Bladder Control Problems

Types of bladder control problems

Common causes

In women

• Pregnancy and vaginal childbirth, which stretch and weaken the pelvic floor and its nerves
• Menopause, when lower estrogen thins the lining of the urethra
• Pelvic organ prolapse, where the bladder or womb drops into the vagina
• Obesity, which increases pressure on the bladder
• Chronic cough from smoking, asthma or COPD, and constipation with straining

In men

• Enlarged prostate (benign prostatic hyperplasia), which narrows the outflow, causing a weak stream, urgency, frequency and sometimes overflow leaking
• Prostate surgery or radiation, which can damage the sphincter
• Prostatitis

In anyone

• Overactive bladder: urgency with or without leaking, often with no clear cause
• Urinary tract infection: sudden urgency, burning and sometimes temporary leaking
• Nerve problems: diabetes, multiple sclerosis, Parkinson's disease, stroke, spinal cord injury and spina bifida can cause neurogenic bladder
• Medicines: diuretics (water pills), sedatives, some blood pressure drugs, and antihistamines or antidepressants that cause retention
• Bladder irritants: caffeine, alcohol, fizzy drinks and artificial sweeteners
• Constipation, which presses on the bladder
• Interstitial cystitis (bladder pain syndrome), causing urgency and pelvic pain

Temporary causes

Incontinence that comes on suddenly is often reversible. A simple memory aid doctors use is DIAPPERS: delirium, infection, atrophic vaginitis, pharmaceuticals, psychological factors, excess urine output (high blood sugar, too much fluid), restricted mobility and stool impaction.

Sudden loss of bladder control

A sudden, complete loss of bladder control is different from gradually worsening leaks. Together with back pain, leg weakness or numbness in the saddle area, it suggests pressure on the nerves at the base of the spine (cauda equina syndrome), which needs emergency surgery. With one-sided weakness or slurred speech, it may be a stroke. In an older adult with new confusion, it often means infection.

How doctors assess bladder problems

Your doctor will ask when and how you leak, how often you go, how much you drink, about childbirth, surgery, medicines and bowel habits. You may be asked to keep a bladder diary for 3 days, recording drinks, toilet visits, volumes and leaks.

Tests may include:

• Urine test for infection, blood and sugar
• Physical exam: abdomen, pelvic exam in women (checking pelvic floor strength and prolapse), prostate exam in men, and a brief nerve exam
• Cough stress test: watching for leaks with a cough on a full bladder
• Post-void residual: a bladder ultrasound after you urinate to check how much is left
• Urodynamic studies, before surgery or when the cause is unclear
• Cystoscopy if there is blood in the urine or a suspected blockage

Treatment

First-line treatments

• Pelvic floor muscle training (Kegels): the first treatment for stress and mixed incontinence. Squeeze the muscles you would use to stop passing gas, hold for up to 10 seconds, relax, and repeat 10 times, three times a day, for at least 3 months. A pelvic floor physical therapist improves results.
• Bladder training: gradually increasing the time between toilet visits to retrain an overactive bladder, using urge-suppression techniques (stand still, squeeze the pelvic floor, breathe, then walk calmly).
• Lifestyle changes: cut down caffeine and alcohol, drink normal amounts (about 6 to 8 cups a day), lose weight if needed, treat constipation, stop smoking.
• Timed voiding and prompted toileting for people with memory or mobility problems.

Medicines

• For overactive bladder: beta-3 agonists (mirabegron, vibegron) or anticholinergics (antimuscarinics). Anticholinergics can cause dry mouth and constipation and may affect memory in older adults, so beta-3 agonists are often preferred for them.
• Vaginal estrogen for women after menopause.
• For enlarged prostate: alpha-blockers and 5-alpha reductase inhibitors.

Devices and procedures

• Vaginal pessaries to support the bladder neck or a prolapse
• Botox injections into the bladder for overactive bladder that does not respond to medicines
• Nerve stimulation: tibial nerve stimulation at the ankle or sacral neuromodulation
• Surgery for stress incontinence: midurethral sling, colposuspension, bulking injections, or an artificial urinary sphincter in men
• Prostate procedures for bladder outlet obstruction
• Intermittent self-catheterization for a bladder that does not empty

Practical help

Absorbent pads and pants, skin care with barrier creams, and toilet access planning help while treatment takes effect. Do not reduce your fluid intake too much, which concentrates urine and irritates the bladder.

Frequently asked questions

What causes loss of bladder control?

Common causes include weak pelvic floor muscles after childbirth or menopause, an overactive bladder, an enlarged prostate, urinary infections, nerve damage from diabetes or MS, certain medicines and constipation. Sudden loss of control with back pain or leg numbness needs emergency care.

Is losing bladder control a normal part of aging?

No. It becomes more common with age, but it is not inevitable or normal. Most people improve significantly with treatment such as pelvic floor exercises, bladder training, medicines or minor procedures. Talk to your doctor.

How can I improve bladder control naturally?

Daily pelvic floor (Kegel) exercises, bladder training, cutting down caffeine and alcohol, losing excess weight, avoiding constipation and stopping smoking all improve bladder control. Results usually take 6 to 12 weeks of regular practice.

Why do I leak when I cough or sneeze?

Leaking with coughing, sneezing, laughing or exercise is stress incontinence. The pelvic floor muscles and urethral sphincter are not strong enough to hold urine when belly pressure rises suddenly. It is common after childbirth and menopause and often responds to pelvic floor training.

What doctor treats bladder control problems?

Start with your primary care doctor. You may be referred to a urologist, a urogynecologist (for women), or a pelvic floor physical therapist. Many people get good results without needing specialist care.