What is urinary incontinence?

People with urinary incontinence have trouble controlling their bladder function and leak urine from the urethra.

The experience is of course unpleasant and affects a person’s daily life. People might feel embarrassed about their bladder control. They might plan activities around bathroom availability, nervous about having an “accident” when they’re out with friends or at work. They might try pads and other absorbent products, which can be uncomfortable and irritate the skin. And they might shy away from socializing, becoming isolated and depressed.

Fortunately, there are effective treatments for urinary incontinence.

Is urinary incontinence a normal part of aging?

Some people think urinary incontinence is just something to accept as they get older. But that’s not the case. It is possible to improve bladder control and reduce (or eliminate) leaks. Incontinence can be managed by making behavioral changes and doing exercises. There are also devices and surgical procedures that can help.

It’s worth talking to a health care professional about incontinence.

How does the urinary system work?

For most people, the urinary tract is made up of these key components:

• The kidneys are two fist-sized organs that filter blood and produce liquid waste (urine).
• The ureters are two tubes that connect the kidneys and the bladder. Urine flows from the kidneys, through the ureters, to the bladder. One ureter is connected to one kidney. Both ureters connect to the bladder on the other end.
• The bladder is a flexible, muscular “holding tank” that stores urine until it’s time to empty it (“go to bathroom”). Usually, people start feeling the urge to urinate when the bladder is about half full.
• Sphincter muscles keep the bladder closed until it’s time to urinate.
• The urethra is the tube connecting the bladder and the outside of the body. When a person urinates, urine flows from the bladder to the toilet through the urethra.
• The pelvic floor is a group of muscles that support the pelvic organs. They are sometimes described as a “hammock” that keeps these organs in place.

When the bladder needs emptying, the brain signals for urination to start. Bladder muscles contract, which opens the sphincter muscles, allowing urine to flow from the bladder, through the urethra, and out of the body. When the bladder is empty, it relaxes again and the sphincter muscles close.

If a problem interferes with this process, urinary incontinence can occur.

What are the different types of urinary incontinence?

There are five main types:

Stress urinary incontinence (SUI)

This is the most common type. SUI occurs when there is sudden pressure on the bladder that makes the sphincter muscles open for a short time. A person might leak urine when they laugh, cough, sneeze, stand up, or lift heavy objects. Some people with SUI leak just a few drops of urine. But others might leak enough to need a change of clothes.

SUI is usually caused by damage to or weakening of the pelvic floor. This can happen after pregnancy, childbirth, pelvic surgery, and prostate surgery. Nerve injuries and a chronic cough may also contribute to SUI.

Urge urinary incontinence (UUI)

UUI occurs when the bladder muscles contract at the wrong time, even if there is no urine in the bladder. People with UUI feel an intense, sudden need to urinate and will leak urine if they can’t get to the bathroom in time. UUI is sometimes called overactive bladder (OAB).

UUI can be a symptom of several urological conditions, including bladder cancer, bladder stones, inflammation, and infections. It might also happen in people with neurological conditions, like multiple sclerosis, stroke, or spinal cord injury. Men with an enlarged prostate (e.g., BPH or prostatitis) can develop UUI, too.

Sometimes, no cause is found.

Mixed incontinence

People with mixed incontinence have symptoms of both SUI and UUI.

Overflow incontinence

With this type, the bladder reaches its capacity and cannot hold any more urine. Or people may be unable to empty their bladder completely. As a result, leaks occur. Urine flow may be slow or dribbling.

Overflow incontinence can happen if there is a blockage in the urethra or if the bladder muscles are weakened. It can also happen after pelvic surgery or with the use of certain medications. Unlike other types of incontinence, overflow incontinence is more common in men.

Functional incontinence

People with functional incontinence may have trouble recognizing that their bladder is full or be unable to reach the toilet in time. For example, a person with dementia or mental illness might not be aware that it’s time to urinate. Someone who uses a walker might not be able to access the path to the bathroom. And a person with arthritis might have difficulty unfastening buttons, buckles, or zippers on their clothing.

How is urinary incontinence different for men and women?

In general, women are about twice as likely to have incontinence than men are. Pregnancy, childbirth, and menopause can weaken pelvic floor muscles that support pelvic organs, including the bladder. In addition, women have shorter urethras than men do, so there is less muscle keeping urine contained in the bladder.

The anatomical differences between men and women also affect some of the causes and treatments of urinary incontinence. For example, a man might leak urine because of an enlarged prostate; a woman may do so after childbirth. For treatment, men may receive an artificial urinary sphincter, while women may use a vaginal pessary. (Read more about these devices below.)

Doctors use a combination of methods to determine what type of incontinence a person has

How is incontinence diagnosed?

Doctors use a combination of methods to determine what type of incontinence a person has. They will also consider whether related health conditions need to be addressed.

Medical history

Doctors usually start by asking questions about general health, urinary symptoms, and the effects of incontinence on daily life. Some example questions include the following:

• What, specifically, are your symptoms?
• How much urine do you leak?
• Do you have pain, discomfort, bloating, or similar symptoms?
• How long have you been having symptoms?
• What do you eat and drink regularly? Do you find that symptoms worsen after you’ve had a particular food or beverage?
• When do you typically eat and drink?
• What medications do you take (both prescription and over the counter)? How much and how often?
• Do you take dietary supplements? If so, what are they?
• Have you ever had pelvic surgery?
• Have your symptoms interfered with your daily life? How?
• How do these symptoms make you feel? Are you depressed or anxious?
• (For women) Have you given birth to children?
• (For women) Have you gone through menopause?

Urinary habits can be awkward to discuss, but it’s best to be open and honest about symptoms. Providing as much information as possible helps doctors come up with an effective treatment plan.

Bladder diary

A bladder diary is a record of how often a person urinates, how frequently they have leaks, and what they eat and drink each day. It also notes a person’s activities (such as coughing or laughing) when leaks occur.

Physical exam

The abdomen, genitals, rectum, and pelvic floor are examined. Women may have an internal pelvic exam. Men may have their prostate gland checked.

