Introduction

Millions of people in the United States live with urinary incontinence and bladder control symptoms. This condition can limit daily activities and prevent individuals from living the life they want, as the fear of being far from a bathroom can be overwhelming. The Urology Care Foundation encourages people to talk openly about their incontinence issues with their healthcare team. Many individuals wait years before seeking treatment, thinking there are no good solutions or feeling embarrassed. This guide provides helpful information about urinary incontinence and treatment options, and we suggest speaking openly with your healthcare provider to find relief.

Becca's Story

Before receiving treatment, Becca experienced severe symptoms of Overactive Bladder (OAB), needing to use the bathroom up to 40 times a day, sometimes every 20 minutes. Her daily commute was affected, as the 25-mile bus ride to work was too long to wait without stopping. Even driving into the city meant planning for extra hours to accommodate the numerous rest stops she needed to make.

Becca’s primary care doctor referred her to a urologist, who diagnosed her with OAB. Tests revealed that her bladder was constantly signaling the urge to go, even when it wasn’t full. Although prescription drugs and lifestyle changes were suggested, they weren't enough to help Becca. After considering other options, Becca chose sacral neuromodulation (SNM), often called a “bladder pacemaker.” This device, implanted under the skin, stimulates nerves controlling the bladder to calm it down.

After her surgery, Becca was amazed at how much her symptoms improved—she could wait up to four hours between bathroom visits. Becca encourages anyone experiencing OAB symptoms to talk to their doctor about possible treatments, as the right approach can significantly improve quality of life.

What is Urinary Incontinence?

Urinary incontinence refers to the uncontrolled leakage of urine, typically caused by issues with bladder and sphincter control. It can manifest as urgency, frequency, or leaks, often affecting a person's ability to live freely. Urinary incontinence can result from both short-term conditions like urinary tract infections or constipation, and long-term issues like diabetes, stroke, or multiple sclerosis. It is important to note that urinary incontinence is not a normal part of aging.

Causes of Urinary Incontinence

Urinary incontinence is not a disease, but a symptom of various health issues. These causes can be divided into short-term and long-term health conditions:

Short-term causes:

Urinary tract infections (UTIs)
Constipation (hard, dry stool)
Certain medications (e.g., diuretics, antihistamines)

Long-term causes:

Diabetes
Stroke
Multiple sclerosis
Enlarged prostate (for men)
Childbirth or menopause (for women)

Types of Urinary Incontinence

Stress Urinary Incontinence (SUI): Caused by weak pelvic floor muscles, this type of incontinence occurs when physical activities like coughing, sneezing, or laughing put pressure on the bladder, resulting in leaks.
Overactive Bladder (OAB) / Urgency Urinary Incontinence (UUI): OAB is a condition that includes frequent urination and sudden, intense urges to urinate. If you can’t make it to the bathroom in time, this leads to urgency urinary incontinence (UUI). Common in older adults, OAB can also occur in people with conditions like diabetes or multiple sclerosis.
Overflow Urinary Incontinence: Occurs when the bladder fails to empty completely, leading to overflow leakage. It is more common in men with prostate problems but can also occur in women with certain conditions.
Mixed Urinary Incontinence: This is a combination of different types of incontinence, such as SUI and OAB. People with mixed incontinence may experience both leaks from physical stress and urgency-related leaks.

Diagnosing Urinary Incontinence

To diagnose the cause of incontinence, your healthcare provider will start by asking questions about your symptoms and medical history. Tests may include:

Urinalysis: To check for UTIs or other bladder irritants.
Physical exams: To assess pelvic floor function.
Bladder ultrasound: To check how well your bladder empties.
Urodynamic testing: For more complex cases, this test helps understand bladder function.

In some cases, additional assessments such as a cough stress test, or evaluation for pelvic organ prolapse (POP) may be necessary.

Treatment Options for Urinary Incontinence

There are various treatment options available for urinary incontinence, ranging from lifestyle changes to medications and surgical interventions.

Lifestyle Changes

Lifestyle modifications are often the first step in managing incontinence. These changes may involve adjusting your diet or daily habits. Some examples include:

Fluid control: Track your fluid intake and limit bladder irritants like caffeine and alcohol. Drinking more water (six to eight glasses per day) and reducing fluid intake before bed can also help.
Dietary adjustments: Avoid certain foods or drinks that may irritate the bladder, such as spicy foods, coffee, or colas. It’s important to notice how different foods affect your symptoms.
Bladder training: Keep a bladder diary to track fluid intake and urination habits. A regular schedule for urination can help reduce leaks and improve bladder control.

