Updated July 28, 2006

Urinary Incontinence

by Jeanette S. Brown, M.D., and Janis Luft, N.P., M.S.N.

“I wake up four or five times a night to use the bathroom. I’m exhausted!” “I must know every public restroom in the city.” “I had to cancel the trip I was planning because I didn’t think my bladder could handle it.” “I’ve stopped going to my exercise class because I leak.”

Do these comments sound familiar? Current estimates suggest that 13 million Americans experience urinary incontinence—the involuntary loss of urine—and that up to 85% of those affected are women. Like many other health problems, the risk of developing incontinence increases as a person ages. By the year 2030, 20% of the U.S. population will be older than 65, meaning the number of Americans affected by urinary incontinence will almost certainly grow.

Incontinence can have an enormous effect on a woman’s quality of life, including her emotional well-being and ability to carry out ordinary, daily activities. As one woman put it, “Incontinence doesn’t kill you; it just takes your life away.” It is also a costly problem. An estimated $25 to $36 billion is spent every year on medical and personal care costs associated with incontinence, from evaluations and treatments to extra loads of laundry. But the human toll in embarrassment, shame, social isolation, and depression is inestimable.

Diabetes and urinary incontinence
Women with diabetes have up to a 70% greater risk of developing urinary incontinence. Diabetes is also associated with an earlier onset and increased severity of incontinence. Classically, it was thought that the most common problem for women with diabetes was bladder cystopathy (also known as neurogenic bladder), a disorder characterized by diminished bladder sensation and impaired ability of the bladder muscle to contract, resulting in an inability to empty the bladder. However, bladder cystopathy most likely represents end-stage bladder failure. It is now thought that urinary incontinence in women with diabetes is a progressive condition, encompassing a broad spectrum of symptoms including urinary urgency (or a strong pressure to void), frequent daytime and nighttime voiding, and incontinence.

The exact mechanism by which diabetes causes incontinence is not yet known. However, it is known that high blood sugar can cause an increase in the amount of urine produced, resulting in urgency, frequent urination, and possibly incontinence. Similarly, complications associated with diabetes, such as autonomic neuropathy, may damage the nerves of the bladder to varying extents, possibly causing incontinence. Whether or not improved blood glucose control can improve bladder control in women with urinary incontinence and diabetes is currently under investigation.

Of course, diabetes is not the only cause of urinary incontinence. Some commonly used substances and drugs can also trigger incontinence or exacerbate existing incontinence as a side effect. For example, alcohol can contribute to urinary frequency, while diuretics (water pills) and caffeine can contribute to both frequency and urgency. People who take antidepressants in the class called SSRIs are also at an elevated risk of developing urinary incontinence. (Alternatively, a variety of drugs can lead to urinary retention.)

Types of urinary incontinence
Common types of incontinence are urge incontinence or overactive bladder, stress incontinence, and mixed incontinence. A relatively uncommon type of incontinence is called overflow incontinence.

Urge incontinence or overactive bladder. Urge incontinence is a loss of urine that is associated with a sudden, strong desire to urinate. A person with urge incontinence or overactive bladder may describe a mounting need to urinate or sudden urine loss while approaching the bathroom or front door of her home, when she hears the sound of running water, or when she is suddenly exposed to cold. Other symptoms include a need to urinate frequently and waking often during the night to urinate. Some people with overactive bladder manage to avoid wetting accidents by urinating very often and restricting fluids excessively. These strategies may work early on, but they fail as symptoms increase.

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Continence Resources

Jeanette S. Brown is Professor and Director at the University of California, San Francisco (UCSF) Women’s Continence Center (WCC), and Director of the UCSF Specialized Center of Research on Lower Urinary Tract Function in Women. Janis Luft is the Director of the UCSF WCC Pelvic Floor Rehabilitation Program.

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