Editing Urinary incontinence

{{Short description|Uncontrolled leakage of urine}}
{{More medical citations needed|date=January 2025}}
{{Infobox medical condition (new)
| name            = Urinary incontinence
| image           = Female and Male Urethra.jpg
| caption         = Anatomy of the human [[urogenital system]]. The top diagram shows the female system, and the bottom shows the male system.
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| synonyms        = Involuntary urination
| field           = [[Urology]], [[gynecology]]
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<!-- Definition and symptoms -->

'''Urinary incontinence''' ('''UI'''), also known as '''involuntary urination''', is any uncontrolled [[urination|leakage of urine]]. It is a common and distressing problem, which may have a significant effect on [[quality of life]].<ref>{{cite book | vauthors = Ackley B | title = Nursing diagnosis handbook : an evidence-based guide to planning care |edition=9th| publisher = Mosby | location = Maryland Heights, Mo | year = 2010 | isbn = 9780323071505 }}</ref> Urinary incontinence is common in older women and has been identified as an important issue in [[geriatrics|geriatric]] health care.<ref>{{cite web |title=Urinary Incontinence in Older Adults |url=https://www.nia.nih.gov/health/urinary-incontinence-older-adults |access-date=18 March 2018 |website=National Institute on Aging}}</ref><ref>{{cite book | vauthors = Venes D | title = Taber's cyclopedic medical dictionary | publisher = F.A. Davis | location = Philadelphia | year = 2013 | isbn = 9780803629776 }}</ref> The term [[enuresis]] is often used to refer to urinary incontinence primarily in children, such as [[nocturnal enuresis]] (bed wetting).<ref>{{cite web|url=http://www.medicaldictionaryweb.com/Enuresis-definition/|title=Enuresis|work=medicaldictionaryweb.com}}</ref> UI is an example of a [[Social stigma|stigmatized]] medical condition, which creates barriers to successful management and makes the problem worse.<ref>{{Cite book |url=https://gutscharity.org.uk/wp-content/uploads/2018/08/Continence-needs-report-C402-August-2018.pdf |title="My bladder and bowel own my life." A collaborative workshop addressing the need for continence research. |publisher=Guts UK  |year=2018}}</ref> People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

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Pelvic surgery, pregnancy, childbirth, attention deficit disorder (ADHD), and menopause are major risk factors.<ref name=womengov>{{cite web | title = Urinary incontinence fact sheet | publisher=Womenshealth.gov | date = July 16, 2012| url = https://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html| access-date = 2016-12-05  }}</ref><ref>{{Cite journal |last1=de Sena Oliveira |first1=Ana Cecília |last2=Athanasio |first2=Bruno da Silva |last3=Mrad |first3=Flávia Cristina de Carvalho |last4=Vasconcelos |first4=Monica Maria de Almeida |last5=Albuquerque |first5=Maicon Rodrigues |last6=Miranda |first6=Débora Marques |last7=Simões E Silva |first7=Ana Cristina |date=2021 |title=Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis |url=https://pubmed.ncbi.nlm.nih.gov/34009466 |journal=Pediatric Nephrology (Berlin, Germany) |volume=36 |issue=11 |pages=3547–3559 |doi=10.1007/s00467-021-05083-y |issn=1432-198X |pmid=34009466}}</ref> Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners.<ref>{{cite web|url=http://www.nps.org.au/health_professionals/publications/nps_news/current/nps_news_66_managing_urinary_incontinence_in_primary_care|title=Medicinewise News|work=NPS MedicineWise|access-date=2013-09-24|archive-url=https://web.archive.org/web/20120630171922/http://www.nps.org.au/health_professionals/publications/nps_news/current/nps_news_66_managing_urinary_incontinence_in_primary_care|archive-date=2012-06-30|url-status=dead}}</ref> There are four main types of incontinence:<ref name=Mayo2008>{{cite book| vauthors = Ghosh AK |title=Mayo Clinic internal medicine concise textbook|date=2008|publisher=Mayo Clinic Scientific Press|location=Rochester, MN|isbn=9781420067514|page=339|url=https://books.google.com/books?id=YJtodBwNxokC&pg=PA339}}</ref>
* [[Urge incontinence]] due to an overactive bladder
* [[Stress incontinence]] due to "a poorly functioning urethral sphincter muscle (intrinsic sphincter deficiency) or to hypermobility of the bladder neck or urethra"<ref>{{Cite book| vauthors = Santoro GA, Murad-Regadas S, Causa L, Mellgren A  |url= https://www.worldcat.org/oclc/863638540|title=Pelvic Floor Disorders: Surgical Approach|date=19 November 2013|publisher=Springer|isbn=978-88-470-5441-7| veditors = Gaspari AL, Pierpaolo S |location=Milan|pages=58|oclc=863638540 }}</ref>
* [[Overflow incontinence]] due to either poor bladder contraction or blockage of the urethra
* [[Mixed incontinence]] involving features of different other types

<!-- Treatment -->
Treatments include behavioral therapy, [[pelvic floor muscle training]], [[bladder training]], medication, surgery, and electrical stimulation.<ref name=Sham2012/> Treatments that incorporate behavioral therapy are more likely to improve or cure stress, urge, and mixed incontinence, whereas, there is limited evidence to support the benefit of hormones and periurethral bulking agents.<ref>{{cite journal |vauthors=Balk EM, Rofeberg VN, Adam GP, Kimmel HJ, Trikalinos TA, Jeppson PC |date=April 2019 |title=Pharmacologic and Nonpharmacologic Treatments for Urinary Incontinence in Women: A Systematic Review and Network Meta-analysis of Clinical Outcomes |journal=Annals of Internal Medicine |volume=170 |issue=7 |pages=465–479 |doi=10.7326/M18-3227 |pmid=30884526 |s2cid=83458685 |doi-access=}}</ref> The complications and long-term safety of the treatments is variable.<ref name=Sham2012>{{cite journal | vauthors = Shamliyan T, Wyman J, Kane RL | title = Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness | journal = Comparative Effectiveness Reviews | date = April 2012 | pmid = 22624162 | url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0042108 | publisher = Agency for Healthcare Research and Quality (US) | series = AHRQ Comparative Effectiveness Reviews }}</ref>
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==Causes==
Urinary incontinence can result from both [[Urology|urologic]] and non-urologic causes. Urologic causes can be classified as either [[Urinary bladder|bladder]] dysfunction or [[Urethral sphincters|urethral sphincter]] incompetence and may include [[Overactive bladder|detrusor overactivity]], poor bladder compliance, [[urethral hypermobility]], or [[intrinsic sphincter deficiency]]. Non-urologic causes may include [[infection]], medication or drugs, psychological factors, [[polyuria]], [[hydrocephalus]],<ref>{{cite journal | vauthors = Edwards RJ, Dombrowski SM, Luciano MG, Pople IK | title = Chronic hydrocephalus in adults | journal = Brain Pathology | volume = 14 | issue = 3 | pages = 325–336 | date = July 2004 | pmid = 15446589 | doi = 10.1111/j.1750-3639.2004.tb00072.x | pmc = 8096062 }}</ref> [[fecal impaction|stool impaction]], and restricted mobility.<ref>{{cite web|title=American Urological Association - Medical Student Curriculum: Urinary Incontinence|url=http://www.auanet.org/education/auauniversity/medical-student-education/medical-student-curriculum/urinary-incontinence|website=www.auanet.org|access-date=11 January 2018}}</ref> The causes leading to urinary incontinence are usually specific to each sex, however, some causes are common to both men and women.{{citation needed|date=April 2021}}