Pelvic Floor Exercises (Kegels)

Kegel exercises help strengthen the pelvic floor muscles, which support the bladder and urethra. These exercises can be effective for both SUI (by strengthening muscles) and OAB/UUI (by suppressing the urge to urinate). Consistent practice is necessary to see results.

Medications for Incontinence

If lifestyle changes don’t provide enough relief, medications may be prescribed:

Anticholinergics (e.g., oxybutynin, tolterodine): These drugs help relax the bladder muscles and are commonly used to treat OAB/UUI. However, they may cause side effects like dry mouth, constipation, and blurred vision.
Mirabegron: An alternative medication for OAB that doesn’t cause the side effects associated with anticholinergics but can raise blood pressure.
Hormonal treatments: For women, estrogen therapy (local vaginal or urethral estrogen) may help ease symptoms of incontinence, particularly after menopause.

Surgical Treatments for Stress Urinary Incontinence (SUI)

Surgical options are available for more severe cases of SUI. These procedures aim to support the bladder and improve urine control:

Sling Procedures:

Female Sling: A soft mesh sling is placed under the urethra to provide support during physical stress (coughing, sneezing, lifting). This outpatient procedure has a quick recovery time.
Male Sling: Similar to the female sling, this surgery places a mesh tape under the male urethra to support it and prevent leaks.

Bladder Neck Suspension (Burch Colposuspension): A more invasive surgery that lifts the bladder neck towards the pubic bone. This procedure involves a larger incision and a longer recovery time but can be performed laparoscopically for a quicker recovery.
Bulking Agents: Injections are used to "bulk up" the tissues around the urethra, helping it close properly to prevent leaks. This method is effective for females but is not FDA-approved for use in men.

Artificial Urinary Sphincter (AUS)

An artificial urinary sphincter (AUS) may be an option for both men and women, though it is the most common treatment for men with Stress Urinary Incontinence (SUI). While this device can help some women, it is rarely needed for them due to other available surgical options.

The AUS consists of three parts:

The Cuff: A fluid-filled cuff placed around the urethra to control urine flow.
The Balloon: A fluid-filled, pressure-sensing balloon that connects to the cuff and regulates its pressure. This balloon is placed in the lower abdomen.
The Pump: Placed in the scrotum for men (or labia for women), the pump transfers fluid between the cuff and the balloon, opening and closing the cuff. The pump is controlled by the patient.

At rest, the AUS cuff stays closed (full of fluid) to prevent leaks. When the patient decides to empty their bladder, they activate the pump to move fluid from the cuff to the balloon. This opens the urethra, allowing urine to flow and empty the bladder.

This option may not be suitable for individuals who have had radiation, scar tissue in the urethra, or other bladder problems.

Overactive Bladder (OAB) Treatments

If lifestyle changes and medications do not manage OAB symptoms, other treatment options may be considered. A trained urologist or urogynecology and reconstructive pelvic surgery (URPS) specialist can assist in exploring further treatments.

Bladder Botox® Treatment

Botox® (onabotulinumtoxin) can help relax the bladder wall muscle, reducing urinary urgency and urge incontinence. The effects last about six to nine months, so repeat treatments are needed as OAB symptoms return. The procedure involves using a cystoscope to inject small amounts of Botox® into the bladder wall. This is usually done in the office with local anesthesia.

Some individuals may have difficulty emptying their bladder immediately after treatment and may need a catheter temporarily until bladder function improves.

Nerve Stimulation

Nerve stimulation, or neuromodulation therapy, sends electrical pulses to nerves that control the bladder. In OAB, the nerve signals between the bladder and the brain may be disrupted, and electrical pulses can help improve this communication.

There are two main types of nerve stimulation:

Percutaneous Tibial Nerve Stimulation (PTNS): This involves placing a small needle electrode near the ankle to send stimulation pulses to the pelvic nerves. PTNS sessions last about 30 minutes, typically performed weekly for 12 treatments, followed by ongoing monthly sessions.
Implantable Tibial Nerve Stimulator: Similar to PTNS, but with a small device implanted in the ankle to allow at-home stimulation instead of office visits.
Sacral Nerve Stimulation (SNS): This method involves stimulating the pelvic nerve root near the spinal cord to improve bladder function. It is a two-step process. First, a small wire is temporarily placed near the sacral nerves and connected to an external pacemaker for testing. If it provides relief, a permanent pacemaker is implanted to continuously regulate pelvic nerve activity and control OAB symptoms.