Pad test

This assessment involves wearing an absorbent pad for a certain period of time. The goal is to find out if the body leaks urine when it moves a specific way—and if so, how much?

A pad test can be done in two different ways:

• The patient wears a pad for an hour at the doctor’s office and does some activities, like exercise. At the end of the hour, the pad is weighed to see how much urine has leaked.
• The patient is given a set of pads to use at home for 24 hours. Used pads are stored in an airtight bag and weighed by the doctor at the end of the test. With this test, doctors can see how much urine leaks during a typical day and night.

Urinalysis

A urinalysis is a urine test. The doctor will check a urine sample for substances like bacteria or white blood cells (which might suggest an infection). Urine cytology is a test that checks for cancer cells in the urine.

Urine culture

Similar to a urinalysis, a urine culture also uses a urine sample. However, part of the sample will be placed in a petri dish in a lab for a few days. Lab technicians will check for bacteria or any other growth that could indicate an infection.

Urodynamic tests

Urodynamic tests assess the quantity of urine the body makes, how much the bladder can hold, the quality of the urine stream, and the rate at which urine flows. It also checks the strength of the sphincter muscles.

Imaging tests

With imaging tests, a doctor can see inside the urinary tract. These tests might include a bladder scan, X-ray, or ultrasound.

Cystoscopy

Cystoscopy allows a doctor to see inside the bladder using a special tool called a cystoscope. After a person is given local anesthesia, the doctor threads the cystoscope up the urethra and into the bladder. A camera at the end of the cystoscope provides an interior view.

Post-void residual urine test

This test measures how much urine remains in the bladder after a person urinates.

Treatment

How is incontinence treated?

There are effective treatments for urinary incontinence

Lifestyle changes

Often, the first steps toward better bladder control are lifestyle changes. These options can work well in combination with other treatments. They are also good ways to prevent incontinence from becoming a problem in the future:

• Quit smoking.
• Reduce fluid intake, especially at bedtime.
• Avoid foods and drinks that worsen symptoms. Alcohol, caffeine, spicy foods, and acidic foods are common bladder irritants.
• Lose weight if overweight.
• Make sure blood sugar is well-controlled.
• Take diuretic medication at times when a bathroom is close by.

Bladder retraining

The bladder can be “taught” to hold urine for longer periods of time. This technique starts with a urination schedule. For example, a person might decide to urinate every hour to start. They try to hold the urine for this hour, and when the time is up, they go to the bathroom. Once their body is used to this schedule, they increase the time by 15 minutes. Then 30 minutes. Eventually, they may train their bladder to hold urine for 3 to 4 hours between bathroom visits.

This technique takes time and practice. A person shouldn’t feel discouraged if they can’t increase the time by 15 minutes. Trying a shorter time frame, such as five minutes, is a good goal, too.

Double voiding

Double voiding means urinating twice in one bathroom trip and trying to empty the bladder. This technique can be helpful for people with overflow incontinence.

Medications

There are medications available that can relax the bladder. Here are some examples:

• Anticholinergics (such as oxybutynin and tolterodine). These drugs improve the neurological connection between the brain and the bladder so messages can transmit properly.
• Beta agonists (such as mirabegron). These drugs relax bladder muscles and increase the amount of urine the bladder can store.
• Alpha blockers (such as alfuzosin and tamsulosin). An enlarged prostate can cause urinary symptoms, including incontinence, in men. Alpha blockers treat those symptoms by relaxing prostate muscle fibers and bladder neck muscles.
• Topical estrogen. The decline of estrogen at menopause can weaken the urethra and tissues around the bladder. Estrogen may strengthen these areas.

Botox injections are another possibility. Like the medications noted above, Botox injections can relax the bladder and allow it to hold more urine. Injections are delivered through a cystoscope—a hollow tube that is gently placed into the urethra. (Local anesthesia may be given.) The effects of Botox injections do wear off over time, and some people need to repeat treatment every 3 to 12 months.

Doctors may also prescribe drugs used to treat underlying conditions, such as an enlarged prostate or urinary tract infection.

Note: Currently, the FDA has not approved any medications to treat stress urinary incontinence.

Pelvic floor muscle training

At the gym, people do lunges to strengthen their hamstrings or pushups to tone their upper body. The same principle applies to the pelvic floor muscles. Exercising this area can support the muscles that control urine flow.

Sometimes, this approach is called pelvic floor physical therapy. Specialists help patients identify the correct muscles and teach specific exercises, such as Kegel exercises.

Pelvic floor muscle training might also include the following methods:

• Biofeedback. This technique, done by a specialist, uses a sensor (placed in the vagina or anus) to help patients find and control their pelvic floor muscles. When they squeeze these muscles, they can see their movements graphed on a monitor.
• Electrical stimulation. A physical therapist delivers a mild electrical current to the pelvic floor area through a probe in the vagina or anus. The current contracts bladder muscles.
• Vaginal cones. Women place a weighted cone in the vagina and squeeze the pelvic floor muscles to keep it in place. This technique can be done at home.

Percutaneous tibial nerve stimulation (PTNS)

Located at the lower end of the spine, the sacral nerves help transmit sensory messages that are important for good bladder and pelvic floor function. Percutaneous tibial nerve stimulation (PTNS) applies gentle electrical pulses to these nerves by way of the tibial nerve, which is found in the leg. To access it, a doctor places a small needle electrode in the ankle. The electrical pulses then move up the tibial nerve to the sacral nerves. There might be a tingling sensation, but the process shouldn’t hurt.

People undergoing PTNS may need several treatments before they start seeing results. Some patients have additional treatments every once in a while to maintain improvements.

Sacral nerve stimulation

This approach uses a special device that is surgically implanted in the belly. The device sends a mild electrical current to the sacral nerves, which play a role in bladder function. A person can manage the current with a hand-held controller.

Vaginal pessaries (for women)

A vaginal pessary is a flexible device that a woman inserts into her vagina. It reduces leaks by putting pressure on the vaginal wall, which helps support the bladder and urethra. Pessaries are available by prescription and over the counter. If a pessary is fitted well, it shouldn’t be uncomfortable.