=== Women ===
[[File:1116 Muscle of the Female Perineum.png|alt=Pelvic floor muscles in women|thumb|upright=1.5|Pelvic floor muscles in women]]
The most common types of urinary incontinence in women are [[Stress incontinence|stress urinary incontinence]] and [[Overactive bladder|urge urinary incontinence]]. Women that have symptoms of both types are said to have "mixed" urinary incontinence. After [[menopause]], [[estrogen]] production decreases and, in some women, [[urethra]]l tissue will demonstrate [[atrophy]], becoming weaker and thinner, possibly playing a role in the development of urinary incontinence.<ref name="womengov" />

[[Stress incontinence|Stress urinary incontinence]] in women is most commonly caused by loss of support of the [[urethra]], which is usually a consequence of damage to [[Pelvic floor|pelvic support structures]] as a result of [[pregnancy]], childbirth, [[obesity]], age, among others.<ref>{{Cite web|title=Urinary incontinence - Causes|url=https://www.nhs.uk/conditions/urinary-incontinence/causes/|date=2017-10-23|website=nhs.uk|language=en|access-date=2020-05-08}}</ref> About 33% of all women experience urinary incontinence after giving birth, and women who deliver vaginally are about twice as likely to have urinary incontinence as women who give birth via a [[Caesarean section]].<ref>{{cite journal | vauthors = Thom DH, Rortveit G | title = Prevalence of postpartum urinary incontinence: a systematic review | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 89 | issue = 12 | pages = 1511–1522 | date = December 2010 | pmid = 21050146 | doi = 10.3109/00016349.2010.526188 | s2cid = 18385231 | doi-access = free }}</ref> Stress incontinence is characterized by leaking of small amounts of urine with activities that increase abdominal pressure such as coughing, sneezing, laughing and lifting. This happens when the urethral sphincter cannot close completely due to the damage in the sphincter itself, or the surrounding tissue.  Additionally, frequent exercise in high-impact activities can cause [[athletic incontinence]] to develop. Urge urinary incontinence, is caused by uninhibited contractions of the [[detrusor muscle]], a condition known as [[Overactive bladder|overactive bladder syndrome]]. This type of urinary incontinence is more commonly seen in women of older age.<ref name="auto">{{Cite report |url=https://www.pcori.org/sites/default/files/PCORI-AHRQ-Nonsurgical-Treatments-Urinary-Incontinence-Women-Systematic-Review-Update-Report-August-2018.pdf |title=Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update |last1=Balk |first1=Ethan |last2=Adam |first2=Gaelen P. |date=2018-08-08 |publisher=Agency for Healthcare Research and Quality (AHRQ) |issue=Comparative Effectiveness Review No. 212 |doi=10.23970/ahrqepccer212 |location=Rockville, MD |last3=Kimmel |first3=Hannah |last4=Rofeberg |first4=Valerie |last5=Saeed |first5=Iman |last6=Jeppson |first6=Peter |last7=Trikalinos |first7=Thomas}}

Also available at: https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-212-urinary-incontinence-updated.pdf</ref> It is characterized by leaking of large amounts of urine in association with insufficient warning to get to the bathroom in time.{{citation needed|date=April 2021}}

=== Men ===
[[File:Prostatic urethra.svg|alt=prostatic urethra|thumb|upright=1.5|The prostate with the urethra passing through it ([[prostatic urethra]])]]
[[Overactive bladder|Urge incontinence]] is the most common type of incontinence in men.<ref name="Clemens_2022">{{Cite web | vauthors = Clemens JQ | date = 3 January 2022 | veditors = O'Leary MP, Law K |title=Urinary Incontinence in Men|url=https://www.uptodate.com/contents/urinary-incontinence-in-men|work = UptoDate|access-date=8 May 2020}}</ref> Similar to women, urine leakage happens following a very intense feeling of urination, not allowing enough time to reach the bathroom, a condition called [[Overactive bladder|overactive bladder syndrome]]. In men, the condition is commonly associated with [[benign prostatic hyperplasia]] (an enlarged prostate), which causes [[bladder outlet obstruction]], a dysfunction of the [[detrusor muscle]] (muscle of the [[Urinary bladder|bladder]]), eventually causing [[Overactive bladder|overactive bladder syndrome]], and the associated incontinence.<ref name="Clemens_2022" />

[[Stress incontinence|Stress urinary incontinence]] is the other common type of incontinence in men, and it most commonly happens after prostate surgery.<ref name="Wang">{{cite journal | vauthors = Wang W, Huang QM, Liu FP, Mao QQ | title = Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis | journal = BMC Urology | volume = 14 | issue = 1 | pages = 99 | date = December 2014 | pmid = 25515968 | pmc = 4274700 | doi = 10.1186/1471-2490-14-99 | doi-access = free }}</ref> [[Prostatectomy]], [[transurethral resection of the prostate]], [[prostate brachytherapy]], and [[Radiation therapy|radiotherapy]] can all damage the [[Urethral sphincters|urethral sphincter]] and surrounding tissue, causing it to be incompetent. An incompetent urethral sphincter cannot prevent urine from leaking out of the urinary bladder during activities that increase the intraabdominal pressure, such as coughing, sneezing, or laughing. Continence usually improves within 6 to 12 months after prostate surgery without any specific interventions, and only 5 to 10% of people report persistent symptoms.<ref name="Clemens_2022" />

=== Both ===
* Age is a risk factor that increases both the severity and prevalence of UI
* [[Polyuria]] (excessive urine production) of which, in turn, the most frequent causes are: uncontrolled [[diabetes mellitus]], [[primary polydipsia]] (excessive fluid [[drinking]]), [[central diabetes insipidus]] and [[nephrogenic diabetes insipidus]].<ref name="merck">{{cite web | vauthors = Maddukuri G | date = December 2022 | title = Pathophysiology of Polyuria | url = http://www.merck.com/mmpe/sec17/ch226/ch226i.html | work = [[Merck Manual]] }}</ref> Polyuria generally causes [[urinary urgency]] and [[urinary frequency|frequency]], but does not necessarily lead to incontinence.
* Neurogenic disorders like [[multiple sclerosis]], [[spina bifida]], [[Parkinson's disease]], [[stroke]]s and [[spinal cord injury]] can all interfere with nerve function of the bladder.<ref name="Thomas_2019">{{cite journal | vauthors = Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL | title = Interventions for treating urinary incontinence after stroke in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 2 | pages = CD004462 | date = February 2019 | pmid = 30706461 | pmc = 6355973 | doi = 10.1002/14651858.CD004462.pub4 }}</ref> This can lead to [[neurogenic bladder dysfunction]]
* [[Overactive bladder|Overactive bladder syndrome]]. However, the etiology behind this is usually different between men and women, as mentioned above.
* Other suggested risk factors include [[smoking]], caffeine intake and [[Depression (mood)|depression]]

==Mechanism==
=== Adults ===
The body stores urine—water and wastes removed by the kidneys—in the [[urinary bladder]], a balloon-like organ. The bladder connects to the [[urethra]], the tube through which urine leaves the body.<ref>{{cite journal | vauthors = Andersson KE, Arner A | title = Urinary bladder contraction and relaxation: physiology and pathophysiology | journal = Physiological Reviews | volume = 84 | issue = 3 | pages = 935–986 | date = July 2004 | pmid = 15269341 | doi = 10.1152/physrev.00038.2003 }}</ref>{{citation needed|date=April 2021}}