Bladder Reconstruction / Urinary Diversion Surgery

These major abdominal surgeries are used in rare and complicated cases of OAB. The main types of surgery are:

Augmentation Cystoplasty: A procedure that makes the bladder larger to increase its capacity.
Urinary Diversion: A surgery that reroutes urine away from the bladder, often requiring a stoma and an external appliance to collect urine.

Due to the risks involved in these surgeries, they are only recommended when other treatments are ineffective. To prevent setbacks after surgery, it's important to:

Maintain a healthy weight
Practice Kegel exercises
Avoid bladder-irritating foods and drinks
Eat more fiber and drink plenty of fluids to prevent constipation
Avoid smoking

Overflow Urinary Incontinence Treatments

Overflow urinary incontinence occurs when the bladder cannot empty fully, leading to dribbling as pressure builds up. This often requires procedural or surgical intervention to address blockages in the bladder neck or urethra. Common issues in men, such as benign prostatic hyperplasia (BPH) or urethral strictures, can lead to this condition. Speak with your healthcare provider to determine the best treatment for you.

Products and Devices to Help with Incontinence

For some individuals, incontinence products and devices can help manage bladder issues. These include:

Indwelling Catheters: Catheters that stay in place day and night, connected to a drainage bag.
Intermittent Catheters: Used multiple times each day.
External Collecting Systems: Condoms for men and funnel pouches for women.
Absorbent Products: Pads, adult diapers, or tampons.
Pessaries: For women, especially those with SUI.
Toilet Substitutes: Portable commodes.

There are many options available to help manage incontinence. It is important to consult a healthcare provider who specializes in bladder and incontinence issues, such as a urologist, to find the right solution for you.

Preventing Future Problems

Managing or treating urinary symptoms can significantly improve your quality of life, allowing you to engage in activities without being bothered by incontinence or leakage. The first steps typically involve lifestyle and dietary changes, which should be maintained consistently for ongoing benefits. Some recommendations include:

Keep a healthy weight
Drink about two liters of fluid daily, spread throughout the day, to stay hydrated
Avoid foods and drinks known to irritate the bladder
Eat more fiber to prevent constipation
Practice Kegel exercises to strengthen the pelvic floor
Follow bladder re-training programs

After making lifestyle changes, many people see improvement. If symptoms persist, medications or surgical options may be appropriate next steps. Working closely with your healthcare team is essential to finding the best treatment plan for you.

Questions to Ask Your Health Care Team

When discussing your urinary symptoms with your healthcare team, consider asking the following questions:

What type of incontinence do I have?
What tests will tell us the type and severity of my incontinence?
Can you help me, or should I see another doctor?
If another doctor is needed, how can I find the right one?
What do you think is causing my incontinence?
Should I keep a bladder diary?
Without treatment, what will happen to me?
Will diet and lifestyle changes help my condition?
Should I try Kegel exercises? How do I perform them correctly?
What other treatments do you suggest, and why?
Are there potential risks or side effects from treatment?
If my incontinence is linked to menopause, could hormone replacement therapy (HRT) help?
Do you recommend surgery? What are the pros and cons?
What does the healing process look like after surgery?
If I continue to have problems, what other options are available?
What follow-up care do I need?
What is my long-term care plan?

GLOSSARY

Abdomen
Also known as the belly. The part of the body that holds all internal structures between the chest and the pelvis.

Anticholinergic Drugs
One type of medication used to treat OAB. It relaxes the bladder muscle to stop it from contracting (or squeezing) when it is not full. Common side effects are dry mouth, constipation, blurred vision, and dementia.

Artificial Urinary Sphincter (AUS)
Surgical device used to treat urinary incontinence. It has three parts that are implanted surgically: a pump, a balloon, and a cuff that surrounds the urethra. It prevents urine from leaking out.

Augmentation Cystoplasty
This is a major abdominal surgery performed to make the bladder larger so that it will hold more urine at any given time.

Benign Prostatic Hyperplasia (BPH)
BPH is a benign (non-cancerous) enlargement of the prostate. It is not linked to nor caused by cancer. BPH can cause problems going to the bathroom because, as the prostate grows, it puts pressure on the urethra, narrowing the urethral channel and making it harder to void.

Bladder
The hollow, balloon-shaped organ where urine is stored in the body. The “holding tank” for urine. When it is full, it sends a signal to the brain that it is time to void.

Bladder Diary
The most useful bladder diary is done for three days. During this time, you write down what and how much you drink, as well as when you go to the bathroom. In some cases, you might even be asked to measure the amount of urine you void with each trip to the bathroom. Tracking if or when you leak urine and any other related feelings or activities will help to better see what happens with your symptoms on a day-to-day basis.