A prescription pessary is custom fitted, and it’s important to follow a doctor’s directions on its care. Women might be able to remove, clean, and reinsert the pessary themselves. In other cases, they’ll have the pessary removed, cleaned, and replaced at the doctor’s office.

A doctor will also advise on how long to wear the pessary at one time. Often, women wear their pessary during the day and remove it at night. Wearing it for too long might lead to irritation. Pessaries might be removed before intercourse as well.

Over-the-counter pessaries are disposable, intended for just one use. Inserted with an applicator, they can be used for up to 8 hours and removed by pulling a string that’s attached.

Penile clamp/clip (for men)

Men with incontinence may choose to try a penile clamp or clip. These devices are worn on the penis and reduce urine leaks by placing pressure on the urethra.

The clamp is worn only during the day, not during sleep. It also needs to be removed every 1 to 2 hours so that urine can be released. Each time the clamp is put back on, it should be in a different spot from the time before. Avoid setting the clamp too tight.

A doctor will recommend what type of device to use.

Urethral injections

With this approach, a doctor injects a synthetic bulking agent into the urethra. This method helps the sphincter close more effectively.

Urethral injections can be administered at the doctor’s office under local anesthesia. Eventually, the injected material is absorbed by the body, so additional injections may be necessary.

Urethral sling

A urethral sling is a strap of material that is surgically implanted to support the urethra. Slings may be made from tissue from a patient’s own body or from synthetic material (mesh). They can be implanted in several ways.

In women, the sling may be implanted through an incision in the vagina or urethra. In men, the sling is usually placed between the scrotum and rectum.

Bladder neck suspension (for women)

Women may opt for bladder neck suspension surgery. With this technique, sutures starting in the vagina are attached to ligaments near the pubic bone. In this way, the urethra and sphincter muscles are supported and less likely to open by accident.

Patients undergoing bladder neck suspension may be given general anesthesia. The surgery may be open (using an abdominal incision to reach the area) or laparoscopic (using a smaller incision, specially designed instruments, a camera, and a video monitor).

Other terms for this procedure include retropubic suspension, colposuspension, and Burch suspension.

Artificial sphincter (for men)

An artificial sphincter system is a 3-part device that is surgically implanted. The system includes an inflatable cuff (which wraps around the urethra), a balloon reservoir (placed in the belly), and an activation pump (placed in the scrotum).

The cuff acts as the sphincter itself. Normally, it is filled with fluid. This arrangement keeps the urethra closed so urine won’t leak out.

When a man needs to urinate, he presses the pump in his scrotum. Then, the fluid flows out of the cuff into the balloon reservoir, which holds the fluid temporarily. At this point, the urethra opens, and urine can flow out.

Once he’s finished urinating, the man presses the pump again. The fluid flows from the reservoir back to the cuff, closing the urethra once again.

Catheterization

In rare cases, people with overflow incontinence might need to use a catheter—a flexible tube that drains urine from the bladder into the toilet or into a collection bag. There are several type of catheters. Some are permanent, but others can be inserted and removed as needed by the patient or a caregiver at home.

Surgery to remove blockage

If incontinence is caused by an obstruction, surgery can be done to clear the pathway. For example, men with an enlarged prostate might have excess prostate tissue removed, relieving pressure on the urethra. This makes it easier for urine to flow out.

Augmentation cystoplasty (bladder enlargement)

This procedure makes the bladder larger, so it can hold more urine. People who undergo augmentation cystoplasty might still be unable to completely empty their bladder. They may need to use a catheter for the long term.

Resources

American College of Obstetricians and Gynecologists

“FAQs: Urinary Incontinence”
(Last reviewed: July 2020)
https://www.acog.org/womens-health/faqs/urinary-incontinence

American Urogynecologic Society

“Botox® Injections to Improve Bladder Control”
(2018)
https://www.voicesforpfd.org/assets/2/6/Botox.pdf

American Urological Association

Jaspreet S. Sandhu, MD, et al.
“Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)”
(2019)
https://www.auanet.org/guidelines/guidelines/incontinence-after-prostate-treatment#x14371

Kobashi, Kathleen C., MD, FACS, FPMRS, et al.
“Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2017)”
(2017)
https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guideline#x4496

Winters, J. Christian, et al.
“Adult Urodynamics: AUA/SUFU Guideline (2012)”
(2012)
https://www.auanet.org/guidelines/guidelines/urodynamics-guideline

Cleveland Clinic

“Augmentation Cystoplasty (Bladder Augmentation)”
(Last reviewed: June 1, 2015)
https://my.clevelandclinic.org/health/treatments/15846-augmentation-cystoplasty-bladder-augmentation

“Overflow Incontinence”
(Last reviewed: November 5, 2021)
https://my.clevelandclinic.org/health/diseases/22162-overflow-incontinence

Healthline.com

Ross-Hazel, Lindsay and Kristeen Cherney
“Overflow Incontinence: What Is It and How Is It Treated?”
(Updated: August 12, 2020)
https://www.healthline.com/health/overactive-bladder/overflow-incontinence

Scaccia, Annamarya
“Is it Possible to Have a Loose Vagina?”
(Updated: May 11, 2022)
https://www.healthline.com/health/womens-health/loose-vagina

International Urogynecological Association

“Colposuspension for Stress Incontinence”
https://www.yourpelvicfloor.org/conditions/colposuspension-for-stress-incontinence/

Mayo Clinic

“Bladder control: Medications for urinary problems”
(July 15, 2022)
https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

“Urinary incontinence: Diagnosis and treatment”
(December 17, 2021)
https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814

MedlinePlus.gov

“Urge incontinence”
(Review date: July 31, 2019)
https://medlineplus.gov/ency/article/001270.htm

“Urinary incontinence – urethral sling procedures”
(Review date: January 10, 2021)
https://medlineplus.gov/ency/article/007376.htm

Medscape.com

Vasavada, Sandip P., MD
“What is overflow urinary incontinence?”
(Updated: January 22, 2021)
https://www.medscape.com/answers/452289-172411/what-is-overflow-urinary-incontinence