Continence and [[micturition]] involve a balance between [[urethra]]l closure and [[detrusor]] muscle activity (the muscle of the bladder). During [[urination]], [[detrusor muscle]]s in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, [[sphincter]] muscles surrounding the urethra relax, letting urine pass out of the body.  The [[Urethral sphincters|urethral sphincter]] is the muscular ring that closes the outlet of the urinary bladder preventing urine to pass outside the body. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the [[Urinary bladder|bladder]], and maintaining continence.<ref>{{cite journal | vauthors = DeLancey JO | title = Anatomy and physiology of urinary continence | journal = Clinical Obstetrics and Gynecology | volume = 33 | issue = 2 | pages = 298–307 | date = June 1990 | pmid = 2190733 | doi = 10.1097/00003081-199006000-00014 | s2cid = 43806356 }}</ref> The urethra is supported by [[Pelvic floor|pelvic floor muscles]] and tissue, allowing it to close firmly. Any damage to this balance between the [[detrusor muscle]], [[Urethral sphincters|urethral sphincter]], supportive tissue and nerves can lead to some type of incontinence .{{citation needed|date=April 2021}}

For example, [[Stress incontinence|stress urinary incontinence]] is usually a result of the incompetent closure of the urethral sphincter. This can be caused by damage to the sphincter itself, the muscles that support it, or nerves that supply it. In men, the damage usually happens after prostate surgery or radiation,<ref name="Clemens_2022" /> and in women, it's usually caused by childbirth and pregnancy.<ref>{{cite journal | vauthors = DeLancey JO | title = The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment | journal = World Journal of Urology | volume = 15 | issue = 5 | pages = 268–274 | date = 1997-10-01 | pmid = 9372577 | doi = 10.1007/BF02202011 | hdl-access = free | s2cid = 12952663 | hdl = 2027.42/47055 }}</ref> The pressure inside the abdomen (from coughing and sneezing) is normally transmitted to both urethra and bladder equally, leaving the pressure difference unchanged, resulting in continence. When the sphincter is incompetent, this increase in pressure will push the urine against it, leading to incontinence.{{citation needed|date=April 2021}}

Another example is urge incontinence. This incontinence is associated with sudden forceful contractions of the [[detrusor muscle]] (bladder muscle), leading to an intense feeling of urination, and incontinence if the person does not reach the bathroom on time. The syndrome is known as [[Overactive bladder|overactive bladder syndrome]], and it's related to dysfunction of the detrusor muscle.<ref>{{Cite web|title=Overactive Bladder (OAB): Symptoms, Diagnosis & Treatment | work = Urology Care Foundation |url= https://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab) |access-date=2020-05-08}}</ref>

===Children===
[[File:Voiding dysfunction.svg|thumb|upright=1.6|Voiding dysfunction]]
{{main|Enuresis}}
Urination, or voiding, is a complex activity. The bladder is a balloon-like muscle that lies in the lowest part of the abdomen. The bladder stores urine and then releases it through the urethra, which is the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord and the brain.{{citation needed|date=April 2021}}

The bladder is made of two types of muscles: the detrusor and the sphincter. The detrusor is a muscular sac that stores urine and squeezes to empty. Connected to the bottom or next of the bladder, the sphincter is a circular group of muscles that automatically stays contracted to hold the urine in. It will automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.{{citation needed|date=April 2021}}

A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system develops. The child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.{{citation needed|date=June 2022}}

Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.{{citation needed|date=June 2022}}

==Diagnosis==
[[File:Ultrasound of trabeculated urinary bladder.jpg|alt=Ultrasound of the urinary bladder|thumb|upright=1.4|Ultrasound of the urinary bladder of an 85-year-old man. It shows a trabeculated wall, which is a sign of [[urinary retention]].]]
The pattern of voiding and urine leakage is important as it suggests the type of incontinence. Other points include straining and discomfort, use of drugs, recent surgery, and illness.{{citation needed|date=June 2022}}

The [[physical examination]] looks for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.{{citation needed|date=June 2022}}

Other tests include:<ref>{{Cite web | vauthors = Lukacz ES | date = 2 August 2023 | veditors = Schmader KE, Law K | title=Evaluation of Females with Urinary Incontinence|url=https://www.uptodate.com/contents/evaluation-of-females-with-urinary-incontinence|website=UptoDate}}</ref>
* [[Stress testing|Stress test]]&nbsp;– the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
* [[Urinalysis]]&nbsp;– urine is tested for evidence of infection, urinary stones, or other contributing causes.
* [[Blood test]]s&nbsp;– blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
* [[Ultrasound]]&nbsp;– sound waves are used to visualize the kidneys and urinary bladder, assess the capacity of the bladder before voiding, and the remaining amount of urine after voiding. This helps know if there's a problem in emptying.
* [[Cystoscopy]]&nbsp;– a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.
* [[Urodynamics]]&nbsp;– various techniques measure pressure in the bladder and the flow of urine.

People are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

Research projects that assess the [[efficacy]] of anti-incontinence therapies often quantify the extent of urinary incontinence. The methods include the 1-h pad test, measuring leakage volume; using a voiding diary, counting the number of incontinence episodes (leakage episodes) per day; and assessing of the strength of pelvic floor muscles, measuring the maximum vaginal squeeze pressure.

=== Main types ===
There are 4 main types of urinary incontinence:
# [[Stress incontinence]], also known as effort incontinence, is essentially due to incomplete closure of the urinary sphincter, due to problems in the sphincter itself or insufficient strength of the pelvic floor muscles supporting it. This type of incontinence is when urine leaks during activities that increase intra-abdominal pressure, such as coughing, sneezing or bearing down.<ref>{{Cite web|title=Urinary incontinence: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/003142.htm|access-date=2021-03-31| work = MedlinePlus | publisher = U.S. National Library of Medicine |language=en}}</ref>
# [[Urge incontinence]] is an involuntary loss of urine occurring while suddenly feeling the need or urge to urinate, usually secondary to [[Overactive bladder|overactive bladder syndrome]].
# [[Overflow incontinence]] is the incontinence that happens suddenly without feeling the urge to urinate and without necessarily doing any physical activities. It is also known as under-active bladder syndrome. This usually happens with chronic obstruction of the bladder outlet or with diseases damaging the nerves supplying the urinary bladder. The urine stretches the bladder without the person feeling the pressure, and eventually, it overwhelms the ability of the urethral sphincter to hold it back.<ref>{{Cite web|title=Overflow Incontinence | work = Michigan Medicine|url=https://www.uofmhealth.org/health-library/uh1227 |access-date=2020-05-08}}</ref>
# [[Mixed incontinence]] contains symptoms of multiple other types of incontinence. It is not uncommon in the elderly female population and can sometimes be complicated by [[urinary retention]].