Bladder Neck
The area of thick muscle where the bladder joins the urethra. The bladder neck muscles react to signals from the brain to contract and hold urine in, or to relax and allow urine out. Based on your bladder problem, bladder training techniques can be used to help “retrain” your bladder to follow a more normal daily voiding plan. Such programs are mixed with other pelvic floor exercises (Kegels), proper hydration, diet changes, and other lifestyle changes. Some people feel better quickly; others may need longer to build the changes into their day-to-day life.

Catheter
A thin tube, put in through the urethra and into the bladder, to drain urine from the bladder.

Constipation
When feces (stool) are hard and dry and hard to push out. Regular dietary fiber is most helpful in keeping from being constipated. Chronic straining (pushing hard) during bowel movements can lead to many other bladder and pelvic problems and should be avoided.

Cystoscope
A thin tube with an attached light and camera used to look at the inside of the bladder.

Double Voiding
This technique can be helpful for those who really have a hard time getting their bladder empty or have the steady feeling or nagging urge to void after they have just voided. After passing urine, wait a few seconds to a minute and then relax and try again to empty the last bits of urine from your bladder.

Hernia
When part of the intestine in the abdomen or groin bulges through the weakened wall of the abdomen. The lump is often clearly seen and felt. When in the vagina, the weakened vaginal wall and its supporting ligaments causes the bladder, rectum, and/or uterus to bulge out the vaginal opening. This is known as pelvic organ prolapse (POP), a type of hernia in the vagina.

Implantable Tibial Nerve Stimulator
A small device implanted into the ankle so that stimulation can be done at home instead of a doctor's office.

Kegel Exercises
Exercises used to control the muscles of the pelvic floor. Kegel exercises can be used to make these muscles strong, helping against SUI, but are also used with other pelvic exercise programs to help the bladder to calm down, such as in the case for OAB/UUI.

Kidneys
Two large bean-shaped structures found in the upper back (one on each side) that remove certain waste products from the blood, which then get removed from the body in the urine.

Menopause
The time in a woman’s life when menstrual periods permanently stop. This is due to age-related changes in hormones produced by the ovaries – estrogen, progesterone, and testosterone. Many changes take place in a woman’s body when these hormones are no longer being produced, such as changes in the vagina, genitals, bladder, and even bowel. Some of these changes can be helped with hormone replacement therapy. Ask your health care team if and what type of hormone replacement therapy might be right for you.

Multiple Sclerosis
A disease that affects the brain and spinal cord and slows down or blocks neurological messages between the brain and the body needed for normal bodily functions.

Overactive Bladder (OAB)
A condition that causes strong sudden urges to pass urine that are hard to ignore. The urge may be so strong as to cause uncontrollable leaking of urine (UUI). Other common symptoms include frequent bothersome trips to the bathroom and/or getting up more than once at night to pass urine.

Pelvis
Bones and muscles that connect the legs to the abdomen and help support the internal organs.

Pelvic Floor Muscles
These muscles serve as the support, or the floor, of the pelvis, and hold the pelvic organs (bladder, uterus, and rectum) in place. When you squeeze to keep yourself from passing urine or from passing gas, you are squeezing the pelvic floor muscles. This is also called a “Kegel” exercise.

Pelvic Organ Prolapse (POP)
A condition where the pelvic muscles and tissue become weak, allowing the bladder and/or rectum to drop and bulge into the vagina. In severe cases, the prolapsed bladder can appear at or even through the opening of the vagina.

Percutaneous Tibial Nerve Stimulation (PTNS)
A treatment for OAB in which a tiny needle electrode (like an acupuncture needle) gives electrical pulses to the tibial nerve near the ankle, up the leg, and to the pelvic nerves that regulate the bladder. This electrical stimulation helps to modulate the information to the bladder to get it to calm down.

Pessaries
A firm yet flexible supportive device placed in the vagina (much like a diaphragm) to help treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pessaries are available in many shapes and sizes to fit the needs of the patient. Proper pessary fitting is needed for success.

Prostate
This walnut-shaped gland in men surrounds the urethra at the bladder neck. The prostate makes fluid for semen.

Sacral Nerve Stimulation (SNS)
A treatment for OAB in which a device – like a pacemaker – is implanted under the skin and gives electrical pulses to the sacral nerves that modulate the function of the bladder. It can help signal between the spinal cord and the bladder to get the bladder to calm down.

