Signs and Symptoms

• Not being able to hold your urine until you get to a bathroom
• Frequent and unusual urges to urinate

What Causes It?

• Stretched pelvic muscles from pregnancy and childbirth; women with gestational diabetes are at a higher risk
• Low estrogen levels in women (common during menopause)
• Enlarged prostate in men
• Side effects of certain medications
• Recurrent urinary tract infections (UTIs)
• Frequent constipation
• Being overweight
• Diseases that damage nerve pathways from the bladder to the brain, such as Alzheimer's disease, stroke, or multiple sclerosis
• Weakened muscles that control urination, such as urethral sphincter and pelvic floor muscles
• Hip dysfunction and prior hip surgery

What to Expect at Your Doctor's Office

Your doctor will give you a physical examination and ask questions about:

• Any past prostate problems
• Pregnancy or hysterectomy
• Your pattern of urinating
• When your urine leakage occurs
• Whether you strain or have discomfort when urinating

You may be asked to cough vigorously to see if it causes urine loss. This is a sign of stress incontinence.

Your doctor may suggest urine tests to find:

• Infection
• Urinary stones
• Diabetes
• Other underlying causes

Your doctor may order a pelvic ultrasound to look at your bladder, kidneys, and urethra.

Treatment Options

Treatment can help more than 80% of people with urinary incontinence. Exercise and behavioral therapies are most successful. But there are also several drugs available to help with urge incontinence, including:

• Tolterodine (Detrol)
• Darifenacin (Enablex)
• Fesoterodine fumarate (Toviaz)

Options for urge incontinence that hasn't responded to medication include:

• Percutaneous tibial nerve stimulation (or PTNS), which involves electrical stimulation of the sacral nerve by way of the tibial nerve. This would be done in your doctor's office.
• InterStim Therapy, where a device is implanted that directly stimulates the sacral nerve.

Surgery may help women with stress incontinence and men with an enlarged prostate. Other options include:

• Catheters
• Urethral plugs
• Condom catheters
• Vaginal slings
• Absorbent pads or underwear

Recent studies suggest that midurethral slings are the most commonly performed surgical treatments for stress incontinence.

Complementary and Alternative Therapies

Common alternative therapies include:

• Kegel exercises. To strengthen pelvic floor muscles, squeeze and hold the muscles, then release. To find the muscles, pretend you are trying not to pass gas or trying to stop the flow of urine without tightening your buttocks or abdominals. Hold the muscles tight for a count of 10, then relax for a count of 10. Work your way up to 20 repetitions, twice daily.
• Biofeedback. Using a machine that shows you when you are exercising the right muscles can help you learn to do the exercises properly.
• Relaxation techniques. May help you go longer without urinating.
• Bladder retraining. Helps your body get used to going to the bathroom on a regular schedule.

Other alternative therapies include:

• Acupuncture
• Hypnosis
• Yoga
• Herbal therapies

Always tell your doctor about the herbs and supplements you are using.

• Cranberries and blueberries contain substances that keep bacteria from sticking to the bladder. This may help prevent urinary tract infections that can make incontinence worse. However, some people with overactive bladder may find that cranberries irritate their bladder because they are acidic. People who are allergic to aspirin, and those who take other medications, should not take large amounts of cranberry supplements.
• Avoid caffeine, alcohol, artificial sweeteners, and tobacco.
• Drink 6 to 8 glasses of filtered water daily. While you may think you should limit liquids, not drinking enough water can irritate the bladder and make incontinence worse.
• Some foods may make urge incontinence worse for some people, including citrus fruits, tomatoes, spicy foods, caffeine, and carbonated sodas. In one study, researchers linked caffeine consumption of about 2 cups of coffee daily (250 mg) with moderate-to-severe urinary incontinence among men.
• Exercise for at least 30 minutes daily, 5 days a week.

One study suggested that chondroitin sulfate helped with symptoms of urge incontinence and overactive bladder, as well as the medication Detrol. More studies are needed to know whether it really works. Avoid chondroitin sulfate if you are allergic to shellfish or have asthma. Chondroitin sulfate can increase the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix). Pregnant or breastfeeding women should not take chondroitin sulfate. Men with prostate cancer should ask their doctor before taking chondroitin.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 g) herb per cup of hot water. Steep covered 5 to 10 minutes for leaves or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted. Speak to your doctor about any herbal therapies you are considering.

One laboratory study suggested that St. John's wort (Hypericum perforatum) has the potential to help with urinary incontinence. But this use has not been tested in humans. St. John's wort can interfere with many medications. Check with your doctor before taking St. John's wort if you are taking prescription medications, including birth control pills. St. John's wort can affect mood, so people with a history of psychiatric illness should ask their doctors before taking it. DO NOT take St. John's wort if you are trying to become pregnant, or if you have a history of liver disease.

The following are some of the most common remedies used for urinary incontinence. Usually, the dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until symptoms improve.

• Causticum. For stress incontinence, especially with retention from holding the urine and frequent urges to urinate.
• Natrum muriaticum. For stress incontinence, vaginal dryness, and pain during sex, especially with a history of grief.
• Pareira. For retention of urine from an enlarged prostate.
• Sepia. For stress incontinence with sudden urge to urinate, especially with prolapsed uterus and vaginitis.
• Zincum. For stress incontinence, urinary retention from prostate problems, and the inability to urinate while standing.

Acupuncture may help, depending on what's causing the incontinence. Acupuncture may also strengthen the urinary system. In one study, women who received 4 weekly bladder acupuncture treatments had significant improvement in symptoms of urinary incontinence compared to women who received placebo treatments.