=== Other types ===
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* [[Functional incontinence]] occurs when a person recognizes the need to urinate but cannot make it to the bathroom. The loss of urine may be large. There are several causes of functional incontinence including confusion, dementia, poor eyesight, mobility or dexterity, unwillingness to use the toilet because of depression or anxiety or inebriation due to alcohol.<ref name="au">{{cite web|title=Functional incontinence|url=http://www.health.gov.au/internet/main/publishing.nsf/Content/continence-what-functional.htm|year=2008|publisher=Australian Government Department of Health and Ageing|archive-url=https://web.archive.org/web/20080723150611/http://health.gov.au/internet/main/publishing.nsf/Content/continence-what-functional.htm <!-- Bot retrieved archive -->|archive-date=2008-07-23|access-date=2008-08-29}}</ref>  Functional incontinence can also occur in certain circumstances where no biological or medical problem is present. For example, a person may recognize the need to urinate but may be in a situation where there is no toilet nearby or access to a toilet is restricted.
* Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, an [[ectopic ureter]]). [[Fistula]]s caused by obstetric and gynecologic trauma or injury are commonly known as [[obstetric fistula]]s and can lead to incontinence. These types of vaginal fistulas include, most commonly, vesicovaginal fistula and, more rarely, ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a [[vaginogram]] or radiologically viewing the [[vaginal vault]] with instillation of contrast media.<ref name="pmid7265431">{{cite journal | vauthors = Macaluso JN, Appell RA, Sullivan JW | title = Ureterovaginal fistula detected by vaginogram | journal = JAMA | volume = 246 | issue = 12 | pages = 1339–1340 | date = September 1981 | pmid = 7265431 | doi = 10.1001/jama.246.12.1339 }}</ref>
* [[Nocturnal enuresis]] is episodic UI while asleep. It is normal in young children.
* Transient incontinence is temporary incontinence most often seen in pregnant women when it subsequently resolves after the birth of the child.<ref name="SangsawangSangsawang2013">{{cite journal | vauthors = Sangsawang B, Sangsawang N | title = Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment | journal = International Urogynecology Journal | volume = 24 | issue = 6 | pages = 901–912 | date = June 2013 | pmid = 23436035 | pmc = 3671107 | doi = 10.1007/s00192-013-2061-7 }}</ref>
* [[Giggle incontinence]] is an involuntary response to laughter. It usually affects children.
* Double incontinence. There is also a related condition for [[defecation]] known as [[fecal incontinence]]. Due to involvement of the same muscle group ([[levator ani]]) in bladder and bowel continence, patients with urinary incontinence are more likely to have fecal incontinence in addition.<ref name="Shamliyan 2007">{{cite journal | vauthors = Shamliyan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ | title = Prevention of urinary and fecal incontinence in adults | journal = Evidence Report/Technology Assessment | issue = 161 | pages = 1–379 | date = December 2007 | pmid = 18457475 | pmc = 4781595 }}</ref>  This is sometimes termed "double incontinence".
* [[Post-void dribbling]] is the phenomenon where urine remaining in the urethra after voiding the bladder slowly leaks out after urination.
* [[Coital incontinence]] (CI) is urinary leakage that occurs during either [[coitus|penetration]] or [[orgasm]] and can occur with a sexual partner or with [[masturbation]]. It has been reported to occur in 10% to 24% of sexually active women with pelvic floor disorders.<ref>{{cite web | vauthors = Karlovsky ME | url = http://www.femalepatient.com/html/arc/sig/uroG/articles/034_08_032.asp | archive-url = https://web.archive.org/web/20101122151307/http://www.femalepatient.com/html/arc/sig/uroG/articles/034_08_032.asp | archive-date = 22 November 2010 | title = Female Urinary Incontinence During Sexual Intercourse (Coital Incontinence): A Review | work = The Female Patient }}</ref>
* [[Climacturia]] is urinary incontinence at the moment of orgasm. It can be a result of radical [[prostatectomy]].

===Screening===
Yearly screening is recommended for women by the Women's Preventive Services Initiative (WPSI) and people who test positive in the screening process would need to be referred for further testing to understand how to help treat their condition.<ref name="O'Reilly_2018" /><ref>{{cite journal | vauthors = Armstrong C | title = Urinary Incontinence: Screening Recommendation from the WPSI | language = en-US | journal = American Family Physician | volume = 99 | issue = 3 | pages = 194 | date = February 2019 | pmid = 30702263 | url = https://www.aafp.org/pubs/afp/issues/2019/0201/p194.html }}</ref> Screening questions should inquire about what symptoms they have experienced, how severe the symptoms are, and if the symptoms affect their daily lives.<ref name="O'Reilly_2018">{{cite journal | vauthors = O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, Phipps M, Salganicoff A, Ramos D, Zahn C, Qaseem A | display-authors = 6 | title = Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative | journal = Annals of Internal Medicine | volume = 169 | issue = 5 | pages = 320–328 | date = September 2018 | pmid = 30105360 | doi = 10.7326/M18-0595 | s2cid = 51972975 | doi-access =  }}</ref> {{as of|2018}}, studies have not shown a change in outcomes with urinary incontinence screenings in women.<ref>{{cite journal | vauthors = Nelson HD, Cantor A, Pappas M, Miller L | title = Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative | journal = Annals of Internal Medicine | volume = 169 | issue = 5 | pages = 311–319 | date = September 2018 | pmid = 30105353 | doi = 10.7326/M18-0225 | s2cid = 51971188 }}</ref>

==Management==
Treatment options include conservative treatment, behavioral therapy, bladder retraining,<ref>{{cite web | title = Bladder retraining |url = http://www.ichelp.org/page.aspx?pid=368#how | archive-url = https://web.archive.org/web/20120301182023/http://www.ichelp.org/page.aspx?pid=368#how | archive-date = 1 March 2012 | work = Interstitial Cystitis Association | access-date = 13 July 2012 }}</ref> [[Interstitial cystitis#Pelvic floor treatments|pelvic floor therapy]], collecting devices (for men), fixer-occluder devices for incontinence (in men), medications, and surgery.<ref>{{cite journal | vauthors = Price N, Jackson SR | title = Clinical audit of the use of tension-free vaginal tape as a surgical treatment for urinary stress incontinence, set against NICE guidelines | journal = Journal of Obstetrics and Gynaecology | volume = 24 | issue = 5 | pages = 534–538 | date = August 2004 | pmid = 15369935 | doi = 10.1080/01443610410001722590 | s2cid = 10473508 }}</ref> Both nonpharmacological and pharmacological treatments may be effective for treating UI in non-pregnant women.<ref name="auto" /> All treatments, except hormones and [[Periurethral gland|periurethral]] bulking agents, are more effective than no treatment in improving or curing UI symptoms or achieving patient satisfaction.<ref name="auto"/><ref name="auto2"/> For urinary incontinence in women, it is typical in clinical practice to begin with behavioral therapy, then move on to oral medication if behavioral therapy is ineffective. If both behavioral therapy and oral medication are ineffective, the patient may be given bladder botox or neuromodulation therapy.<ref name="auto" />