Memorial Sloan Kettering Cancer Center

“How to Use Your Incontinence Clamp”
(Last updated: February 7, 2022)
https://www.mskcc.org/cancer-care/patient-education/incontinence-clamp

National Association for Continence

“Female Stress Urinary Incontinence Procedures”
https://www.nafc.org/female-stress-incontinence-procedures

“Incontinence Conditions From A – Z”
https://www.nafc.org/conditions-overview

“Injection Therapy for Incontinence”
https://nafc.squarespace.com/injection-therapy

Neurology and Urodynamics

Krhut, Jan, et al.
“Pad weight testing in the evaluation of urinary incontinence”
(First published: June 24, 2013)
https://onlinelibrary.wiley.com/doi/10.1002/nau.22436

Office on Women’s Health, U.S. Department of Health and Human Services

“Urinary incontinence”
(Page last updated: January 31, 2019)
https://www.womenshealth.gov/a-z-topics/urinary-incontinence

The Simon Foundation for Continence

“Functional incontinence”
https://simonfoundation.org/functional-incontinence/

“Percutaneous Tibial Nerve Stimulation (PTNS)”
https://simonfoundation.org/ptns/

“Sacral Nerve Stimulation for Incontinence”
https://simonfoundation.org/sacral-nerve-stimulation/

UpToDate.com

Clemens, J. Quentin, MD, FACS, MSCI
“Urinary incontinence in men”
(Topic last updated: January 3, 2022)
https://www.uptodate.com/contents/urinary-incontinence-in-men

Doctors and editors at UpToDate
“Patient education: Surgery to treat stress urinary incontinence in women (The Basics)”
(Retrieved: April 4, 2022)
https://www.uptodate.com/contents/surgery-to-treat-stress-urinary-incontinence-in-women-the-basics

Doctors and editors at UpToDate
“Patient education: Urinary incontinence in males (The Basics)”
(Retrieved: February 26, 2022)
https://www.uptodate.com/contents/urinary-incontinence-in-males-the-basics

Lukacz, Emily S., MD, MAS
“Patient education: Urinary incontinence in women (Beyond the Basics)”
(Topic last updated: January 21, 2022)
https://www.uptodate.com/contents/urinary-incontinence-in-women-beyond-the-basics

Urology Care Foundation

“Stress Urinary Incontinence (SUI)”
https://www.urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)

“Urodynamic Tests: What You Should Know”
(2020)
https://www.urologyhealth.org/educational-resources/urodynamic-tests

“What is Cystoscopy?”
https://www.urologyhealth.org/urology-a-z/c/cystoscopy

“What is Urine Cytology?”
https://www.urologyhealth.org/urology-a-z/u/urine-cystology

Uroweb.org (European Association of Urology)

“Sling implantation in men”
(Last updated: April 2022)
https://patients.uroweb.org/treatments/sling-implantation-men/

WebMD

Brown, Steven
“What Is a Post-Void Residual Urine Test?”
(February 10, 2022)
https://www.webmd.com/urinary-incontinence-oab/post-void-residual-test

You might already have an exercise program for toning your abs, biceps, triceps, hamstrings, and quads. By stressing your muscles through exercise, you can improve stamina, posture, and mood, reduce the risk for chronic disease, and generally support your overall health.

How about your pelvic floor?

Your pelvic floor muscles support your pelvic organs, including your bladder. They are sometimes compared to a hammock—a layer attached to your sit bones (i.e., bones in the lower part of your pelvis), tail bone, and pubic bone—that keeps your pelvic organs in place.

Just like any muscle group, your pelvic floor can weaken over time. This happens as we age, but it can also happen after certain circumstances, such as pregnancy, childbirth, or prostate surgery. Being overweight can take a toll on pelvic floor muscles, too.

Just like any muscle group, your pelvic floor can weaken over time.

It’s easy to keep your pelvic floor muscles in shape. Kegel exercises (also called pelvic floor muscle training) have been around for decades. They were first developed by American gynecologist Arnold Kegel in the 1940s. But they’re not just for women. Men benefit from Kegels too.

Why should men and women do Kegels?

Urologists often recommend Kegel exercises to people with overactive bladder, pelvic organ prolapse, and other urologic issues, such as incontinence (urine leakage). Strengthening and toning pelvic floor muscles can help with these problems.

Kegels can have sexual benefits, too. Men may have improved erections. Women who do Kegel exercises regularly often find that vaginal penetration becomes more comfortable. Orgasms may intensify for both men and women.

One you learn the technique, Kegel exercises are easy to do. You need no special equipment, and they can be done anywhere. They’re also discreet; nobody will know when you’re doing Kegels.

Note: Kegels aren’t appropriate for everyone. In some cases, pelvic floor problems develop because the muscles are too tense and are difficult to relax, making Kegels less effective. Your doctor can guide you on your personal situation.

How do I get started with Kegels?

While Kegels are simple, they need to be done correctly, so talk to a doctor or other healthcare professional before making them part of your routine.

The most important aspect of Kegel exercises is making sure you’re working the right muscle group. Here are some ways to make sure:

• Imagine that you’re about to pass gas. Squeeze the muscles that would stop you from doing so. The pulling sensation you feel when you squeeze indicates your pelvic floor muscles.
• The next time you urinate, stop the urine flow midstream, paying attention to the muscles you use. If you can stop the flow, you have found your pelvic floor muscles.
• Women might try putting a finger inside their vagina, then imagining they’re stopping their urine stream. When squeezing the muscles, they should feel a tightness around their finger.

It can take time and practice to determine which muscles to target.

Each time you squeeze those muscles, you’re doing a Kegel.

At first, try holding each Kegel for a second or two. Then relax for a few seconds. Then Kegel again. This pattern of repeated squeezing and relaxing is the core component of a Kegel exercise program.

Over time, as your pelvic floor starts to strengthen, you should find that you can hold Kegels for longer durations. Ten seconds is a good goal, but if you can’t do it at first, that’s fine. Your ability to hold the Kegel for longer periods of time should improve with repetition.