Following Up

Exercise and behavioral therapy can help many people get rid of their symptoms. You have to stick with the changes for them to work, so it may help to have support from a loved one and close monitoring by your doctor.

Special Considerations

If you are pregnant, consult with your doctor before taking any medication. For men, regular prostate examinations can find problems early. If the condition worsens, patients may suffer from depression, recurrent urinary tract infections, and social isolation. Stress urinary incontinence and urge urinary incontinence may lead to sexual dysfunction.

Supporting Research

Abed H, Rogers R. Urinary Incontinence and Pelvic Organ Prolapse: Diagnosis and Treatment for the Primary Care Physician. Medical Clinics of North America. 2008;92(5):1273-1293.

Barbosa AM, Marini G, Piculo F, Rudge CV, Calderon IM, Rudge MV. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study. Sao Paulo Med J. 2013;131(2):95-99.

Buchsbaum GM. Urinary incontinence and pelvic organ prolapse. Minerva Urol Nefrol. 2006;58(4):311-319.

Burgio K. Behavioral treatment of urinary incontinence, voiding dysfunction, and overactive bladder. Obstetrics and Gynecology Clinics. 2009;36(3):475-491.

Capasso R, Borrelli F, Capasso F, et al. Inhibitory effect of the antidepressant St. John's wort (hypericum perforatum) on rat bladder contractility in vitro. Urology. 2004;64(1):168-172.

Cherniack EP. Biofeedback and other therapies for the treatment of urinary incontinence in the elderly. Altern Med Rev. 2006;11(3):224-231.

Chuang CM, Lin IF, Horng HC, Hsiao YH, Shyu IL, Chou P. The impact of gestational diabetes mellitus on postpartum urinary incontinence: a longitudinal cohort study on singleton pregnancies. BJOG. 2012;119(11):1334-1343.

Courtesse A, Cardot V. Recommendations for the clinical evaluation of non-neurological female urinary incontinence. Prog Urol. 2007;17(6 Suppl 2):1242-1251.

Davis NJ, Vaughan CP, Johnson TM, et al. Caffeine intake and its association with urinary incontinence in United States men: results from National Health and Nutrition Examination Surveys 2005-2006 and 2007-2008. J Urol. 2013;189(6):2170-2174.

Dean NM, Ellis G, Wilson PD, Herbison GP. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2006;3:CD002239.

Devore EE, Townsend MK, Resnick NM, Grodstein F. The epidemiology of urinary incontinence in women with type 2 diabetes. J Urol. 2012;188(5):1816-1821.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-275.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-316.

Djavan B. Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life. Urology. 2003;62(3 Suppl 1):6-14.

Emmons SL, Otto L. Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol. 2005;106(1):138-143.

Erdem N, Chu FM. Management of overactive bladder and urge urinary incontinence in the elderly patient. Am J Med. 2006;119(3 Suppl 1):29-36.

Fan HL, Chan SS, Law TS, Cheung RY, Chung TK. Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study. Aust N Z J Obstet Gynaecol. 2013;53(3):298-304.

Ferri FF. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Gauruder-Burmester A, Wildt B, Tunn R. Treatment of overactive bladder with sodium chondroitin sulphate. Zentralbl Gynakol. 2006;128(6):336-340.

Griebling TL. Urinary incontinence in the elderly. Clin Geriatr Med. 2009;25(3):445-457.

Hashim H, Abrams P. Pharmacological management of women with mixed urinary incontinence. Drugs. 2006;66(5):591-606.

Hay-Smith EJ, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments for urinary incontinence in women. Cochrane Database Syst Rev. 2006;(1):CD005654.

Hermieu JF. Recommendations for the urodynamic examination in the investigation of non-neurological female urinary incontinence. Prog Urol. 2007;17(6 Suppl 2):1264-1284.

Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013;87(9):634-640.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-1456.

Lee E, Nitti V, Brucker B. Midurethral slings for all stress incontinence. Urol Clin North Am. 2012;39(3):299-310.

Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal, and dual incontinence in the Nurses' Health Study. Obstet Gynecol. 2013;122(3):539-545.

McKertich K. Urinary incontinence-assessment in women: stress, urge or both? Aust Fam Physician. 2008;37(3):112-117.

Myers DL. Female mixed urinary incontinence: a clinical review. JAMA. 2014;311(19):2007-2014.

Naranjo-Ortiz C, Clemente-Ramos LM, Salinas-Casado J, Mendez-Rubio S. Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics. Arch Esp Urol. 2012;65(10):879-886.

Smith PP, McCrery RJ, Appell RA. Current trends in the evaluation and management of female urinary incontinence. CMAJ. 2006;175(10):1233-1240.

Su CC, Sun BY, Jiann BP. Association of urinary incontinence and sexual function in women. Int J Urol. 2015;22(1):109-113.

Tamaki T, Oinuma K, Shiratsuchi H, Akita K, Iida S. Hip dysfunction-related urinary incontinence: a prospective analysis of 189 female patients undergoing total hip arthroplasty. Int J Urol. 2014;21(7):729-731.

Tenfelde S, Janusek LW. Yoga: abiobehavioral approach to reduce symptom distress in women with urge urinary incontinence. J Altern Complement Med. 2014;20(10):737-742.

Trutnovsky G, Rojas RG, Mann KP, Dietz HP. Urinary incontinence: the role of menopause. Menopause. 2014;21(4):399-402.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.