Bladder leakage is a common condition faced by millions of men and women. Having small or large amounts of urine escape during a laugh, sneeze, or for no apparent cause can be embarrassing. However, it may be treated by making a few small changes to your lifestyle.
Whether the urine incontinence is due to genetics, hormone changes, an underlying health condition, or the aging process itself, managing the condition begins with understanding and knowing the causes, symptoms, and various types of incontinence.
Urinary incontinence is defined as a loss of bladder control, with amounts ranging from small dribbles of urine to uncontrollable wetting. It results from an interruption of the controlled workings of the nerves or bladder muscles.
There are various types of urinary incontinence, and the leakage depends on the cause behind the condition. In most cases, the bladder muscles are weakened and fail to perform the proper function of closing the sphincter to prevent urine from leaking out.
Bladder leakage may occur during a period of laughing, coughing, or running. It can also be seen following a sudden, unexpected urge to pee.
A leaky bladder can happen to anyone of any age, but most cases appear among adult women. Some 17% of women aged 18 and older and 16% of their male counterparts suffer from an overactive bladder. Men and women share many causes of bladder leaks with a few distinct differences.
While stress incontinence is the most common form of bladder leakage in women, bladder leakage in men is frequently related to the prostate gland.
Treatment only works in accordance to the type and severity of the condition, and as expected, is also based on gender. Lifestyle changes, medications, medical devices, and surgical procedures are available treatment options.
Bladder Leakage Causes
Before we understand what causes bladder leakage, we need to sort out the common causes men and women share when it comes to bladder incontinence.
Both men and women can experience some form of bladder leakage with obesity, nerve damage, or with kidney issues. Certain medical conditions such as spina bifida, Parkinson’s disease, multiple sclerosis, diabetes, and the effects of a stroke can cause urine leaks in men and women.
Other causes of urinary incontinence between the genders include:
- Excessive coughing: Chronic coughing from an illness or disorder may add extra pressure to the pelvic floor muscles as well as the muscles within the bladder.
- Nerve damage: Damage from health conditions that cause neurological problems of the brain or spine may result in minor or major loss of bladder control.
- Sedentary lifestyle: If a man or woman tends to be physically inactive, bladder leakage may occur due to muscle weakness and from weight gain.
- Obesity: The excessive weight from being obese may place added pressure on the pelvic floor muscles and the bladder. This can shorten the intervals of needing to urinate sensation.
- Aging: As we age, our muscles throughout the body, especially in the bladder, weaken and can cause the bladder to fail in storing urine.
Temporary incidents of small-to-moderate bladder leaks can be experienced in males and females as a result of excess fluid intake. This is commonly seen with extra cups of coffee or excessive amounts of alcohol or carbonated beverages.
Urinary Incontinence in Women
Bladder leakage in women may develop during development in the womb with the urinary tract as a birth defect or may be related to the genetics as it can be a family trait.
The racial background of a woman may also dictate urinary incontinence as Caucasians have a higher risk than those of African American, Asian American, and Hispanic/Latin descent.
Pregnancy often sees an increase in the urge to urinate as the growing fetus can place pressure on the bladder. This may cause temporary bladder leakage.
Bladder leakage in women may also be caused by damage to the pelvic floor muscles during childbirth as they can be overstretched.
Urinary incontinence may become a more permanent issue after childbirth or surgery as a result of pelvic organ prolapse disorder. This condition may see the bladder drop out of normal positioning.
Hormonal changes to the female body as seen during menopause can cause urinary incontinence. The reduction of hormones produced result in weakness of the bladder and urethra linings.
Urinary Incontinence in Men
Bladder leakage in men can be caused by a birth defect of the urinary tract.
Men also have the risk of contracting urinary incontinence with a history of prostate cancer. The treatment from radiation and medication may result in temporary or permanent bladder leakage.
An enlarged prostate without cancer cells may lead to a condition known as benign prostatic hyperplasia, or BPH. This condition causes the prostate to expand and apply pressure to the urethra, resulting in the walls of the bladder also expanding and thickening. Over time, the bladder weakens and retains some volume after urination.