Create a Kegel exercise plan

Once you’ve gotten the hang of Kegels, make them a daily routine. Some experts recommend doing Kegel exercises 3 times a day in sets of 10 to 15 squeeze-relax repetitions (sometime called reps).

You can also vary your position. Consider doing some of your Kegels while standing, others while sitting, and the rest while lying down.

Another way to vary your Kegels is to do short or long reps. Short reps are quick in succession: you hold each Kegel for a couple seconds, relaxing for a few seconds in between each one. For long Kegels, you hold each Kegel for a longer period (such as 10 seconds) with an equal rest time in between each one. Doing short and long reps gives your pelvic floor more comprehensive training.

A word about weights: Some people use special weights or cones to enhance their Kegel practice. You might see some of these products for sale. Such devices should be purchased and used only with the guidance of a qualified healthcare professional.

Tips for doing Kegel exercises

As you start out with Kegels, keep these tips mind:

• Make sure you’re relaxing your pelvic floor muscles between each Kegel squeeze. This resting period is part of the program and to avoid injury, it’s important not to skip it.
• Make sure the muscles in your stomach, back, thighs, and buttocks stay relaxed while you do your Kegel exercises. Focus on your pelvic floor only.
• Breathe normally. Don’t hold your breath while you’re doing Kegels.
• Don’t do Kegel exercises while you’re urinating. This can actually weaken the pelvic floor and damage your kidneys and bladder.
• Don’t overdo it! As the saying goes, “all things in moderation.” This idea applies to Kegels. If you do too many Kegels, your pelvic floor can become too tight, and that can lead to urine leaks, pelvic organ prolapse, and sexual pain.

Getting Results

Once you start a regular routine of doing Kegels, you should start seeing a difference in about 4 to 6 weeks. This might mean fewer urine leaks, fewer trips to the bathroom, or improved sexual health. However, for some people, improvement takes longer, so we encourage you to stick with it.

Resources

Healthline.com

Crouch, Marcy, PT, DPT, CLT, WCS
“Yes, You Really Can Do Too Many Kegels. Here’s What Happens”
(December 11, 2020)
https://www.healthline.com/health/parenting/yes-you-really-can-do-too-many-kegels-heres-what-happens

National Association for Continence

“Kegel Exercises: A Step-By-Step Guide”
https://www.nafc.org/kegel-exercises

“Kegel Exercises for Men”
https://www.nafc.org/kegel-exercises-for-men

National Institute of Diabetes and Digestive and Kidney Diseases

“Kegel Exercises”
(Last reviewed: April 2014)
https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises

Urology Care Foundation

“Kegel and Pelvic Floor Exercises”
(April 1, 2019)
https://www.urologyhealth.org/healthy-living/care-blog/2019/kegel-and-pelvic-floor-exercises

VoicesForPFD.org (American Urogynecologic Society)

“Pelvic Floor Muscle Exercises and Bladder Training”
(2016)
https://www.voicesforpfd.org/assets/2/6/Bladder_Training.pdf

“Pelvic Floor Muscle Strengthening”
https://www.voicesforpfd.org/assets/2/6/Kegel_Exercises.pdf

WebMD

Fries, Wendy C.
“Kegel Exercises: Treating Male Urinary Incontinence”
(Medically reviewed: July 21, 2020)
https://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence

Most people are familiar with that occasional, urgent need to urinate—the feeling that there’s little time to spare and you need a bathroom ASAP.

But imagine having that feeling constantly. That’s the situation for people with overactive bladder (OAB). They may need to plan their day around bathroom availability, watching for the nearest restroom sign when they are away from home.

Overactive bladder is not a specific disease, but a group of symptoms:

• An almost-constant, urgent need to urinate, even after the bladder has been emptied.
• Urge incontinence. Some people with OAB leak urine, from a few drops to the entire contents of the bladder.
• Waking up more than once during the night to urinate (nocturia).
• Needing to urinate frequently, sometimes more than 8 times in 24 hours.

OAB is sometimes called “spastic bladder” or “irritable bladder.”

OAB can affect a person’s emotional health, too. Many people feel anxious about urine leak accidents or embarrassed about needing the bathroom so frequently. They may shy away from socializing, feel isolated, and become depressed.

About 33 million people in the United States have OAB, according to the National Association for Continence (NAFC). It’s particularly common in older people, women who have gone through menopause, and men with prostate issues. People with neurological conditions like stroke or multiple sclerosis are also more likely to have OAB.

OAB is sometimes called “spastic bladder” or “irritable bladder.”

Some people think that poor bladder control is just something they have to live with, especially as they get older. But that’s not the case at all.

The good news is that OAB is treatable. With time and patience, OAB symptoms can greatly improve.

How does the urinary system work?

Typically, a person has two kidneys. These are the organs that make urine. Extending from each kidney is a ureter—a tube that connects to the bladder. Once produced, urine flows from the kidneys, through the ureters, to the bladder, where it is stored until a person urinates. On average, the bladder can hold about 2 cups (16 ounces) of urine before it needs to be emptied.

At that time, the nerves in the bladder send a message to the brain, signaling the need for emptying. When it’s time to urinate, the brain sends a message to open the bladder’s sphincter muscle, which acts as a valve. Once open, urine flows from the bladder out of the body through a tube called the urethra.

With OAB, communication between the brain and bladder muscles are disrupted.

What causes overactive bladder?

With OAB, communication between the brain and bladder muscles are disrupted. As a result, a person will have that “I need go right now” feeling more urgently and more often. It also happens when the bladder isn’t full.

How is overactive bladder diagnosed?

Lots of people are reluctant to discuss urinary symptoms with a healthcare provider because it can be awkward and embarrassing to talk about bathroom issues. Hiding the problem doesn’t help and leads to unnecessary suffering.

When a person talks about urinary symptoms like those related to OAB with a healthcare provider, the provider will ask about the patient’s overall health and the medications currently being taken. They’ll also want to know about any past illnesses or surgeries.

