Bladder Control Issues

What are bladder control issues?

Bladder control issues (urinary incontinence) cause you to lose control of your bladder. The issues cause you to urinate (pee) or leak uncontrollably.

Your kidneys remove waste from your blood and make pee so your body can get rid of the waste. Pee travels through tubes of muscle called ureters (yer-it-ters) to your bladder.

Your bladder is a round, hollow organ in your pelvic area that holds your pee. It’s below your kidneys and behind your pelvis bone. It’s about the size of a grapefruit, and it expands as it fills with pee and shrinks when you go to the bathroom.

When you have to pee, muscles in the walls of your bladder contract (tighten), and a sphincter muscle that keeps pee inside your bladder relaxes. This allows pee to flow out of your bladder through a tube called a urethra (yer-ree-thruh) and eventually exit your body.

Bladder control problems happen when your bladder muscles contract more than usual or don’t contract at the same time. If your bladder muscles contract with excessive strength, they can over overpower your sphincter muscles. This results in pee exiting from the bladder, into your urethra and out of your body uncontrollably.

What are the different types of bladder control issues?

There are different types of bladder control issues, including:

• Stress incontinence. Sudden stress (pressure) on your bladder causes stress incontinence. Common causes include coughing, sneezing, laughing, lifting and physical activity. Younger and middle-aged women and people assigned female at birth (AFAB) near or experiencing menopause are most likely to have stress incontinence.
• Urge incontinence. Urge incontinence occurs when you have an urge to pee but can’t make it to the bathroom in time. Urge incontinence commonly affects people with diabetes, stroke, multiple sclerosis, Alzheimer’s disease and Parkinson disease.
• Overflow incontinence. Overflow incontinence occurs when your bladder is full, and you can’t empty it completely. As a result, pee may constantly dribble because you have a full bladder but you can’t sense the need to use the bathroom. An enlarged prostate that blocks your urethra or a spinal cord injury may prevent you from being able to empty your bladder when you pee.
• Functional incontinence. Conditions that prevent you from reaching the bathroom in time cause functional incontinence. Arthritis, injuries, neurological conditions, dementia and medications that cause grogginess (sedatives) may prevent you from moving quickly enough to the bathroom or communicating to others that you have to go to the bathroom.

Who do bladder control issues affect?

Bladder control issues can affect anyone. However, you may be more likely to have bladder control issues if you:

• Are a woman or a person AFAB.
• Are over 50 years of age.
• Have obesity.
• Have a family history of bladder control issues.

How common are bladder control issues?

Bladder control issues are twice as common in women and people AFAB because pregnancy, childbirth and menopause can affect your pelvic muscle strength.

As your body changes throughout pregnancy to accommodate a growing baby, pressure may build on your bladder. This bladder pressure is normal for many during pregnancy.

Bladder control issues affect approximately 30% of women and people AFAB over 50 and approximately 15% of men and people assigned male at birth (AMAB) over 50.

How do bladder control issues affect the body?

Millions of people have bladder control issues, but many feel embarrassed or ashamed to talk about them. They can make you worry about how others look at you, which may affect how you think about yourself and your behavior. If bladder control issues cause you stress, anxiety or depression, see your healthcare provider right away.

What are the signs that something is wrong with your bladder?

Common signs of bladder control issues include:

• Peeing more than you typically would. Most people pee on average seven times a day, but it may be as low as four or as high as 10 depending on how much you drink and if you drink fluids that make you pee more (natural diuretics).
• Accidentally peeing or leaking pee during common activities. Common activities may include sneezing, coughing, exercise and sex.
• Leaking urine without feeling like you have to go. Your body might not tell you that you have to pee.
• Not being able to hold your pee. Your body might suddenly tell you that you have to pee, but you can’t hold it in.
• Wetting your bed. Your body may not wake you up in the middle of the night to pee.
• Spinal cord damage symptoms. Symptoms may include feelings of weakness in your legs and numbness or lack of sensation in your genital area.
• Pressure or muscle spasms in your pelvic area. Pressure and an uncomfortable tightening of muscles around your bladder can make you suddenly have to pee.

What causes poor bladder control?

Changes to your health, certain health conditions and your lifestyle may cause poor bladder control. These may include:

Changes to your health

Changes to your health that may cause bladder control issues may include:

• Aging.
• Constipation.
• Diabetes.
• Obstructed urinary tract, usually from a kidney stone, ureteral stone, enlarged prostate or scar tissue.
• Overweight.
• Urinary tract infection (UTI).

Health conditions

Certain health conditions may damage the muscles in your bladder or the nerves in your body that tell the muscles in your bladder to tighten or release. These health conditions may include:

• Alzheimer’s.
• Multiple sclerosis.
• Parkinson disease.
• Pregnancy and childbirth.
• Prostate surgery.
• Spinal cord damage.
• Stroke.

Lifestyle aspects

Certain foods, drinks and medications that may cause bladder control issues include:

• Alcohol.
• Artificial sugar substitutes.
• Blood pressure medications.
• Caffeine (coffee, tea and energy drinks).
• Sedatives.
• Soda pop and carbonated beverages.
• Spicy foods.
• Large doses of vitamin C.
• Smoking and a physically inactive lifestyle in which you don’t move around much can also cause bladder control issues.

How are bladder control issues diagnosed?

Your healthcare provider will ask about your symptoms. Questions may include:

• Approximately how much do you accidentally pee?
• How much pee makes it in the toilet versus on your clothes?
• Do you have bladder control issues during certain times of the day?
• Do specific movements or actions cause bladder control issues, like sneezing or exercising?
• Do you have any pain or discomfort when you pee?
• Does the urge to pee come on suddenly?
• How often do you pee during the day?
• When you go to the bathroom, is it difficult to start peeing?
• How strong is your pee stream?
• Does your bladder feel completely empty after peeing?

