Urinary incontinence happens when you lose bladder control or you leak urine involuntarily. It mostly affects women, especially older women. The more times a woman has given birth, the more her risk of urinary incontinence goes up. Smoking is also a risk factor.

Most of these women have stress incontinence, where you leak urine when you laugh, cough, sneeze, or exercise. Another type is urge incontinence, when you may have to "go" suddenly and can't hold the urine in. Some women have both types. Some people may experience temporary incontinence.

• Not being able to hold your urine until you get to a bathroom
• Frequent and unusual urges to urinate

• Stretched pelvic muscles from pregnancy and childbirth; women with gestational diabetes are at a higher risk
• Low estrogen levels in women (common during menopause)
• Enlarged prostate in men
• Side effects of certain medications
• Recurrent urinary tract infections (UTIs)
• Frequent constipation
• Being overweight
• Diseases that damage nerve pathways from the bladder to the brain, such as Alzheimer's disease, stroke, or multiple sclerosis
• Weakened muscles that control urination, such as urethral sphincter and pelvic floor muscles
• Hip dysfunction and prior hip surgery

Your doctor will give you a physical examination and ask questions about:

• Any past prostate problems
• Pregnancy or hysterectomy
• Your pattern of urinating
• When your urine leakage occurs
• Whether you strain or have discomfort when urinating

You may be asked to cough vigorously to see if it causes urine loss. This is a sign of stress incontinence.

Your doctor may suggest urine tests to find:

• Infection
• Urinary stones
• Diabetes
• Other underlying causes

Your doctor may order a pelvic ultrasound to look at your bladder, kidneys, and urethra.

Treatment can help more than 80% of people with urinary incontinence. Exercise and behavioral therapies are most successful. But there are also several drugs available to help with urge incontinence, including:

• Tolterodine (Detrol)
• Darifenacin
• Fesoterodine fumarate (Toviaz)

Options for urge incontinence that hasn't responded to medication include:

• Percutaneous tibial nerve stimulation (or PTNS), which involves electrical stimulation of the sacral nerve by way of the tibial nerve. This would be done in your doctor's office.
• InterStim Therapy, where a device is implanted that directly stimulates the sacral nerve.

Surgery may help women with stress incontinence and men with an enlarged prostate. Other options include:

• