, or control, the strong urge to urinate, called urge or urgency suppression. With this type of bladder training, you can worry less about finding a bathroom in a hurry. Some people distract themselves to take their mind off needing to urinate. Other people find that long, relaxing breaths or holding still can help. Doing pelvic floor exercises to strengthen your pelvic floor also can help control the urge to urinate. Quick, strong squeezes of the pelvic floor muscles can help suppress urgency when it occurs, which may help you get to the toilet before you leak.
How can my doctor treat my bladder control problem?
If you can’t manage your UI using self-care and new habits, your doctor may prescribe medicine, a medical device, a bulking agent, or—as a last resort—surgery to help treat UI.
For urgency incontinence your doctor may prescribe one of the following medicines in a pill, liquid, or patch to relax your bladder
- antimuscarinics, such as oxybutynin and tolterodine
- beta-3 agonists
- beta-3 adrenergic receptor stimulators
- tricyclic antidepressants
A doctor may use botulinum toxin A, or Botox, to treat urinary incontinence when other medicines or self-care treatments don’t work. Injecting Botox into the bladder relaxes it, which makes more room for urine and lowers the chances of developing UI.
For men. If you’re a man with UI, your doctor may prescribe another type of medicine, in addition to antimuscarinics, if you also have an enlarged prostate. These medicines include
Women and men with overflow incontinence may need to use a catheter to empty their bladder. A health care professional can teach you how to use a catheter. You may need to use a catheter once in a while, a few times a day, or all the time. Catheters that are used all the time drain urine from your bladder into a bag attached to your thigh with a strap. Watch for signs of a bladder infection if you use a catheter all the time.
For women. A pessary is a soft plastic ring used for stress incontinence that you or your doctor insert into your vagina. The pessary presses against the wall of your vagina and the nearby urethra. The pressure helps hold up the urethra, so you have less leaking.
Another newer product to treat stress incontinence is a tampon-like disposable device that you can insert into your vagina for up to 12 hours at a time. The product expands to push up against your urethra to help decrease leaks.
During a short office visit, a doctor can inject a bulking gel or paste near your urinary sphincter to treat stress incontinence. The injected material “bulks” or helps thicken the area around the urethra and helps close your bladder opening so you have less leaking.
Electrical nerve stimulation
If you’ve tried other ways to stay dry, including medicines and lifestyle changes, and nothing has worked, your doctor may suggest electrical nerve stimulation for urgency incontinence and other symptoms. Electrical nerve stimulation involves changing your bladder’s reflexes using pulses of electricity.
If you have overflow incontinence caused by a blockage or a narrowed urethra, a doctor can treat it with surgery to remove the blockage.
For women. A weak bladder neck or poorly supported urethra can cause stress incontinence and may be treated with some type of surgery. In sling surgery, a surgeon works through the vagina to insert a strip of material—usually mesh—in the tissue between the vagina and urethra. Mesh is a screenlike material that doctors can implant in your body to support the bladder or urethra or repair a hernia. A doctor performs the operation in a hospital or surgery center. You’ll receive general, spinal, or local anesthesia. Most women can leave the hospital the same day, though some may need to stay overnight. Full recovery takes 2 to 3 weeks.
Although sling surgeries with surgical mesh, sometimes called “mid-urethral slings,” can be successful and safe, serious complications can occur in some women. Your doctor can explain the risks and benefits of surgery for stress incontinence and what kind of results you can expect. He or she can help you decide whether surgery is right for you.
For men. Stress incontinence in men is sometimes treated with surgery. Surgery includes the artificial urinary sphincter (AUS) and the male sling procedures. A doctor performs the operations in a hospital. You’ll receive general or spinal anesthesia. Most men can leave the hospital the same day, though some may need to stay overnight. Your doctor can explain the risks and benefits of surgery for UI and what kind of results you can expect.
Minimally invasive surgeries are available for men with an enlarged prostate.
How can I cope with bladder control problems?
Even after treatment, you may still leak urine from time to time. Certain products can help you cope with leaking urine
- Pads. You can wear disposable pads in your underwear to absorb leaking urine.
- Absorbent, washable underwear. You can use underwear lined with extra fabric to absorb urine.
- Adult incontinence briefs. You can wear incontinence briefs that act like diapers to keep your clothes dry.
- Waterproof underwear. Waterproof underwear can protect your clothes from getting wet.
- Large disposable pads. You can use large disposable pads to protect chairs and beds from urine.
- External catheters. An external catheter can collect urine from a man’s body and drain it into a bag that is attached to the thigh with a strap.
- Special skin cleaners and creams. Special skin cleaners and creams may keep your skin around the urethra from becoming irritated. Creams can help block urine from your skin.
- Urine deodorizing tablets. Talk with your doctor about whether taking urine deodorizing tablets by mouth can make your urine smell less strong.
Bladder control problems are common, yet many people feel too embarrassed to talk about them. At the very least, talk with your doctor about your bladder problems. Your doctor can help you connect with a support group for people with similar problems.
Consider speaking with your family and friends about your UI. Your family and friends also may help find easier ways for you to use the bathroom regularly. In sharing your struggle, you may find that other people in your life have bladder problems as well.
How can I prevent bladder control problems?
Follow a healthy eating plan
Many people find that alcohol; spicy foods; chocolate; artificial sweeteners; caffeinated, carbonated, and citrus beverages; and high-acid foods such as citrus and tomatoes may contribute to bladder irritation and inflammation, which can sometimes lead to UI. You may want to avoid these foods and drinks for a time to see if your symptoms improve. A dietitian can help you plan meals if you’re trying to avoid certain foods that make your UI worse.
Drink enough fluids
Drink enough fluids so that you need to urinate every few hours. Learn what’s normal for you and avoid becoming dehydrated. Your urine should be pale yellow if you are drinking enough fluids. Talk with your doctor about how much fluid you should drink based on your size, activity level, and where you live. Water is best. However, if you have kidney failure or heart failure, you should not drink too much water.
Keep a healthy weight
If you’re overweight, losing weight may improve your UI, and keeping a healthy weight may prevent UI. If you’re overweight, talk with a health care professional about how to lose weight by eating healthy and being physically active. Your chances of developing UI and other conditions, like diabetes, increase if you have obesity. Reducing obesity and diabetes may lessen UI, especially in women.5
Change your bathroom habits
Go to the bathroom when you need to go. Often, people hold their urine in because it’s not a good time to go to the bathroom. However, regularly holding urine in can wear out your bladder muscles. You’re also more likely to develop a bladder infection if you hold urine in. Bladder infections can cause UI.
Women should try to relax the muscles around their bladder when they urinate to make it easier to go. It’s best to sit on the toilet seat or in a full crouching squat. Hovering over a toilet seat to avoid touching it does not allow muscles to fully relax and may result in urine being left in the bladder. Take as much time as needed to urinate and empty your whole bladder.
If you smoke, stop. Quitting smoking at any age is good for your bladder health and overall health. Smoking raises your chances of developing stress incontinence because smoking causes coughing. Smoking also causes most cases of bladder cancer. Some people say smoking makes their bladder irritation worse.
Constipation can make urinary tract health worse and can lead to UI. To prevent constipation, eat plenty of high-fiber foods such as whole grains, vegetables, and fruits; drink enough water; and be physically active. Medicines that doctors use to treat UI, such as the antimuscarinics oxybutynin and tolterodine, have side effects that include constipation.
Do pelvic floor muscle exercises
Your pelvic floor muscles help hold urine in the bladder. Pelvic floor exercises, also called Kegel exercises, can make those muscles stronger and help keep urine from leaking out when you laugh, cough, sneeze, or lift. Both men and women can benefit from pelvic floor muscle exercises.
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Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.
What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank Catherine Bradley, MD, MSCE, University of Iowa Hospitals & Clinics; Joseph A. Costa, DO, University of Florida Health, Jacksonville