=== Behavioral therapy, physical therapy and exercise ===
Behavioral therapy involves the use of both suppressive techniques (distraction, relaxation) and learning to avoid foods that may worsen urinary incontinence. This may involve avoiding or limiting consumption of caffeine and alcohol. Behavioral therapies, including bladder training, biofeedback, and pelvic floor muscle training, are most effective for improving urinary incontinence in women, with a low risk of adverse events.<ref>{{cite journal | vauthors = Balk EM, Adam GP, Corsi K, Mogul A, Trikalinos TA, Jeppson PC | title = Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review | journal = Journal of General Internal Medicine | volume = 34 | issue = 8 | pages = 1615–1625 | date = August 2019 | pmid = 31062225 | pmc = 6667523 | doi = 10.1007/s11606-019-05028-0 }}</ref><ref name="auto2">{{cite journal | vauthors = Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D | title = Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 9 | pages = CD012337 | date = September 2022 | pmid = 36053030 | pmc = 9437962 | doi = 10.1002/14651858.CD012337.pub2 | collaboration = Cochrane Incontinence Group }}</ref><ref>{{cite journal | vauthors = Imamura M, Williams K, Wells M, McGrother C | title = Lifestyle interventions for the treatment of urinary incontinence in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 12 | pages = CD003505 | date = December 2015 | pmid = 26630349 | pmc = 8612696 | doi = 10.1002/14651858.CD003505.pub5 | collaboration = Cochrane Incontinence Group }}</ref><ref name="auto" /> Behavioral therapy is not curative for urinary incontinence, but it can improve a person's quality of life. Behavioral therapy has benefits as both a monotherapy (behaviorial therapy alone) and as an adjunct to medications (combining different therapies) for symptom reduction.<ref name="Elavsky DrugTopics">{{cite journal| vauthors = Elavsky M |title=Urinary Incontinence: What Pharmacists Should Know|journal=DrugTopics|date=February 2018|volume=162|issue=2|page=24}}</ref> Time voiding while urinating and bladder training are techniques that use biofeedback. In time voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak.<ref name="auto" /> Biofeedback and muscle conditioning, known as bladder training, can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.<ref>{{cite web |author=Beaumont Health |title=Treatment for Incontinence |url=https://www.beaumont.org/treatments/incontinence-treatment |access-date=19 October 2018 |website=www.beaumont.org}}</ref>

Avoiding heavy lifting and preventing constipation may help with uncontrollable urine leakage. Stopping smoking is also recommended as it is associated with improvements in urinary incontinence in men and women.<ref>{{cite journal | vauthors = Wyman JF, Burgio KL, Newman DK | title = Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence | journal = International Journal of Clinical Practice | volume = 63 | issue = 8 | pages = 1177–1191 | date = August 2009 | pmid = 19575724 | pmc = 2734927 | doi = 10.1111/j.1742-1241.2009.02078.x }}</ref> Weight loss may also be helpful for people who are overweight to improve symptoms of incontinence.<ref name="Qa2014" /><ref>{{cite journal | vauthors = Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK | display-authors = 6 | title = Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis | journal = Clinical Obesity | volume = 11 | issue = 4 | pages = e12450 | date = August 2021 | pmid = 33955687 | doi = 10.1111/cob.12450 | hdl-access = free | s2cid = 233869987 | hdl = 10044/1/89229 | url = https://pure.ulster.ac.uk/en/publications/0730378b-974c-4c2d-bb92-2dc159a27548 }}</ref><ref name="auto2" />

Physical therapy can be effective for women in reducing urinary incontinence.<ref>{{cite journal | vauthors = López-Liria R, Varverde-Martínez ML, Padilla-Góngora D, Rocamora-Pérez P | title = Effectiveness of Physiotherapy Treatment for Urinary Incontinence in Women: A Systematic Review | journal = Journal of Women's Health | volume = 28 | issue = 4 | pages = 490–501 | date = April 2019 | pmid = 30575448 | doi = 10.1089/jwh.2018.7140 | s2cid = 58590966 }}</ref> [[Pelvic floor physical therapy|Pelvic floor physical therapists]] work with patients to identify and treat underlying pelvic muscle dysfunction that can cease urinary incontinence. They may recommend exercises to strengthen the muscles, [[electrostimulation]], or [[biofeedback]] treatments.<ref>{{cite journal | vauthors = Wallace SL, Miller LD, Mishra K | title = Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women | journal = Current Opinion in Obstetrics & Gynecology | volume = 31 | issue = 6 | pages = 485–493 | date = December 2019 | pmid = 31609735 | doi = 10.1097/GCO.0000000000000584 | s2cid = 204703488 }}</ref><ref>{{cite journal | vauthors = Rosenbaum TY | title = Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review | journal = The Journal of Sexual Medicine | volume = 4 | issue = 1 | pages = 4–13 | date = January 2007 | pmid = 17233772 | doi = 10.1111/j.1743-6109.2006.00393.x }}</ref> Exercising the muscles of the pelvis such as with [[Kegel exercise]]s are a first line treatment for women with stress incontinence.<ref name="Qa2014">{{cite journal | vauthors = Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P | title = Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians | journal = Annals of Internal Medicine | volume = 161 | issue = 6 | pages = 429–440 | date = September 2014 | pmid = 25222388 | doi = 10.7326/m13-2410 | s2cid = 15004955 | doi-access =  }}</ref> Efforts to increase the time between urination, known as [[bladder training]], is recommended in those with urge incontinence.<ref name="Qa2014" /> Both these may be used in those with mixed incontinence.<ref name="Qa2014" />

Physical therapy, both by itself and in combination with anticholinergic drugs, was found to be more successful in reducing urinary incontinence in women than anticholinergics by themselves.<ref name="auto"/>

Small vaginal cones of increasing weight may be used to help with exercise.<ref>{{cite web|title=How to Use Vaginal Weights|url=http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-url = https://web.archive.org/web/20130329212916/http://www.nationalincontinence.com/blog/how-to-use-vaginal-weights/ | archive-date = 29 March 2013 |publisher=National Incontinence|access-date=10 October 2012 |date=September 4, 2012 |author=Chelsea|work=Incontinence Blog - NationalIncontinence.com }}</ref><ref name="Herb2013">{{cite journal | vauthors = Herbison GP, Dean N | title = Weighted vaginal cones for urinary incontinence | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD002114 | date = July 2013 | volume = 2013 | pmid = 23836411 | pmc = 7086390 | doi = 10.1002/14651858.CD002114.pub2 }}</ref> They seem to be better than no active treatment in women with stress urinary incontinence, and have similar effects to training of pelvic floor muscles or [[electrostimulation]].<ref name="Herb2013" />

[[Biofeedback]] uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence. The evidence supporting the role for biofeedback devices in treating urinary incontinence is mixed.<ref name="Leonardo_2022">{{cite journal | vauthors = Leonardo K, Seno DH, Mirza H, Afriansyah A | title = Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials | journal = Neurourology and Urodynamics | volume = 41 | issue = 6 | pages = 1258–1269 | date = August 2022 | pmid = 35686543 | doi = 10.1002/nau.24984 | s2cid = 249545181 }}</ref> There is some very weak evidence that electrical stimulation that is low in frequency may be helpful in combination with other standard treatments for women with overactive bladder condition,<ref>{{cite journal | vauthors = Stewart F, Berghmans B, Bø K, Glazener CM | title = Electrical stimulation with non-implanted devices for stress urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 12 | pages = CD012390 | date = December 2017 | pmid = 29271482 | pmc = 6486295 | doi = 10.1002/14651858.CD012390.pub2 | collaboration = Cochrane Incontinence Group }}</ref> however, the evidence supporting a role for biofeedback combined with pelvic floor muscle training is very weak and likely indicates that biofeedback-assistance is not helpful when included with conservative treatments for overactive bladder.<ref name="Leonardo_2022" />

Preoperative pelvic floor muscle training in men undergoing radical prostatectomy was not effective in reducing urinary incontinence.<ref name="Wang" />

Alternative exercises have been studied for stress urinary incontinence in women.<ref name="Bø_2013">{{cite journal | vauthors = Bø K, Herbert RD | title = There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review | journal = Journal of Physiotherapy | volume = 59 | issue = 3 | pages = 159–168 | date = September 2013 | pmid = 23896331 | doi = 10.1016/S1836-9553(13)70180-2 | quote = There is not yet strong evidence that alternative exercise regimens can reduce urinary leakage in women with stress urinary incontinence. | doi-access = free }}</ref> Evidence was insufficient to support the use of [[Paula method]], [[abdominal muscle]] training, [[Pilates]], [[Tai chi]], [[breathing exercises]], postural training, and generalized fitness.<ref name="Bø_2013" />

===Devices===
[[File:Foley Catheter Drainage.png|alt=foley catheter|thumb|279x279px|Example of a [[foley catheter]]]]
Individuals who continue to experience urinary incontinence need to find a management solution that matches their individual situation. The use of mechanical devices has not been well studied in women, as of 2014.<ref>{{cite journal | vauthors = Lipp A, Shaw C, Glavind K | title = Mechanical devices for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | pages = CD001756 | date = December 2014 | pmid = 25517397 | pmc = 7061494 | doi = 10.1002/14651858.CD001756.pub6 }}</ref>
* [[External urine collection device|Collecting systems]] (for men) – consists of a sheath worn over the penis funneling the urine into a urine bag worn on the leg. These products come in a variety of materials and sizes for individual fit. Studies<ref name="pmid20950307">{{cite journal | vauthors = Chartier-Kastler E, Ballanger P, Petit J, Fourmarier M, Bart S, Ragni-Ghazarossian E, Ruffion A, Le Normand L, Costa P | display-authors = 6 | title = Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men | journal = BJU International | volume = 108 | issue = 2 | pages = 241–247 | date = July 2011 | pmid = 20950307 | doi = 10.1111/j.1464-410X.2010.09736.x | doi-access = free }}</ref> show that urisheaths and urine bags are preferred over absorbent products – in particular when it comes to 'limitations to daily activities'. Solutions exist for all levels of incontinence. Advantages with collecting systems are that they are discreet, the skin stays dry all the time, and they are convenient to use both day and night.  Disadvantages are that it is necessary to get measured to ensure proper fit, and in some countries, a prescription is needed.
* Absorbent products (include [[Incontinence pad|shields]], [[incontinence pad]]s, undergarments, protective underwear, briefs, diapers, [[adult diapers]] and underpants) are the best-known product types to manage incontinence. They are widely available in pharmacies and supermarkets. The advantages of using these are that they barely need any fitting or introduction by a healthcare specialist. The disadvantages with absorbent products are that they can be bulky, leak, have odors and can cause skin breakdown due to the constant dampness.
* [[Intermittent catheterisation|Intermittent catheters]] are single-use catheters that are inserted into the bladder to empty it, and once the bladder is empty they are removed and discarded. Intermittent catheters are primarily used for urinary retention (inability to empty the bladder), but for some people they can be used to reduce or avoid incontinence.  These are prescription-only medical devices.
* [[File:Pessaries.JPG|alt=Vaginal pessaries|thumb|321x321px|Different types of pessaries. These are inserted inside the vagina for support.]]Indwelling [[catheter]]s (also known as [[Foley catheter|foleys]]) are often used in hospital settings, or if the user is not able to handle any of the above solutions himself/herself (e.g. severe neurologic injury or neurodegenerative disease). These are also prescription-only medical devices. The indwelling catheter is typically connected to a urine bag that can be worn on the leg or hung on the side of the bed. Indwelling catheters need to be monitored and changed on a regular basis by a healthcare professional. The advantage of indwelling catheters is that because the urine is funneled away from the body, the skin remains dry. However, the disadvantage is that it is very common to incur urinary tract infections when using indwelling catheters.  Bladder spasms and other problems can also occur with long-term use of indwelling catheters.<ref name="pmid10670503">{{cite journal | vauthors = Cravens DD, Zweig S | title = Urinary catheter management | journal = American Family Physician | volume = 61 | issue = 2 | pages = 369–376 | date = January 2000 | pmid = 10670503 }}</ref>
* [[Penis clamp]] (or penis compression device), which is applied to compress the [[urethra]] to compensate for the malfunctioning of the natural urinary [[sphincter]], preventing leakage from the [[Urinary bladder|bladder]].<ref>{{cite journal | vauthors = Chong JT, Simma-Chiang V | title = A historical perspective and evolution of the treatment of male urinary incontinence | journal = Neurourology and Urodynamics | volume = 37 | issue = 3 | pages = 1169–1175 | date = March 2018 | pmid = 29053886 | doi = 10.1002/nau.23429 | s2cid = 4769215 }}</ref> This management solution is only suitable for light or moderate incontinence.
* [[Pessary|Vaginal pessaries]] for women are devices inserted into the vagina. This device provides support to the urethra which passes right in front of it, allowing it to close more firmly.

===Medications===
A number of medications exist to treat urinary incontinence including: [[fesoterodine]], [[tolterodine]] and [[oxybutynin]].<ref name=Med2012>{{cite journal | vauthors = Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL | title = Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review | journal = Annals of Internal Medicine | volume = 156 | issue = 12 | pages = 861–74, W301-10 | date = June 2012 | pmid = 22711079 | doi = 10.7326/0003-4819-156-12-201206190-00436 | s2cid = 29778547 }}</ref> These medications work by relaxing [[smooth muscle]] in the bladder.<ref>{{Cite web|url=https://www.drugs.com/monograph/oxybutynin-chloride.html|title=Oxybutynin Chloride Monograph for Professionals|website=Drugs.com|language=en|access-date=2019-08-05}}</ref><ref>{{Cite web|url=https://www.drugs.com/pro/tolterodine-tartrate-tablets.html|title=Tolterodine Tartrate Tablets - FDA prescribing information, side effects and uses|website=Drugs.com|language=en|access-date=2019-08-05}}</ref><ref>{{Cite web|url=https://www.drugs.com/pro/fesoterodine-tablets.html|title=Fesoterodine Tablets - FDA prescribing information, side effects and uses|website=Drugs.com|language=en|access-date=2019-08-05}}</ref> While some of these medications appear to have a small benefit, the risk of side effects are a concern.<ref name=Med2012/> Medications are effective for about one in ten people, and all medications have similar efficacy.<ref name="Med2012"/>

Medications are not recommended for those with stress incontinence and are only recommended in those with urge incontinence who do not improve with bladder training.<ref name=Qa2014/> While medications have been shown to be helpful with treating urinary incontinence, studies have shown that the first line treatment that's most effective against urinary incontinence is behavioral therapy.<ref name=":0" />

Injectable bulking agents may be used to enhance urethral support, however, they are of unclear benefit.<ref>{{cite journal | vauthors = Kirchin V, Page T, Keegan PE, Atiemo KO, Cody JD, McClinton S, Aluko P | title = Urethral injection therapy for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 7 | pages = CD003881 | date = July 2017 | pmid = 28738443 | pmc = 6483304 | doi = 10.1002/14651858.cd003881.pub4 }}</ref><ref>{{cite journal | vauthors = Matsuoka PK, Locali RF, Pacetta AM, Baracat EC, Haddad JM | title = The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review | journal = Clinics | volume = 71 | issue = 2 | pages = 94–100 | date = February 2016 | pmid = 26934239 | pmc = 4760362 | doi = 10.6061/clinics/2016(02)08 }}</ref>