Different Types of Bladder Leakage (Urine Incontinence)
Millions of people suffer from one of the types of incontinence of the bladder. The bladder leakage can be linked to a specific type based on the volume, frequency, or association with an underlying health condition.
1. Stress Incontinence
With stress incontinence, leakage is usually linked to weak pelvic floor muscles. These muscles can weaken from the excessive pressure placed on the bladder as it becomes full. This pressure often overpowers the urethra’s ability to remain closed to prevent leakage.
Small or moderate amounts of urine may escape during a time of coughing, laughing, sneezing, or with lifting heavy objects. Movement during exercise routines may also cause this type of incontinence to develop, as well as the act of sexual intercourse.
Certain health conditions may weaken the muscles, such as obesity, the results of male prostate surgery, or the effects of some medications.
Temporary or permanent stress incontinence may also be seen with pregnancy and after childbirth as the bladder walls and muscles are stretched. Many women experience bladder leakage with the onset of menopause, as the pelvic floor muscles weaken with age.
2. Urge Incontinence
Urge incontinence may be caused by an overactive bladder, resulting in frequent bathroom trips due to muscle spasms. These spasms stimulate urination and are usually caused by damage to the bladder muscles and nerves, resulting in uncontrollable bladder issues.
Certain medications may also have an effect on the detrusor muscles found in the bladder walls. These muscles are responsible for allowing the bladder to fill with urine by relaxing before contracting during urination.
SurgeryOther nerves of the central nervous system may play a part as this type of incontinence can been seen with various health disorders and diseases. These may include infections, Parkinson’s disease, multiple sclerosis, bladder stones, diabetes, Alzheimer’s disease, and even stroke.
3. Functional Incontinence
As the name implies, functional incontinence occurs in those who have difficulty accessing a bathroom before urinating. The bladder and pelvic floor muscles are often in great shape and have full strength.
This type is seen in patients with physical and mental impediments related to conditions such as Alzheimer’s disease, dementia, Parkinson’s disease, or arthritis.
4. Overflow Incontinence
With overflow incontinence, the bladder does not empty completely and allows dribbles of urine to be expelled. There is no sensation to urinate at this time and can be referred to as chronic urinary retention.
This type of incontinence is often seen in men with enlarged prostates and with women experiencing health conditions of the pelvic region. Overflow incontinence may be caused by nerve damage, weak bladder muscles, medications, bladder blockage, or constipation.
Other Types of Bladder Leakage
- Mixed Incontinence: This label is given to bladder leakage conditions that stem from more than one form of incontinence, whether stress, urge, functional, or overflow. Women can be often diagnosed with stress and urge incontinence at the same time.
- Transient Incontinence: A transient incontinence refers to a temporary condition of a bladder leakage. It is often seen with complications after surgery, an irritated bladder, chronic constipation, and as a side effect of some diuretic and sleep-induced medication.
- Total Incontinence: A total loss of bladder function is referred to as total incontinence. This may be a result of nerve or bladder damage or disease that hinders the regular functioning of the bladder. Some cases of multiple sclerosis and spinal cord injuries may see a malfunction of the bladder to store urine.
Bladder Leakage Symptoms
Bladder leakage may begin with a small amount of urine secretion or frequent loss of moderate amounts of urine. The types of urine leaks may depend on the symptoms and when it occurs.
- Stress Incontinence – Bladder pressure during a sneeze, cough, laugh, or while exercising may cause leakage. It may also happen with exertion while lifting a heavy object.
- Urge Incontinence – Minor to moderate urine leaks may follow an urgent sense of needing to urinate. It can be frequent and suddenly occur during the nighttime hours. This is usually seen with a health condition such as diabetes, a neurological disorder, or during an infection
- Functional Incontinence – Urination may occur before you are able to prepare for it, as seen with physical or mental inability. Arthritis patients often have trouble making it to the toilet due to fumbling with pant buttons.