They may also ask you about conditions or medications that may cause bladder control issues. Questions may include:

• Do you have a neurological condition, kidney or ureter stones or a prostate condition?
• Are you currently taking any medications?
• What medications are you taking?
• Are you taking any herbal or vitamin supplements?
• Have you ever been pregnant and had a vaginal delivery?
• Have you ever had surgery on your abdomen or around your pelvis?
• Have you ever had prostate surgery?

Your healthcare provider will also perform a physical exam. They’ll check for spinal cord damage symptoms, including weakness and a lack of sensation in your legs and genital area.

Your healthcare provider may recommend a rectal exam to check for constipation that may cause bladder control issues. In men and people AMAB, your healthcare provider may also check your prostate.

For women and people AFAB, your healthcare provider may conduct a pelvic exam to check for vaginal atrophy.

What tests will be done to diagnose bladder control issues?

To confirm their diagnosis, your healthcare provider may order the following tests:

• Urinalysis. A urinalysis can screen for liver disease, kidney disease and diabetes. It can also diagnose UTIs.
• Kidney function tests. Kidney function tests are urine or blood tests that evaluate how well your kidneys are working.
• Post-void residual (PVR) urine test. This test measures the amount of pee that stays in your bladder after you’ve gone to the bathroom.
• Urine culture. A urine culture checks your pee for germs that cause UTIs.
• Urodynamic testing. Urodynamic testing measures your nerve function, muscle function, pee stream strength and pressure around and in your bladder.
• Bladder diary. A bladder diary tracks how much fluid you drink, how much you pee, how long it takes you to pee and how often you pee.

How do you fix bladder control issues?

Nonsurgical treatments are the first choice for fixing bladder control issues. These treatments may include:

• Bladder control devices that reposition your urethra to reduce leakage.
• Bladder retraining (going to the bathroom at set times).
• Biofeedback to help you learn to regulate your muscles.
• Cutting back on drinking alcohol and caffeine.
• Electrical stimulation of the nerves that regulate your bladder function.
• Kegel exercises (pelvic floor exercises).
• Physical therapy and exercise.
• Weight loss.

If your bladder control issue doesn’t respond to nonsurgical treatments, your healthcare provider may recommend surgery. Bladder control surgeries may include:

• Surgical mesh.
• Sling procedures.
• Injections that increase the size of your urethral lining (urethral bulking agents).
• Botulism toxin (Botox®) injections in your bladder muscle.
• Nerve stimulation devices.
• Artificial urinary sphincter.

What is the best medicine for bladder control?

If medicine is right for you, your healthcare provider will prescribe bladder control medication based on the type of issue you have.

If you have urge incontinence, your healthcare provider may prescribe:

• Oxybutynin (Oxytrol®).
• Tolterodine (Detrol®).
• Darifenacin (Enablex®).
• Solifenacin (VESIcare®).
• Trospium (Sanctura®).

If you have stress incontinence, your healthcare provider may prescribe:

• Imipramine (Tofranil®).
• Pseudoephedrine (Sudafed®).

If you have overflow incontinence, your healthcare provider may prescribe:

• Bethanechol (Duvoid®).
• Terazosin (Hytrin®).
• Alfuzosin (Uroxatral®).
• Finasteride (Proscar®).

How can I reduce my risk of developing bladder control issues?

You may not be able to prevent bladder control issues, but you can help reduce your risk by:

• Strengthening your pelvic floor with bladder control exercises.
• Cutting back on alcohol, caffeinated drinks, spicy foods and artificial sugar substitutes.
• Avoiding significant weight changes.
• Adding more fiber to your diet.
• Cutting back or quitting smoking.
• Being more physically active.

What can I expect if I have bladder control issues?

For many people, treatment can manage or cure bladder control issues.

Sometimes bladder control issues only last a short amount of time, and they go away once you address the cause. This is true for causes including UTIs and pregnancy.

If you have a long-lasting (chronic) condition, such as diabetes or multiple sclerosis, you may have bladder control issues for a long time. In these cases, it’s important to talk to your healthcare provider about the best ways to manage your issues.

How do I take care of myself?

Many people wear bladder control underwear (incontinence underwear or adult diapers) or pads to absorb their leaks. Bladder supports that work similarly to tampons are also popular and safe. These bladder control products are comfortable and easily fit under your pants. Some adult diapers and pads are disposable, while others are washable and reusable. It’s a good idea to change your adult diapers or pads every few hours to prevent bad odors and skin conditions.

When should I see my healthcare provider?

Short-term loss of bladder control may result from UTIs, constipation, your diet or some medications. Contact your healthcare provider if your bladder control issues last longer than a week.

What questions should I ask my healthcare provider?

• What type of bladder control issue do I have?
• What’s causing my bladder control issue?
• Will my bladder control issue go away on its own?
• Will my bladder control issue come back?
• What treatment options do you recommend?

Why can’t I hold my pee when I see a toilet?

You may get a sudden urge to pee when you see a toilet or even hear running water. These urges are a symptom of urge incontinence. Urge incontinence is a common side effect in people who have nerve damage — your brain tells the nerves in your bladder to relax, even though you’re not ready to pee.

A note from Cleveland Clinic

Bladder control issues can be embarrassing and inconvenient. You may even stop doing your normal activities because you’re afraid of an inopportune urge to go or leak when you’re too far from a bathroom. However, it’s OK to ask your healthcare provider for help. You can manage or even stop most bladder control issues. Together, you and your healthcare provider can identify your type of bladder control issue, its cause and the most effective treatment.