They’ll also want more specific information about the urinary symptoms. For this reason, patients might be asked to keep a bladder diary for a few days.

A bladder diary is a place to jot down symptoms and urination patterns. It can be as simple as a spiral notebook or handwritten chart. Or it can be high-tech, like a smartphone app. Whichever method is chosen, these questions can reveal patterns:

• How often is a patient urinating? What time of day?
• What is the patient doing when he/she feels the need to urinate?
• How strong is the urge to urinate?
• How much urine is being released?
• Are there any accidental urine leaks?
• What is the patient eating and drinking? How much?
• How do the circumstances affect the patient’s daily routine?

Urologists usually ask patients to keep a bladder diary for at least 3 days. Those days don’t have to be consecutive, but they should be 3 typical days. Patients should try to keep track of symptoms for 24 hours at a time.

In addition to the diary, doctors might ask patients to measure how much urine is released. A person might be given a special cup to use, or might use a cup from home, as long as it is known how much liquid it can hold.

When diagnosing OAB, urologists may conduct other assessments, too:

• Physical exams. The doctor might feel your abdominal organs or conduct a pelvic or rectal exam.
• Urinalysis. Lab technicians examine a urine sample under a microscope and check it for certain chemicals and substances.
• Urine culture. Specialists use a urine sample to grow bacteria in a lab. You might have a urine culture if your doctor suspects a urinary tract infection or bladder infection in addition to OAB.
• Post-void residual assessment. Using a catheter or ultrasound, the doctor checks to see how much urine remains in your bladder after you urinate. This test can provide clues about a bladder infection or blockage, which might share symptoms with OAB.

How is overactive bladder treated?

OAB can be treated in several ways. It may just be a matter of changing foods you eat and training your bladder to hold urine longer. Some people take medications to relax the bladder muscle. Others undergo certain procedures or, in rare cases, surgery. Sometimes, a combination of treatments is needed.

Lifestyle Changes

Patients might be able to adjust their daily habits to make them more bladder-friendly.

Dietary Changes

Certain foods and drinks can irritate the bladder:

• Caffeinated and alcoholic beverages. These are called diuretics, and they cause the kidneys to make more urine.
• Citrus fruits, like grapefruits, oranges, and lemons.
• Sugar and artificial sweeteners.
• Tomatoes and tomato-based foods like pasta sauce and ketchup.
• Carbonated beverages, such as soda and seltzer water.
• Spicy foods.
• Onions.
• Cranberries.
• Chocolate.
• Processed foods.

It can be hard to tell whether a specific food is triggering OAB symptoms. For this reason, an elimination diet can be helpful. With this diet, you stop consuming foods and drinks that could be triggers. Then, you gradually add them back, one by one.

For example, you might add oranges back to your diet. If your OAB symptoms worsen, then oranges are probably a trigger for you. But if you have no problems, then you can probably eat oranges with no problem.

Remember, everyone is different. A food that is an OAB trigger for one person may not trigger symptoms in another.

Some patients find that adding fiber to their diet improves OAB symptoms. Fiber may relieve constipation, which puts pressure on your bladder. Fiber is found in foods like whole grains, fruits and vegetables, and beans. An over-the-counter stool softener or laxative might be helpful, too.

Fluid Management

Your doctor can help you determine how much fluid to drink each day.

Double Voiding

Voiding is another term for urinating. Double voiding means urinating twice during the same bathroom visit. Urinate as you normally would, then wait a few seconds. Then try urinating again to empty your bladder.

Delayed Voiding

When you feel the urge to urinate, try waiting a few minutes before going to the bathroom. Over time, try increasing the waiting period. You might start with two or three minutes and gradually build up to waiting 2 or 3 hours. This process trains your bladder to wait longer between bathroom visits.

Timed Urination

This means training your bladder to urinate on a specific schedule. You might start by urinating when you wake up at 7 a.m. Then, plan bathroom visits every 2 to 4 hours, depending on what works for you.

Pelvic Floor Exercises

The pelvic floor muscle group supports your pelvic organs, including your bladder. Strengthening these muscles may improve OAB symptoms. Your doctor can teach you how to target these muscles and develop an effective exercise plan. (Kegel exercises are one example. Another is “quick flicks,” which involve quickly squeezing and releasing your pelvic floor muscles repeatedly.)

Pelvic floor physical therapy might include biofeedback. This technique uses electrodes placed on the abdomen or anal area to help patients identify and control their pelvic floor muscles.

Medications

If symptoms don’t improve with lifestyle changes, medication is usually the next step. We might recommend meds on their own or in combination with lifestyle changes. Sometimes, more than one medication is prescribed.

The most commonly used drugs for OAB are anti-muscarinics and β-adrenoceptor agonists, which can be taken by mouth or administered as a patch that you wear on your skin. These drugs relax the bladder muscle and allow the bladder to hold more urine.

These medications can have side effects, such as dry mouth, dry eyes, constipation, and blurred vision. If you experience these or any other side effects, let your healthcare provider know. Changing the dose or the type of medication might help.

Botox® Injections

If lifestyle changes and medications aren’t successful, injections of Botox® may be another option for treating OAB. Botox® can relax the detrusor muscle (found in the bladder wall) and relieve the urgent feeling. It can also help your bladder hold more urine.

Botox® therapy is given in a urologist’s office and takes about 20 minutes. After you’re given local anesthesia, the doctor inserts a hollow tube called a cystoscope through your urethra and into your bladder. The cystoscope has a camera at the end and allows the doctor to see the inside of your bladder. Botox® injections are given with a thin needle through the cystoscope.

After treatment, you might notice some blood in your urine or a burning sensation when you urinate. These side effects eventually go away. If necessary, medication can be prescribed to relieve some of the discomfort.

It may take a few days—or up to 2 weeks—to notice improvements in OAB symptoms. However, Botox® provides OAB relief for about 6 months, on average. For some people, relief lasts for up to a year. Still, the effect does diminish eventually, and repeat treatments are usually necessary.