- Overflow Incontinence – Bladder leakage in forms of continuous or irregular urine drops are experienced. This occurs with a bladder that does not completely empty.
- Mixed Incontinence – Varying symptoms of frequent, constant, or irregular bladder leakage occurs as a result of more than one type of incontinence.
Bladder Leakage Diagnosis
A bladder leakage diagnosis requires more than just experiencing frequent urination and leaks during the day and night. A proper diagnosis will determine the type of urinary incontinence as well as the appropriate course of treatment.
A complete medical history and episodes of bladder leakage will be discussed by a medical team before further testing is conducted. A bladder diary of intake and output of fluid may give the doctor a better idea of the issue.
Physical examination of the pelvic region may be done in the doctor’s office. Women should expect an inspection of the vaginal walls, and men may require a digital rectal examination in addition to examination of the scrotum.
Medical tests may be ordered, such as a urinalysis to detect any blood, infection, or cancer cells. Blood tests may also be done to determine if any health conditions are at play.
Diagnostic tests such as a pelvic ultrasound would show physical damage to the bladder, while a postvoid residual measurement test reveals if the bladder empties completely after urination.
Other tests may include a stress test to check for urine leakage during forced coughing spells, an urodynamic test to measure tolerance of pelvic floor muscles, or a cystogram X-ray. In this test, an injection dye in the bladder may show problems within the urinary tract during urinating.
A tube may be required to be placed in the urethra with a cystoscopy procedure. This allows the inner lining of the bladder and the urethra to be visualized.
How to Prevent a Leaky Bladder
- Limit or avoid excess caffeine intake through coffee, tea, and carbonated beverages.
- Perform Kegel exercises on regular basis to maintain strength of pelvic floor muscles.
- Avoid fluid intake for several hours before bedtime.
- Limit fluid intake throughout the day, but keep hydrated.
- Avoid smoking as tobacco use increases risk of bladder cancer, which can cause bladder leaks.
- Maintain a healthy weight as obesity can lead to bladder leakage.
- Urinate after sexual intercourse to eliminate bacteria from the urethra.
- Limit or avoid spicy foods, acidic foods, and artificial sweeteners, as they increase fluid output.
- Use caution with diuretics to prevent bladder leakage from frequent urination.
Behavioral and Lifestyle Changes for Bladder Leakage Treatment (Urine Incontinence)
Bladder leakage treatment is based on the underlying cause and type of urine incontinence. Both men and women may face similar challenges within the treatment plan that may include urgency suppression, bladder training, and lifestyle changes.
A treatment plan usually begins with behavioral and lifestyle changes such as exercises for leaky bladder. Medications may be required alongside behavioral tasks to reduce muscle spasms or health conditions such as prostate enlargement. In severe cases, surgical procedures may be necessary.
Behavioral changes begin with training the bladder as to the timing of urination. By training the timing of urinating, the frequency of bathroom trips and urinary tract infections may be reduced.
Men and women alike can follow timed voiding by going to the bathroom at set times with adding minutes to each bathroom break. This may help train the bladder to hold more urine.
Another technique to try may be urgency suppression. This entails training the bladder to have control over the urge to expel. Timed voiding will help as will distracting from the urgency with mind thoughts and concentrating on other tasks until a visit to a bathroom is available. For some, taking deep, long breaths and sitting still until the urge passes may help.
Monitor intake of fluids throughout the day. Reduce the amount you drink without becoming dehydrated, which presents signs of dry skin, fatigue, extreme thirst, and dark-colored urine.
Limit fluids several hours before bedtime to prevent nighttime sleep interruptions. It may also help to limit alcohol and caffeine intake, whether it be coffee, tea, or soda.
The main change in lifestyle that may help with bladder leakage is performing regular exercise with specialized techniques to strengthen the pelvic muscles.
Urgency incontinence can have such an effect on men and women that the motivation to be physically active is significantly decreased. Patients should resist the urge to avoid exercises, and focus on tightening the bladder muscles in order to prevent leakage.
