Types of urinary incontinence and why it happens

There are two main types of incontinence stress incontinence and overactive bladder (urge incontinence). Many women have both types together and this is called mixed incontinence. Look at the box below to see what type you have. About 1 in 4 women with incontinence of urine also have faecal incontinence (Obstetrics and Gynaecology 2002;100:17–23).

Types of urinary incontinence

Questions to ask yourself	Stress incontinence	Overactive bladder	Mixed incontinence
Do you go to the toilet to pass urine more than 7 times a day?	No	Yes	Sometimes
Do you go to the toilet to pass urine more than once during the night?	Not usually	Most nights	Most nights
Do you ever have to hurry to reach the toilet in time (for urine)?	No	Yes	Yes
Do you ever not reach the toilet in time (for urine)?	No	Often	Often
Do you ever leak urine when you laugh, sneeze, cough, run or jump?	Always	No	Always
If you leak urine, is it just a drop or is it sometimes quite a bit more?	Small	Large (usually)	Large
Are you able to hold your urine alright, but you need to pass it more than 7 times a day, in small or large amounts each time?	See your doctor, because you might have a urine infection (small amounts) or diabetes (large amounts and you are thirsty).

Leakage of urine when you cough, laugh or bend over, or with exercise such as jumping or jogging, is called stress incontinence. It is most common in young women (25–49 years of age). It occurs if the muscles at the neck of the bladder are not strong enough to hold the urine in when the pressure in the abdomen is increased (as happens when you laugh or cough). No one knows exactly why these muscles may become weak; some women notice the problem after childbirth or the menopause. Women with stress incontinence often have leakage of urine during sex, usually at penetration (when the penis enters).

Genes are now thought to be a very important cause of stress incontinence, which explains why this type of incontinence tends to run in families (Obstetrics and Gynecology 2005; 106: 12538). Because of their genes, some women are born with a weak pelvic floor. It is probably a weakness of collagen, the tiny strengthening fibres of muscles.

 

Childbirth is probably an important cause of stress incontinence. The actual birth is mostly responsible, not just the pregnancy women who have had Caesarean sections do not usually develop incontinence later. It seems that the nerves can be stretched and bruised during the delivery, and they are unable to make the pelvic floor work after the birth. As a result, the muscles become lazy and weak. However, some research suggests that women who have had children are not more likely to have incontinence (Obstetrics and Gynecology 2005; 106: 12538), so it seems that more research is necessary.

 

Hysterectomy. A woman who has had a hysterectomy is more likely to develop incontinence in middle age than a woman who has not had the operation.

 

Menopause may be another reason, perhaps because the lowering levels of oestrogen make the pelvic floor muscles less efficient. However, recent research shows that although the likelihood of incontinence increases in middle-age, the hormone changes of the menopause may not be the cause. The reason may be that middle-aged women are more likely to be overweight and to have had a gynaecological operation, such as a hysterectomy.

 

High impact sports, such as jogging on hard pavements, are probably not good for the pelvic floor. Sports such as swimming and cycling are fine. Interestingly, women parachutists in the US Air Force have developed incontinence because the impact of landing has damaged their pelvic floor.

 

Lifting heavy objects strains the pelvic floor. If you have to lift anything heavy (such as a baby or small child!), get into the habit of doing it in the right way. Place your feet firmly apart in the walking position, and bend at the knees and hip but keep your back straight. Tighten your pelvic floor muscles, hold the heavy object close to you and then lift by straightening your legs.

 

Obesity. Being overweight is a major cause of incontinence. It puts stress on the pelvic floor muscles.

 

Smoking 20 cigarettes/day (now or in the past) doubles your likelihood of urinary incontinence: another reason for never smoking.

 

Drugs can relax the pelvic floor around the ring of muscles at the neck of the bladder, making leakage more likely. The most common culprits are some blood pressure medications (particularly alpha-blockers such as prazosin and doxazosin). If your incontinence problem seems to be related to starting treatment for blood pressure, ask your doctor if you are taking an alpha-blocker. Medications for other conditions, such as fluoxetine (Prozac) and muscle-relaxant drugs, can also promote urine leakage.

 

The sudden need to pass urine desperately, and maybe not being able to reach the toilet in time, is a slightly different sort of incontinence called overactive bladder. The cause is misbehaviour of the bladder muscle; it starts to contract when it should be stretching to hold more urine. This is called an overactive or irritable bladder (the medical term is detrusor instability, because the bladder muscle is called the detrusor muscle). It means that people with urge incontinence have to pass urine often (probably more than eight times a day and also during the night), but may not pass much each time. Women with urge incontinence often have leakage of urine during sex, usually at orgasm.