Urinary retention—an inability to empty your bladder—can be a side effect of Botox® treatment. If this occurs, you might need to self-catheterize. This process involves inserting a flexible tube called a catheter through your urethra and into your bladder. Urine then drains from the bladder to the toilet or a collection bag. Your healthcare provider will show you how to use a catheter properly.

About 10% of patients experience allergic reactions to Botox®, which can include weakness, changes in vision, and breathing difficulties. Call your provider if these side effects occur.

Nerve Stimulation (Neuromodulation Therapy)

As noted above, OAB occurs when nerve signals between the bladder and brain don’t connect properly. Nerve stimulation uses electrical pulses to improve communication between these organs.

Nerve stimulation can be done in 2 ways:

Percutaneous tibial nerve stimulation (PTNS)

The word percutaneous means “through the skin” and tibial refers to the tibial nerve, located in the leg. With PTNS, electrical pulses are sent to your tibial nerve though an electrode placed under your skin, near your ankle. These pulses help nerve signals travel properly.

PTNS is typically administered in 12 weekly sessions, but some people need more sessions. Each session lasts for about 30 minutes. Side effects are rare, but some people experience mild pain, tingling sensations, bruises, or bleeding.

Sacral neuromodulation (SNS)

SNS involves the sacral nerve, which transmits messages among the brain, spinal cord, and bladder. This procedure is considered surgery and is completed in 2 parts.

The first step is a testing phase. After you’ve been given anesthesia, the surgeon places a small electrical wire beneath the skin in your lower back. This wire is connected to a special device called a stimulator, which triggers the electrical pulses. (Sometimes it is called a pacemaker.) This device runs on batteries and may be worn outside the body, but you can also hold it in your hand. For a few weeks, you and your doctor will test the process and see how it affects your OAB symptoms.

If the test is successful, you’ll have a second procedure to place a permanent stimulator device near the sacral nerve. You will still have a programmer to adjust the stimulation. You will also have follow-up appointments to make sure everything is running smoothly.

Possible complications of SNS surgery include pain, infection, bleeding, and wire movement. Let your doctor know if you have any discomfort.

The implanted, permanent device has a battery, which might need replacing (via surgery) in a few years.

Other Surgical Approaches: Bladder Reconstruction and Urinary Diversion

Severe cases of OAB may require bladder reconstruction or urinary diversion. However, these situations are rare.

• Augmentation cystoplasty is surgery that makes the bladder larger, creating more space to store urine.
• Urinary diversion creates a new path for urine to exit the body, bypassing the bladder.

Resources

American Urological Association

Lightner D.J., et al.
“Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline (2019)”
(Guideline published: 2012; Amended in 2014 and 2019)
https://www.auanet.org/guidelines/guidelines/overactive-bladder-(oab)-guideline#x2904

Healthline.com

Ellis, Mary Ellen
“What Are the Best Medications for an Overactive Bladder?”
(Updated: September 2, 2018)
https://www.healthline.com/health/overactive-bladder/medications-for-overactive-bladder

Healthline Editorial Team
“Botox for Overactive Bladder”
(Updated: November 29, 2017)
https://www.healthline.com/health/overactive-bladder-botox

Wallace, Ryan
“11 Foods to Avoid if You Have OAB”
(September 28, 2017)
https://www.healthline.com/health/11-foods-to-avoid-if-you-have-oab

LiveScience.com

“How Much Urine Can a Healthy Bladder Hold?”
(December 4, 2012)
https://www.livescience.com/32330-how-much-urine-can-a-healthy-bladder-hold.html

MedlinePlus.gov

“Self catheterization – female”(Last reviewed: January 10, 2021)
https://medlineplus.gov/ency/patientinstructions/000144.htm

“Self catheterization – male”
(Last reviewed: January 10, 2021)
https://medlineplus.gov/ency/patientinstructions/000143.htm

“Urine culture”
(Last reviewed: October 10, 2020)
https://medlineplus.gov/ency/article/003751.htm

Medscape

Ellsworth, Pamela I., MD
“Overactive Bladder Treatment & Management”
(Updated: January 21, 2021)
https://emedicine.medscape.com/article/459340-treatment#d11

Rao, Pravin K., MD
“Augmentation Cystoplasty”
(Updated: March 2, 2021)
https://emedicine.medscape.com/article/443916-overview

Merck Manual – Consumer Version

Chung, Paul H., MD
“Urinalysis and Urine Culture”
(Content last modified: May 2020)
https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/diagnosis-of-kidney-and-urinary-tract-disorders/urinalysis-and-urine-culture

National Association for Continence

“Ask The Expert: Can Kegels Really Help My OAB Symptoms?”
https://www.nafc.org/bhealth-blog/ask-the-expert-can-pelvic-floor-exercises-really-help-my-oab-symptoms

“Overactive Bladder”
https://www.nafc.org/overactive-bladder

National Institute of Diabetes and Digestive and Kidney Diseases

“Definition & Facts of Urinary Retention”
(Last reviewed: December 2019)
https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/definition-facts

“Urinary diversion”
(Last reviewed: June 2020)
https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-diversion

Urology Care Foundation

“It’s About Time . . . And It’s About You: It’s Time to Talk About Overactive Bladder”
(2021)
https://www.urologyhealth.org/educational-resources/overactive-bladder

“What is Urinary Diversion?”
https://www.urologyhealth.org/urology-a-z/u/urinary-diversion

VoicesForPFD.org (American Urogynecologic Society)

“Botox® Injections to Improve Bladder Control”
(2018)
https://www.voicesforpfd.org/assets/2/6/Botox.pdf

WebMD

Brown, Steven
“What Is a Post-Void Residual Urine Test?”
(Medically reviewed: February 10, 2020)
https://www.webmd.com/urinary-incontinence-oab/post-void-residual-test

Watson, Stephanie
“What Is Electrical Stimulation for Overactive Bladder?”
(Medically reviewed: February 11, 2020)
https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-electrical-stimulation

Exercise and Incontinence

You’re on your morning run, or playing tennis, or in a cardio class. Whatever you’re doing, your blood is pumping, and you’re working up a sweat. You’re crushing it!