Exercises of the pelvic floor muscles are referred to as Kegel exercises. These strengthen the muscles that may help slow down or stop bladder leakage by preventing the urine from leaking out.
Kegel exercises for women begin with identifying the pelvic muscles by stopping the urine midstream. Avoid performing these exercises during urination often, as it may cause the muscles to weaken.
The pelvic floor muscles should be the only ones contracted. Avoid using the abdominal muscles, thigh muscles, or buttock muscles. Breathe normally during the exercises. Once you know which muscles to tighten, perform this exercise at anytime, anywhere.
Hold the tightening position for five seconds, relax muscles for five seconds, and then begin again, progressing to a hold of 10 seconds. Once a 10-second hold and release period is obtained, repeat three sets of 10 repetitions daily.
Kegel exercises for men are performed similarly. For men, the key muscles are identified by stopping urination midstream or by tightening the muscles as though to avoid passing gas. Again, only stop midstream this one time.
Men begin strengthening the pelvic floor muscles by hold and releasing tensing of muscles for three-second intervals, working up to 10-second sets.
Another lifestyle change is to avoid tobacco use. Smoking stimulates coughing, which may cause stress incontinence to form. Bladder cancer may also be caused by smoking, and urinary incontinence is an effect of this type of cancer.
If bladder leaks are still a problem, there are protective undergarments available for both men and women. There are also pads to line the underwear for smaller leaks.
Bladder Leakage Medications
Alone, or in conjunction with exercises, medication may be used to help weakened pelvic floor muscles. Often times, the same drugs used to treat muscle spasms or infection can be used.
Medications such as antimuscarinics to relax bladder muscles, tricyclic antidepressants to reduce spasms, and beta-3 agonists to stop involuntary contractions all may be used.
An in-office injection procedure may be done with bulking agents to plump up the tissue and narrow the bladder opening. This may involve the injection of carbon beads and collagen with a tube-like instrument called a cystoscope. This device allows for proper guidance into the urethra and bladder.
The injection of the medicine onabotulinumtoxinA, also known as Botox, may help strengthen weak bladder muscles and walls. It is intended to expand storing capacity for urine as it relaxes the bladder.
The above-mentioned medications may be used in men as well as alpha-blockers to relax the bladder neck and prostate muscle and 5-alpha reductase inhibitors to reduce a growing prostate that may be causing the urgency incontinence issue.
Bladder Leakage Surgery
If the bladder leakage is caused by a blockage within the bladder, surgery may resolve the issue. There also may be cases in both men and women where surgical implants of medical devices may help urine incontinence.
Medical devices may include a catheter to be inserted through the urethra and into the bladder for easy drainage of the bladder. Women may have a urethral insert disposable device placed to prevent leaks or a pessary ring inserted into the vagina. This stiff device applies pressure to the walls of the urethra and vagina to stop leakage.
Surgical procedures may include a retropubic suspension wherein the collapsed bladder neck is supported in place with sutures. It may be readjusted in place by a sling made of synthetic mesh tape or body tissue and is attached to the pubic bone area by stitches.
An artificial urinary sphincter, AUS, or a male sling procedure may be an option for men suffering from bladder leakage. The AUS is a pump-like device implanted to be used whenever the male urinates. The male sling is also known as a urethral compression procedure seeing the urethra supported.
An outpatient treatment offered in some cases is known as electrical nerve stimulation. Through percutaneous tibial nerve stimulation or sacral nerve stimulation, the bladder receives electrical pulses to regulate its activity.
Bladder leakage can be an embarrassing incident, especially when out in public, or during a morning jog. Losing voluntary control of urinating can make a person withdraw from social activities as well as their own life enjoyment.
There are treatments, both natural and medical, that may help alleviate the frequency of episodes, if not stop bladder leaks all together. By making several behavioral and lifestyle changes, urinary incontinence does not need to dictate your life.
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