What is urinary incontinence?
Urinary incontinence — loss of bladder control — may feel embarrassing and inconvenient, but it doesn’t have to disrupt your daily activities. At Penn Medicine, our specialized team has years of focused experience caring for people with all types of urinary incontinence.
Urinary incontinence (UI) is loss of bladder control that causes problems ranging from small leaks to sudden accidents without warning. Although UI is more common in older people, it’s not a normal part of aging. Rather, it’s usually a symptom of another condition, and treatment can help or even stop UI.
Our highly trained urinary incontinence team provides comprehensive care. We offer the most advanced treatment options for UI that can help you even if other treatments haven’t worked.
Urinary incontinence types and symptoms
UI has several types, each with different causes that require specific treatments. When you come to Penn Medicine, we do a thorough evaluation to determine the exact causes. With an accurate diagnosis, we can recommend the right treatment options for you.
The types of UI include:
- Stress incontinence: urine leaks when movements, such as laughing, coughing, sneezing, or exercising, put pressure on your bladder. Stress incontinence is the most common type of UI.
- Urge incontinence: you feel a strong, sudden urge to urinate, then the bladder squeezes and you urinate. Sometimes, you don’t have time to get to the toilet before urinating. You may feel the urge often, at night or when you hear running water. Urge incontinence is sometimes called overactive bladder (OAB).
- Mixed incontinence: some people have both stress and urge incontinence.
- Overflow incontinence: your bladder might not empty when you urinate, causing the bladder to become too full. Overflow UI can cause frequent or constant dribbling (urine leakage).
- Functional incontinence: physical or mental limitations can prevent you from getting to the toilet or removing clothing in time.
Causes of urinary incontinence
UI is often a symptom of another health condition, or it can result from certain lifestyle factors. UI can be temporary or long-term (chronic), and causes include:
- Beverages and foods that increase urine production and stimulate the bladder
- Constipation
- Medications, such as diuretics (water pills), certain antidepressants, antihistamines and cold medications
- Hysterectomy and other surgery that affects the female reproductive organs
- Menopause because lower levels of the estrogen hormone can weaken pelvic muscles
- Pregnancy and childbirth
- Benign prostatic hyperplasia (BPH) or enlarged prostate
- Surgery to remove the prostate
- Mental health conditions that affect cognition (thinking), such as dementia, anxiety, or severe depression
- Neurological disorders or injuries that affect the central nervous system (brain, spinal cord, and nerves) such as multiple sclerosis, Parkinson’s disease, stroke, or a tumor
- Obesity
- Obstruction (blockage) in your urinary tract, such as a tumor or urinary stone
- Urinary tract infections (UTIs)
How is urinary incontinence diagnosed?
It can feel awkward to talk about urinary incontinence — we understand, and we’re here to help. In a private, comfortable setting, we do a detailed evaluation to find the underlying causes of your symptoms.
We begin by asking you about your medical history and symptoms. We then do a physical exam with an internal pelvic exam to check your pelvic organs. We may ask you to keep a bladder diary for a few days to track urine leaks and other details that can help us determine the causes.
We can often diagnose the type and causes of UI with our thorough evaluation. If we need more information to confirm a diagnosis, you may need one or more tests, such as:
- Bladder stress test: if you experience urine leaks with certain movements, such as coughing or running, we ask you to do some of those activities. This test can provide more details about the loss of urine.
- Cystoscopy: we examine your urethra and bladder using a thin, tube-shaped scope with a tiny camera inserted through the urethra. Cystoscopy can show bladder inflammation, stones, or tumors.
- Pelvic ultrasound: this imaging test uses sound waves to create pictures of internal organs. We use ultrasound to check the bladder, urethra, and other pelvic organs for anything unusual that may be causing UI.
- Urine test: we take a sample of your urine to test for blood, signs of infection, kidney problems, or other causes of UI.
- Urodynamic testing: these tests check bladder capacity, urine flow, pressure inside the bladder, and other functions.