Scheduled/Timed Voiding
Instead of going when you first feel the urge, you try to hold it and pass urine at set times. This can lengthen the amount of time you can hold your urine. In some cases, your provider may ask you to try to go to the bathroom - even if you do not feel the need - to try to empty your bladder at regular times.

Scrotum
The “sac” of skin that hangs below the penis holding the testicles.

Sling Procedure
A surgery that places a strip of fascial tissue or soft mesh (a “sling”) under the urethra to support it during activity. This helps close the urethra during activity to stop stress-related leaking, or stress urinary incontinence (SUI).

Sphincter Muscle
A muscle at the junction between the top of the urethra and the bottom of the bladder. When contracted, it closes tightly around the urethra to keep urine in the bladder. It only opens when your brain says you are ready to use a toilet. Then it relaxes, opens the urethral sphincter and the urethra, and lets urine drain out of the bladder.

Stress Urinary Incontinence (SUI)
An uncontrollable loss of urine caused by physical stress on the pelvic area, such as with sneezing, coughing, laughing, or exercising.

Urethra
A thin tube that carries urine from the bladder out of the body. In men, this tube runs through the penis and also carries semen.

Urinalysis
A urinalysis is a test of your urine. First, you pass urine into a sterile cup. A mid-stream sample is always best. The sample is then sent to a lab to look for infection, blood, proteins, and other signs of a problem.

Urinary Diversion
A major abdominal surgery done to re-route (divert) the normal flow of urine away from the bladder and out of the body, most often through a stoma (hole) in the abdominal wall. Urine is then gathered in an external pouch that needs to be drained when full. Urinary diversion is done when the bladder or urethra no longer function.

Urinary Incontinence
Uncontrollable leakage of urine.

Urinary Tract
This is the body’s system for clearing some waste and extra fluid from the body. The organs in the urinary system include the kidneys, ureters, bladder, and urethra. All parts of the urinary tract must work well together for normal urination.

Urinary Tract Infection (UTI)
An infection of the urine caused by an overgrowth of bacteria, viruses, or fungus (i.e., yeast) growing in the urinary tract.

Urine
A liquid, often yellow in color, made by the kidneys that contains waste and water.

Urodynamic Test
A “stress test” for the bladder that helps to see how well the bladder works. It is used to record bladder feelings during filling, how much the bladder can hold, urine leakage, bladder contractions or “spasms” and the ability to empty the bladder.

Urologist
A surgeon who specializes in the diagnosis and treatment of problems linked to the urinary tract and nearby pelvic structures.

BLADDER CONTROL

Bladder Diary Assessment Tool
How to Use a Bladder Diary

Wake up.
Begin writing in your diary when you wake up each day. Take notes throughout the day, and continue until you complete 24 hours. For example, if you wake up at 6 a.m. on the first day of your diary, take notes until 6 a.m. the next day.
Note your drinks.
Write down what you drink (e.g., water, juice, coffee, wine) and how much. It is helpful to measure the amount. If you are unable to measure your drinks, then it is valuable to take a good guess about the number of ounces every time you drink something. Most containers will list the number of ounces they contain. Use these listings to help you make an estimate—for example, an 8 oz. cup of juice, 12 oz. can of soda, or 20 oz. bottle of water.
Measure urine.
During both the day and night, write down when and how much urine you pass. Doctors often provide a special collection device to use. It sits under your toilet seat and is marked with measurements to let you know how much urine you pass.
If you are keeping the diary on your own before visiting a health care professional, you may want to collect your urine in a cup from home, such as a kitchen measuring cup. You could also choose a cup that you know holds a certain amount of liquid, such as 8 ounces.
Rinse the collection device with water after each use. Keep the device close to your toilet until you have finished your bladder diary.
Three days.
It is best to keep a diary for at least three days. A one-day diary may not provide enough information to give a true picture of your bladder control. Also, the three days you keep your diary do not have to be three days in a row. Any three days you choose will be fine, as long as they represent three “typical days” for you.
Start tracking.
Get started by using the attached bladder diary to begin tracking! Print as many pages as you need to complete the three days. Also, don’t forget to bring your completed diary with you to your first office visit.

About the Urology Care Foundation

The Urology Care Foundation is the world’s leading urologic foundation and the official foundation of the American Urological Association. We provide information for those actively managing their urologic health and those ready to make health changes. Our information is based on the American Urological Association resources and is reviewed by medical experts.
To learn more, visit the Urology Care Foundation’s website: UrologyHealth.org

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Incontinence patient guide