===Surgery===
Women and men that have persistent incontinence despite optimal conservative therapy may be candidates for surgery. Surgery may be used to help [[Stress incontinence|stress]] or [[overflow incontinence]].<ref name=Mayo2008/> Common surgical techniques for stress incontinence include [[Urethral sling|slings]], tension-free vaginal tape, bladder suspension, artificial urinary sphincters, among others.<ref name=Mayo2008/> It is not clear if [[antibiotic]]s taken [[prophylactically]] after surgery are helpful at decreasing the risk of an infection after surgery.<ref>{{cite journal | vauthors = Temtanakitpaisan T, Buppasiri P, Lumbiganon P, Laopaiboon M, Rattanakanokchai S | title = Prophylactic antibiotics for preventing infection after continence surgery in women with stress urinary incontinence | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 3 | pages = CD012457 | date = March 2022 | pmid = 35349162 | pmc = 8962651 | doi = 10.1002/14651858.CD012457.pub2 | collaboration = Cochrane Incontinence Group }}</ref>

The use of transvaginal mesh implants and bladder slings is controversial due to the risk of debilitating painful side effects such as vaginal erosion.<ref>{{Cite news|url=https://www.lieffcabraser.com/injury/devices/vaginal-mesh/|title=Vaginal Mesh & Bladder Sling Complications and Lawsuits|work=[[Lieff Cabraser]]|access-date=2018-05-10}}</ref> In 2012 transvaginal mesh implants were classified as a high risk device by the US Food and Drug Administration.<ref>{{Cite web|url=https://www.theguardian.com/society/2017/aug/31/vaginal-pelvic-mesh-explainer|title=What does pelvic mesh do and why are women suing over it? – explainer | vauthors = Davey M |date=2017-08-31 |website=the Guardian |access-date=2018-05-10}}</ref> [[Urodynamic testing]] seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence.

Traditional suburethral sling operations are probably slightly better than open abdominal retropubic colposuspension and are probably slightly less effective than mid-urethral sling operations in reducing urinary incontinence in women, but it is still uncertain if any of the different types of traditional suburethral sling operations are better than others.<ref name="Saraswat2020">{{cite journal | vauthors = Saraswat L, Rehman H, Omar MI, Cody JD, Aluko P, Glazener CM | title = Traditional suburethral sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD001754 | date = January 2020 | pmid = 31990055 | pmc = 7027385 | doi = 10.1002/14651858.CD001754.pub5 }}</ref> Similarly, there is insufficient long term evidence to be certain about the effectiveness or safety of single-incision sling operations for urinary incontinence in women.<ref>{{cite journal | vauthors = Carter E, Johnson EE, Still M, Al-Assaf AS, Bryant A, Aluko P, Jeffery ST, Nambiar A | display-authors = 6 | title = Single-incision sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 10 | pages = CD008709 | date = October 2023 | pmid = 37888839 | pmc = 10604512 | doi = 10.1002/14651858.CD008709.pub4 }}</ref> Traditional suburethral slings may have a higher risk of surgical complications than minimally invasive slings but the risk of complications compared with other types of operation is still uncertain.<ref name="Saraswat2020" />

[[Laparoscopy|Laparoscopic]] colposuspension (keyhole surgery through the abdomen) with sutures is as effective as open colposuspension for curing incontinence in women up to 18 months after surgery, but it is unclear whether there are fewer risk of complications during or after surgery.<ref name="Freites_2019">{{cite journal | vauthors = Freites J, Stewart F, Omar MI, Mashayekhi A, Agur WI | title = Laparoscopic colposuspension for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 12 | pages = CD002239 | date = December 2019 | pmid = 31821550 | pmc = 6903454 | doi = 10.1002/14651858.CD002239.pub4 | collaboration = Cochrane Incontinence Group }}</ref> There is probably a higher risk of complications with traditional suburethral slings than with open abdominal retropubic suspension.<ref name="Freites_2019" />
[[File:Artificial urinary sphincters.jpg|alt=artificial urinary sphincter|thumb|250x250px|AMS 800 and ZSI 375 artificial urinary sphincters]]
The [[artificial urinary sphincter]] is an implantable device used to treat stress incontinence, mostly in men. The device is made of 2 or 3 parts: The pump, cuff, and balloon reservoir connected to each other by specialized tubes.  The cuff wraps around the urethra and closes it. When the person wants to urinate, he presses the pump (implanted in the scrotum), to deflate the cuff, and allow the urine to pass. The cuff regains pressure within a few minutes to regain continence.<ref>{{cite journal | vauthors = Downey A, Inman RD | title = Recent advances in surgical management of urinary incontinence | journal = F1000Research | volume = 8 | pages = 1294 | date = 2019-07-31 | pmid = 31448082 | pmc = 6676503 | doi = 10.12688/f1000research.16356.1 | doi-access = free }}</ref> The [[European Association of Urology]] considers the artificial urinary sphincter as the gold standard in surgical management of [[Stress incontinence|stress urinary incontinence]] in men after [[prostatectomy]].<ref>{{Cite journal| vauthors = Burkhard FC, Bosch JL, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A, Ambühl D, Bedretdinova DA, Farag F |title=EAU Guidelines on Urinary Incontinence in Adults|url=https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence-2018-large-text.pdf|journal=European Association of Urology}}</ref>

== Epidemiology ==
Globally, up to 35% of the population over the age of 60 years is estimated to be incontinent.<ref name="Hannestad">{{cite journal | vauthors = Hannestad YS, Rortveit G, Sandvik H, Hunskaar S | title = A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag | journal = Journal of Clinical Epidemiology | volume = 53 | issue = 11 | pages = 1150–1157 | date = November 2000 | pmid = 11106889 | doi = 10.1016/S0895-4356(00)00232-8 }}</ref>
In 2014, urinary leakage affected between 30% and 40% of people over 65 years of age living in their own homes or apartments in the U.S.<ref name="US2014">{{cite web|title=Prevalence of Incontinence Among Older Americans|url=https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf|author1=U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES|date=June 2014|website=CDC|access-date=23 August 2014}}</ref> Twenty-four percent of older adults in the U.S. have moderate or severe urinary incontinence that should be treated medically.<ref name="US2014" /> People with dementia are three times more likely to have urinary incontinence compared to people of similar ages.<ref>{{Cite journal | vauthors = Imison C, Kwint J |date=21 June 2022 |title=Continence, dementia, and care that preserves dignity |url=https://evidence.nihr.ac.uk/themedreview/continence-dementia-and-care-that-preserves-dignity/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_51255|s2cid=251785991 }}</ref><ref>{{cite journal | vauthors = Grant RL, Drennan VM, Rait G, Petersen I, Iliffe S | title = First diagnosis and management of incontinence in older people with and without dementia in primary care: a cohort study using The Health Improvement Network primary care database | journal = PLOS Medicine | volume = 10 | issue = 8 | pages = e1001505 | date = August 2013 | pmid = 24015113 | pmc = 3754889 | doi = 10.1371/journal.pmed.1001505 | veditors = Prince MJ | doi-access = free }}</ref>

Bladder control problems have been found to be associated with higher incidence of many other health problems such as obesity and diabetes. Difficulty with bladder control results in higher rates of depression and limited activity levels.<ref name="pmid12517660">{{cite journal | vauthors = Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R | title = Urinary incontinence and depression in middle-aged United States women | journal = Obstetrics and Gynecology | volume = 101 | issue = 1 | pages = 149–156 | date = January 2003 | pmid = 12517660 | doi = 10.1016/s0029-7844(02)02519-x | s2cid = 33743756 }}</ref>