 

Some people with incontinence have both stress incontinence and an overactive bladder. The ‘stress’ symptoms may be more prominent than the ‘urge’ symptoms, or vice versa.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Wednesday, February 10th 2010

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Comments on this article

Posted by Optional on 07/03/2010 at 10:20:35 am

I have been having urine leakage for about 3 years now. It a small amount, although it seems to be constant. My underpants are always wet and it smells like urine. It's constant and isn't necessarily brought on by coughing, sneezing or stress. Although It's more when I cough or sneeze. I now wear a poise pad which at least protects my underwear and the order - but it is SOOOOO frustrating! I had a baby 3 years ago, I'm now 40. I didn't have this problem before having my son, but I had a c-section, so not sure why this is happening...I can relate to everyone here..it's truly aggravating.

Posted by Diane on 14/01/2010 at 12:00:00 pm

I sometimes have difficulty emptying my bladder. Also, at times I have leakage. For that , I , periodically, start urinating then stop, hold , continue urinating. I do this 2x. this has strengthened the muscles & has eliminated leaking by 80%.

Posted by rakhee amin on 13/01/2010 at 04:19:00 am

Hello, I do not have control to hold urin.All the time i have to wear pad.During the night each two hour i wake up for urin and eventhough i have wet pad. I am so frustret please give me suggetion.

Posted by Elle on 10/01/2010 at 06:56:00 pm

I saw something on tv about stem cells being put into the bladder in order to repair some damage or weak areas. I think it is still in the process of being researched.. but at least it might be something to look forward too!! ...And I'm only 23 and have been having slight incontinence for a couple years. I can't imagine what it'll be like post childbirth and menopause...

Posted by confused? on 03/01/2010 at 05:02:00 am

I have had problems with leakage for some years now and have no idea why, seems like everyday I go through 2 maybe 3 pairs of underwear because of the soiled place in the seat of my underwear. I don't know what to do.

Posted by jen on 01/12/2009 at 12:23:00 am

Go to the bathroom five minutes later have to go again... Don't drink much water because I always have to go........I wake up during the night to go at least once. I take diovan 320mg for high blood pressure. I am overweight as well. It seems like coffee makes it worse.

Posted by Anonymous on 06/09/2009 at 02:38:00 am

does having had breast cancer become a reason for incontinence? Chemotherapy and other cancer drugs....can they cause incontinence?

Posted by Anonymous on 06/07/2009 at 03:02:00 am

I started getting frequent UTIs after endometrial ablation. I once became septic. When my period should occur, I get UTIs and incontinence and soak 10 to 15 pads a day. Levaquin helps but doesn't eradicate this problem. I have had CT scans and trans vaginal sonograms and no fistula was found and bladder capacity normal. This problem interferes with my life - I do not smoke and am not overweight. This problem is not found in my gene pool. I can not have normal sexual activity without getting E. Coli even with meticulour before and after peri-care. What is the problem? Both by gynecologist and urologist seem uncertain. I am afraid of betting so sick again. Any information will be appreciated.

Posted by Julie on 26/05/2009 at 03:33:00 pm

I am 3 wks post op from LAVH had severe endometriosis,am also on HRT patches, have been leaking urine for last wk or so, antibiotics dont seem to have helped.Seems to be worse in the mornings,only happens when standing or sitting not coughing or sneezing. Is this commom!!! What shall i do next. Julie.

Posted by Ana Loe on 29/03/2009 at 05:59:00 pm

Leakage of urine when i cough,laugh i cant hold urine more the 1 hour during the day ,during the night i pass the urine 6 times.

Posted by Betty on 24/12/2008 at 12:56:00 am

I have been having what I call a very serious condition with incontinence. The last two or three days I have wet all over my self without much notice, as soon as I feel the urge to go, I get up and start that way rather quickly which still doesn't help. I usually end up not making it to the toilet in time. I not talking about a little bit of leaking, I am talking about all of my urine starts coming out and I cannot stop it at all. I have to change my clothes several times a day. Very embarrasing to me! I used to be able to hold it but not anymore. The other night I wet 3 pairs of clothes in a fairly short time span. Please let me know what I need to do because like I said this seems to be really becoming a problem!!!