Urinary incontinence treatment at Penn Medicine
Your treatment options depend on the type of UI, what’s causing it, and how severe it is. That’s why it’s important to get an accurate diagnosis.
Our specialists work closely with you to develop a treatment plan that addresses underlying causes. You may need more than one treatment, and we begin with the least invasive options that improve your symptoms. Your treatment team may include:
- Urogynecologists: these doctors are specialists in female pelvic medicine, gynecology, and reconstructive surgery. Our urogynecologists have years of experience treating females with all types of incontinence and pelvic floor conditions.
- Urologists: these doctors specialize in conditions that affect the urinary system (bladder, kidneys) and the male genitals. They provide care for both males and females. Our urologists have completed the highest level of training to ensure you get specialized, expert care.
- Nurse practitioners: our nurse practitioners work specifically in urinary incontinence care. They provide nonsurgical treatment and support for you throughout your treatment.
Our team offers an integrated pelvic floor rehabilitation program to treat UI, which you can do along with other treatments. The program focuses on self-care and behavioral techniques including:
- Healthy eating plan: You can avoid foods and beverages that stimulate the bladder, and eat more fiber to relieve constipation.
- Pelvic floor exercises: Physical therapy can help strengthen your pelvic floor muscles to better support your bladder and other pelvic organs. Our specialized pelvic floor physical therapists work with you to customize a plan, teaching you exercises to do at home.
- Bladder training: These techniques help the bladder hold more urine and empty each time so you can better control the urge to urinate.
Our urogynecologists and nurse practitioner offer additional nonsurgical treatments in the office, including:
- Injections: For urge incontinence (overactive bladder), our urogynecologists can inject Botox® to help relax bladder wall muscles. Injections of bulking agents, such as collagen, in tissues surrounding the urethra help prevent bladder leaks due to stress incontinence.
- Medications: A wide variety of medications in pill form can relax the bladder, help prevent muscle spasms, and increase bladder capacity.
- Percutaneous tibial nerve stimulation (PTNS): To treat an overactive bladder, we place a thin needle electrode under the skin of your ankle near the tibial nerve. A stimulator sends mild electrical pulses through the needle to the tibial nerve and then to other nerves that control bladder function.
- Vaginal pessary: This small, reusable device goes into your vagina to support pelvic floor muscles and the urethra. Pessaries are an option for women with stress incontinence.
If non-surgical treatments aren’t working for you, our urogynecologists offer several surgeries and procedures to treat UI. As specialists in female pelvic medicine and reconstructive surgery, we have years of training and experience in the latest minimally invasive techniques. With smaller incisions, these procedures can help you recover faster and reduce your risk of complications.
We specialize in minimally invasive approaches including:
- Laparoscopic: This approach uses a few small incisions on the abdomen (belly) to access the area for treatment.
- Robotic-assisted: In a laparoscopic procedure, we use robotic equipment to operate surgical instruments, which make more precise movements than a human hand.
- Vaginal (for females): We make small incisions in the vagina to access the area near the urethra.
Procedures include:
- Sling procedures: These procedures use your tissue, donor tissue, or synthetic material to support the urethra and help it stay closed to prevent leaks.
- Suspension procedure: This procedure secures the urethra and bladder neck to strengthen their ability to close and prevent leaks.
- Neuromodulation device: Your doctor implants a small stimulator device under the skin in your buttock. It sends mild electrical pulses to the nerves that control bladder function.
Penn Medicine: clinical trials for urinary incontinence treatment
Penn Medicine Urogynecology is one of the few research sites affiliated with the Pelvic Floor Disorders Network (PFDN), a research and clinical care network sponsored by the National Institutes of Health. Our urogynecologists are at the forefront of care through their participation in PFDN and other research.
Through clinical trials, eligible patients have access to promising new diagnostic technologies, non-surgical therapies, and surgical techniques before they’re available to the public.