Incontinence is expensive both to individuals in the form of bladder control products and to the health care system and nursing home industry. Injury-related to incontinence is a leading cause of admission to assisted living and nursing care facilities. In 1997 more than 50% of nursing facility admissions were related to incontinence.<ref name="pmid9351481">{{cite journal | vauthors = Thom DH, Haan MN, Van Den Eeden SK | title = Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality | journal = Age and Ageing | volume = 26 | issue = 5 | pages = 367–374 | date = September 1997 | pmid = 9351481 | doi = 10.1093/ageing/26.5.367 | doi-access = free }}</ref>

=== Women ===
Approximately 17% of non-pregnant women have urinary incontinence, with the most common types being stress, urgency, and mixed.<ref name=":0">{{Cite report |url=https://effectivehealthcare.ahrq.gov/topics/urinary-incontinence-update/final-report-2018 |title=Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update |last1=Balk |first1=Ethan |last2=Adam |first2=Gaelen P. |date=2018-08-08 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer212 |last3=Kimmel |first3=Hannah |last4=Rofeberg |first4=Valerie |last5=Saeed |first5=Iman |last6=Jeppson |first6=Peter |last7=Trikalinos |first7=Thomas}}</ref> Bladder symptoms affect women of all ages. However, bladder problems are most prevalent among older women.<ref name="pmid11412210">{{cite journal | vauthors = Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ | title = How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study | journal = BJU International | volume = 87 | issue = 9 | pages = 760–766 | date = June 2001 | pmid = 11412210 | doi = 10.1046/j.1464-410x.2001.02228.x | s2cid = 23650548 }}</ref> Women over the age of 60 years are twice as likely as men to experience incontinence; one in three women over the age of 60 years are estimated to have bladder control problems.<ref name="Hannestad" /> One reason why women are more affected is the weakening of [[Pelvic floor|pelvic floor muscles]] by [[pregnancy]].<ref name="Graham">{{cite news| vauthors = Graham J |date=July 29, 2014|title=An 'Emotional Burden' Rarely Discussed|newspaper=New York Times|url=http://newoldage.blogs.nytimes.com/2014/07/22/an-emotional-burden-rarely-discussed/|access-date=August 23, 2014|name-list-style=vanc}}</ref>

=== Men ===
Men tend to experience incontinence less often than women, and the structure of the male [[urinary tract]] accounts for this difference. Stress incontinence is common after [[prostate cancer]] treatments.{{citation needed|date=June 2022}}

While urinary incontinence affects older men more often than younger men, the onset of incontinence can happen at any age. Estimates around 2007 suggested that 17 percent of men over age 60, an estimated 600,000 men in the [[US]], experienced urinary incontinence, with this percentage increasing with age.<ref>{{cite book|title=Urologic Diseases in America Report|vauthors=Stothers L, Thom D, Calhoun E|date=2007|publisher= ([[US]]) [[National Institutes of Health]]|chapter=Chapter 6: Urinary Incontinence in Men}}</ref>

=== Children ===
Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 17-year-olds experience episodes of incontinence. It is twice as common in girls as in boys.<ref>{{Cite book|title=Pediatric incontinence - Franco - 2015 - Wiley Online Books - Wiley Online Library|year=2015|isbn=9781118814789| veditors = Franco I, Austin PF, Bauer SB, von Gontard A, Homsy Y |doi=10.1002/9781118814789}}</ref>

== History ==
The management of urinary incontinence with pads is mentioned in the earliest medical book known, the [[Ebers Papyrus]] (1500 BC).<ref>{{cite book| vauthors = Becker HD, Stenzl A, Wallwiener D, Zittel TT |title=Urinary and fecal incontinence : an interdisciplinary approach; with 89 tables|publisher=Springer|year=2005|isbn=978-3540222255|location=Berlin [u.a.]|page=232|name-list-style=vanc}}</ref>

Incontinence has historically been a taboo subject in Western culture. However, this situation changed some when [[Kimberly-Clark]] aggressively marketed [[adult diaper]]s in the 1980s with actor [[June Allyson]] as spokeswoman. Allyson was initially reticent to participate, but her mother, who had incontinence, convinced her that it was her duty in light of her successful career. The product proved a success.<ref>{{cite news| vauthors = O'Reilly T |date=8 June 2017|title=Now Splinter Free: How Marketing Broke Taboos|publisher=CBC Radio One|agency=Pirate Radio|url=http://www.cbc.ca/radio/undertheinfluence/now-splinter-free-how-marketing-broke-taboos-1.4149558|access-date=10 June 2017|name-list-style=vanc}}</ref>

== Law ==
The case ''Hiltibran et al. v. Levy et al.'' in the [[United States District Court for the Western District of Missouri]] resulted in that court issuing an order in 2011. That order requires [[adult diaper|incontinence briefs]] funded by [[Medicaid]] to be given by Missouri to adults who would be institutionalized without them.<ref>{{Cite web|url=https://www.olmsteadrights.org/advocacytools/recent-cases/|title=Recent Cases - Olmstead Rights|website=www.olmsteadrights.org}}</ref><ref>{{cite court |litigants= Hiltibran et al v. Levy et al |vol= 793 |reporter= U.S. |opinion= |pinpoint= |court= United States District Court Western District of Missouri |date= 24  June 2011 |url= https://www.govinfo.gov/app/details/USCOURTS-mowd-2_10-cv-04185/summary|quote= |postscript= }}</ref>

== Veterinary medicine ==
Urinary incontinence is a common urological condition in domestic [[dog]]s, but is much rarer in domestic [[cat]]s, which have narrower urethras.<ref>{{Cite journal |last1=Mérindol |first1=Isabelle |last2=Dunn |first2=Marilyn |last3=Vachon |first3=Catherine |date=2022-06-01 |title=Feline urinary incontinence: a retrospective case series (2009–2019) |journal=Journal of Feline Medicine and Surgery |language=en |volume=24 |issue=6 |pages=506–516 |doi=10.1177/1098612X211033182 |pmid=34346241 |issn=1098-612X|pmc=11104245 }}</ref>
== Research ==
The effectiveness of different therapeutic approaches to treating urinary incontinence is not well studied for some medical conditions. For example, for people who experience urinary incontinence due to stroke, treatment approaches such as physical therapy, cognitive therapy, complementary medicine, and specialized interventions with experienced medical professionals are sometimes suggested, however it is not clear how effective these are at improving incontinence and there is no strong medical evidence to guide clinical practice.<ref name="Thomas_2019" />


== See also ==
* [[Diaper]]
* [[Fecal incontinence]]
* [[Stress incontinence]]

== References ==
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{{Reflist}}

== External links ==
{{Medical resources
|   DiseasesDB     = 6764
|   ICD10          = {{ICD10|N|39|3|n|30}}-{{ICD10|N|39|4|n|30}}, {{ICD10|R|32||r|30}}
|   ICD9           = {{ICD9|788.3}}
|   ICDO           =
|   OMIM           =
|   MedlinePlus    = 003142
|   eMedicineSubj  = med
|   eMedicineTopic = 2781
|   MeshID         = D014549
}}
* [http://patients.uroweb.org/i-am-a-urology-patient/urinary-incontinence/ Patient-centered information] from the European Urological Association
* [https://www.continenceproductadvisor.org/ Independent continence product advisor]

{{Urinary system symptoms and signs}}
{{Urinary tract disease}}
{{Authority control}}

{{DEFAULTSORT:Urinary Incontinence}}
[[Category:Urinary incontinence| ]]
[[Category:Aging-associated diseases]]
[[Category:Symptoms and signs: Urinary system]]