Urinary incontinence: Signs, treatments & when to talk to your doctor

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Do you have trouble making it to the bathroom when you need to go? Or maybe you’ve had an uncontrollable experience when laughing, coughing or sneezing? If so, you’re not alone.

Urinary incontinence is a fact of life for more than 13 million Americans. It’s most common among females (85%) and the elderly (50%), but it’s something that can affect anyone, says Dr. Lakisha Crigler, a medical director at BlueCross BlueShield of Tennessee.

“Urinary incontinence is a really difficult thing to live with,” says Dr. Crigler. “It’s really a quality of life issue, and one people often just live with because they don’t feel comfortable discussing it, even with their doctors.”

The good news is that urinary incontinence is treatable, and more options are available today than ever before.

What is urinary incontinence?

Dr. Crigler: Urinary incontinence (UI) refers to any involuntary leakage of urine.

Symptoms that may accompany UI include:

  • A strong, immediate urge to go (urgency)
  • Urinating more often than usual (frequency)
  • Waking from sleep to go (nocturia) or leaking urine while sleeping (nocturnal enuresis)

What are the different types of urinary incontinence?

Dr. Crigler: There are 4 main types of urinary incontinence.

1. Stress incontinence

Stress incontinence occurs when urine leaks because of bladder pressure and weakened muscles. This weakness is often the result of pregnancy, childbirth or menopause, which is why it affects females most.

Stress incontinence happens while exercising, laughing, talking, sneezing, coughing or having sex — any activity that causes you to bear down can make you leak.

2. Overactive bladder / urge incontinence

Overactive bladder is marked by a strong, sudden strong urge to urinate that feels impossible to stop. You may have urge incontinence if:

  • You used to be able to hold your urine but now frequently feel like you’re not going to make it to the bathroom, or
  • If you have trouble getting your pants down in time.

3. Functional incontinence

Functional incontinence happens when mental or physical disabilities prevent you from using the bathroom as needed.

  • Mental disabilities such as Alzheimer’s disease or dementia can lead people to forget they need to go.
  • Physical disabilities prevent people from making it to the bathroom on time. These include anyone who has difficulty walking, uses a wheelchair or suffers from conditions such as arthritis.

4. Overflow incontinence

Overflow incontinence happens when your body produces more urine than your bladder can hold, or when your bladder can’t empty completely. It’s often caused by damaged nerve endings that no longer receive the urge to urinate until it’s too late.

Are certain people more likely to be affected by urinary incontinence?

Dr. Crigler: Yes, urinary incontinence more often affects:

  • The elderly
  • Females who’ve experienced pregnancy, childbirth or menopause
  • Males who have prostate issues
  • People with nerve-ending issues, such as people with uncontrolled diabetes
  • People with neurological conditions such as Parkinson’s disease
  • People who are obese (extra weight puts a lot of pressure on the bladder)

How do you treat urinary incontinence?

Dr. Crigler: For most people, UI is caused by weak pelvic-floor muscles. This affects females more often because certain phases of life, such as menopause, are connected to a drop in estrogen, which contributes to pelvic-floor weakening.

Treatment of urinary incontinence may include any or all of the following:

Lifestyle changes

Some lifestyle changes may help treat UI by reducing strain on the body such as:

  • Limiting caffeine
  • Weight loss
  • Avoiding lifting heavy items
  • Smoking cessation

Kegel exercises 

Kegel exercises are used to strengthen the muscles that support the uterus, bladder, small intestine and rectum. They’re most effective when done over time, though they can be difficult to do properly because it’s hard to isolate pelvic-floor muscles.

Pelvic-floor physical therapy (PT)

Pelvic-floor PT helps people perform kegel and other exercises properly. This type of PT helps people train their pelvic floor and build muscles over time, which will ideally prevent surgery.


For a long time, medication was the only treatment for urge incontinence, despite adverse side effects such as dry mouth or drowsiness.


In serious cases, surgery may be needed to reinforce pelvic-floor tissue and add support.


A relatively new UI treatment, injections such as Botox can be used around the urethra to strengthen tissue, which makes urine less likely to leak.

What else should people know about urinary incontinence?

Dr. Crigler: Tell your healthcare provider if you’re experiencing any of the symptoms listed above, and ask about urine tests, especially if you haven’t had one in a while. Urine samples can test for infections of the urinary tract (UTI), bladder or prostate, and they’re a painless way to get a check on your health.

5 questions to ask at your next physical

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.