Overactive bladder is caused by sudden, involuntary bladder contractions. Normally, the bladder expands with urine, much like a balloon. Though the stretching of the bladder wall sends increasingly stronger signals of fullness to the brain as its capacity is being reached, a healthy bladder contracts to expel urine only when given permission by its owner. An overactive bladder may contract at socially awkward times, even when the amount of urine in the bladder is small.
Stress incontinence. Urine loss that results from an increase in pressure on the bladder is called stress incontinence. Coughing, sneezing, laughing, exercising, lifting an object, and even just standing up can cause urine loss in people with this type of incontinence. Stress incontinence is not caused by emotional stress.
Stress incontinence can occur if the muscles supporting the urethra (the tube through which urine exits the bladder and body) are weakened and the urethra loses its ability to remain tightly closed when pressure hits the bladder.
Mixed incontinence. It is possible to have a combination of urge and stress incontinence symptoms. This condition is called mixed incontinence. Often one or another of the types will predominate.
Overflow incontinence. The bladder has two functions: storing and emptying urine. Most incontinence results from defects in ability of the bladder to store urine. Overflow incontinence, however, results from faulty emptying. In women—especially women with diabetes, who may have some nerve damage to the bladder—the bladder can lose its ability to contract well, causing emptying to become compromised. An overfull bladder tends to spill over, causing leaking accidents.
Functional incontinence. Some people lose bladder control because of factors not related to the urinary tract. If one is unable to walk to the bathroom, if arthritis makes removal of clothing difficult, or if cognitive impairment (from Alzheimer disease, for example) interferes with recognizing the signs of bladder fullness, loss of urine may result. People with these sorts of problems are said to have functional incontinence.
Treatment
The first step toward treating incontinence is to educate yourself about incontinence and bladder function, even before you see a doctor. Many resources are available (click here for some continence resources), and there are many simple approaches you can take toward better bladder control. Being well-informed will also be helpful when you seek treatment from a medical professional.
Next, discuss your incontinence with your primary physician or health-care provider. Ask about the treatments that he can offer for incontinence, and ask whether you should see a specialist. Keeping a diary that includes how often you urinate during the day, a record of the times and events surrounding leakage, and what you drink during the day can be helpful as both a management tool and a document of patterns and changes for you and your health-care provider.
The initial evaluation may be as simple as answering some questions about incontinence and having a urine test to check for a bladder infection. Many doctors will want to perform a pelvic exam to check for pelvic muscle strength and signs of pelvic organ prolapse, the dropping of the pelvic organs out of place, which can contribute to stress incontinence.
Some of the options for treating incontinence include behavioral treatments, drug therapy, devices, and, as a last resort, surgery. Losing excess weight can also help restore continence, although other methods are often prescribed simultaneously since a weight-loss program can take some time to show results.
Behavioral treatments. Because behavioral treatments are effective for most types of incontinence, and because they have no harmful side effects, learning pelvic muscle exercises, urge suppression techniques, and/or bladder retraining is a good first step toward regaining continence.
