Urinary incontinence: What's your type?

Leaks. Dribbles. Strong—and inconvenient—urges to “go.” If you’ve experienced signs of incontinence like these, you’re not alone. This common health issue affects one in two women and one in six men ages 20 or older, according to a recent report from the Department of Veterans Affairs Medical Center in Birmingham, Alabama, published in The Journal of Urology. That’s at least 26 million Americans.

Not all urinary incontinence (UI) is the same. Understanding yours can be an important step toward finding the right solution. Incontinence can interfere with work, your social life, family events, and even your sex life, experts say. That’s why it’s always a good idea to talk about it with your doctor, something most women and men with incontinence aren’t doing, according to recent research. “Many women feel that UI is simply an unfortunate and embarrassing side effect of childbirth or aging. A physical nuisance they just have to deal with,” says Heidi D. Nelson, M.D., M.P.H., M.A.C.P., a principal investigator for the Women’s Preventive Services Initiative. The group recommends that U.S. doctors ask female patients about urinary incontinence every year. “In reality, UI adversely affects health and everyday function, and can often be treated by strengthening exercises, medication, or surgery in some cases.”

Here’s what you should know about the five most common types of incontinence that affect women and men.

Stress Incontinence: Unexpected Leaks at Really Inconvenient Moments

If you “lose” urine when you laugh, cough, sneeze, jump, or lift a heavy object, you likely have stress incontinence. For people with severe stress incontinence, even bending over or getting up from a chair can let lose a splash. Stress incontinence affects up to 45 percent of women aged 30 and older, but it sometimes happens to men, too.

The cause: Weakness in your pelvic floor—the hammock of muscle and connective tissue that supports your bladder and urethra (the tube that carries urine from your bladder to the outside of your body)—and/or weakness of the urethral sphincter, the ring of muscle that normally keeps your urethra shut tight until you decide it’s time to urinate. Everything from pregnancy and childbirth, to aging and prostate surgery and other surgical procedures involving the lower back and pelvic area can affect your pelvic floor, boosting your risk of stress incontinence. Being overweight and smoking boost your odds, too. For men, an enlarged prostate gland can also contribute to stress incontinence because it can push on your bladder. Some high blood pressure medications, such as ACE inhibitors, may also contribute to stress incontinence.

The fix: Lifestyle changes—such as not drinking large amounts of fluid at one time, skipping beverages that act as diuretics (like caffeinated or alcoholic drinks), weight loss, pelvic floor exercises, and surgery can all help. For women, vaginal estrogen cream and inserts—used in the urethra or vagina—may also help prevent leaking.

Urge Incontinence and Overactive Bladder: Suddenly, You’ve Got to Go

If you get sudden, strong, out-of-the-blue urges to urinate, you may have an overactive bladder. If you release urine at unwanted times as a result, it’s called urge incontinence. This type of incontinence affects about 30 percent of women and 40 percent of men after age 75, but can be a problem for young- and middle-aged adults, too.

The cause: Uncontrolled spasms of your detrusor muscle—the muscle tissue inside the wall of your bladder. Irritation (such as from certain foods or drinks), inflammation, and urinary tract infections can send this balloon-shaped muscle into contractions. Medications, such as diuretics, can contribute to urge incontinence and overactive bladder, too. So can a loss of nervous-system control caused by health conditions like diabetes, stroke, Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease.

The fix: Avoiding bladder irritants like caffeine, alcohol, and spicy or acidic foods and drinks may help. So can a bladder-retraining program that helps you regain control of the ability to hold it until you’re ready to go. Medications, injections, and nerve-stimulation procedures that relax your bladder muscle may help, too. 

Mixed Incontinence: Stress Plus Urge Incontinence

For 20 to 30 percent of people with ongoing urinary incontinence, the source of the problem is a combination of stress and urge incontinence. According to the National Association for Continence, the best approach to dealing with mixed incontinence is to first address the more serious problem. That’s a great reason to work with your doctor to find a solution for your incontinence.

Functional Incontinence: Getting to the Bathroom in Time

Common in older adults and in those with disabilities, functional incontinence happens when your bladder control is healthy and normal, but other factors get in the way of getting to a bathroom in time to urinate. Factors that can slow you down include arthritis and hand and finger dexterity problems that can make opening doors and toilet seats, and working buttons and zippers, difficult.

The fix: Make reaching the bathroom and using the toilet as simple as possible. Keeping the bathroom door open and a light on when not in use, adding grab bars and/or a raised toilet seat for easier sitting down, clearing obstacles and clutter out of the path to the bathroom, and wearing elastic-waist pants can all help.

Overflow Incontinence: When Urinating Is Difficult

For about one in 20 people with ongoing incontinence problems, the cause is urinary retention due to a blockage or bladder muscles that don’t contract enough. This leads to overflow incontinence—frequent leaks because your bladder is overly full.

The cause: Everything from childbirth to infections, diabetes, stroke, neurological problems like multiple sclerosis and polio, and pelvic injuries can damage nerves involved with urination or block your urethra, leading to urinary retention. In men, an enlarged prostate gland may also contribute to the problem by pressing on your urethra.

Treatments: Your doctor can determine the cause and recommend solutions including lifestyle changes, bladder retraining, medications, and surgery.