And then it happens. You feel a little urine leak. Your concentration falters and you feel a sense of dread. Is there a restroom nearby? Will anyone notice?

Urinary incontinence while you’re exercising is pretty common, but that doesn’t make it any less inconvenient or embarrassing. The good news is that there are treatments available to resolve incontinence. You can maintain the exercise program that’s so crucial for maintaining good health.

Why do I leak urine when I exercise?

The culprit is stress urinary incontinence (SUI). Typically, the sphincter muscles in your urethra contact to keep urine in your bladder. When you urinate, these muscles relax, and urine is released.

With SUI, pressure on your bladder or urethra makes the sphincter muscles open, sometimes only momentarily, letting urine out. You might notice urine leakage when you laugh, cough, sneeze, too. That’s also considered “stress” urinary incontinence because it’s the pressure caused by movement that puts pressure on the bladder/sphincter and leads to the leakage of urine.

Other types of urinary incontinence are urge incontinence and overflow incontinence.

What can I do about stress urinary incontinence?

First, come see us. We can evaluate your symptoms and help you work out a treatment plan to offer you long-term relief. Here are some of the options:

Non-Surgical Approaches

Pelvic floor exercises and therapy

Kegel exercises are an easy way to strengthen your pelvic floor muscles. They involve squeezing and releasing these muscles several times a day. We will teach you how to do them. We might also refer you to a pelvic floor physical therapist.

Keeping your pelvic floor muscles strong is essential throughout your SUI treatment. It’s a good idea to exercise them every day.

Bladder training

This approach starts with a bladder diary. You’ll keep a log of how much and how often you drink fluids, urinate, and leak urine. With this information, we’ll work out a urination schedule. For example, you might start by urinating every hour. Gradually, you’ll increase the amount of time between bathroom visits, training your bladder to hold urine for longer periods.

Vaginal pessary (for women)

Some women have SUI due to pelvic organ prolapse, when pelvic organs, such as the bladder or uterus, drop into the vagina. A vaginal pessary is a silicone device you can place in your vagina to give these organs more support. There are several different types of pessaries. Some you can insert and take out yourself; others stay in place for up to three months. We’ll guide you through the process.

Clamp/clip device (for men)

Men can wear a special clamp on the penis that presses against the urethra and restricts urine flow. This device cannot be worn constantly, but it may help in short-term situations.

Surgical Approaches

Stress urinary incontinence can also be treated surgically. Some of your options might include:

• Slings. A sling is typically made out of a soft mesh material. In both men and women, a sling can be surgically placed under the urethra to provide support.
• Urethral injections (for women). A woman may choose to have a bulking agent injected into her urethra to thicken it and provide support. This is a short-term solution, however, and you may need to have repeat injections after a year or so.
• Burch procedure (for women). This technique is also called a bladder neck suspension or retropubic colposuspension. During this procedure, stitches are used to attach the bladder neck and urethra to surrounding abdominal tissue. This supports the urethra and sphincter muscles (the muscles that open and close the urethra).
• Artificial urinary sphincter (more common in men). An artificial sphincter is a surgically implanted device. It includes a cuff that is placed around the urethra, a reservoir placed in the abdomen, and a pump. In men, the pump is usually placed in the scrotum; in women, it is placed in the labia. The cuff is filled with fluid and keeps the urethra closed. When you need to urinate, you activate the pump. The fluid then travels from the cuff to the reservoir so that urine can be released. After a few minutes, when you’re finished urinating, the fluid flows back into the cuff to close the urethra again.

Can I still exercise with SUI?

As you can see, there are permanent solutions for urine leaks during exercise. Once you see a urologist and start taking action, you can free yourself from strategies that just hide the problem, like wearing dark clothes and using absorbent products. You’ll no longer have to plan your workout around bathroom breaks, and you’ll have more beverage options when you hydrate.

You’ll also have more choices for exercise, since you won’t be limited to low-impact workouts that put less pressure on your bladder. Instead, you’ll be able to pick other activities, try new ones, or mix and match for variety.

Don’t let incontinence keep you from staying fit. Many people stop their exercise program because of urine leaks, but physical activity is an essential part of staying healthy. Avoiding exercise can raise your risk for other health problems, like obesity and diabetes.

Remember, we are always here to answer your questions and suggest solutions. Just give us a call.

Resources

American Academy of Family Physicians (familydoctor.org)

“Bladder Training for Urinary Incontinence”
(Last updated: June 3, 2020)
https://familydoctor.org/bladder-training-urinary-incontinence/

American Urological Association

Kobashi, K.C., et al.
“Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline”
(2017)
https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guideline

European Association of Urology

“Artificial Urinary Sphincter Implantation in Women”
(Last updated: May 2021)
https://patients.uroweb.org/treatments/artificial-urinary-sphincter-implantation-women/

EverydayHealth.com

Vann, Madeline R., MPH
“Exercising With Stress Incontinence”
(September 14, 2015)
https://www.everydayhealth.com/incontinence/exercising-with-stress-incontinence.aspx

National Association for Continence

“The Best Incontinence Products for Working Out”
https://www.nafc.org/bhealth-blog/the-best-incontinence-products-for-working-out

“Don’t Quit Exercising Because of Urinary Incontinence”
https://www.nafc.org/bhealth-blog/dont-quit-exercising-because-of-urinary-incontinence

UpToDate

“Patient education: Surgery to treat stress urinary incontinence in women (The Basics)”
https://www.uptodate.com/contents/surgery-to-treat-stress-urinary-incontinence-in-women-the-basics

“Patient education: Urinary incontinence in men (The Basics)”
https://www.uptodate.com/contents/urinary-incontinence-in-men-the-basics

Urology Care Foundation

“Bladder Health Exercises”
(July 1, 2015)
https://www.urologyhealth.org/healthy-living/lifestyle-and-exercise/bladder-health-exercises

“Stress Urinary Incontinence (SUI)”
https://urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)

“Stress Urinary Incontinence – What You Should Know”
https://www.urologyhealth.org/resources/incontinence-stress-urinary-incontinence-what-you-should-know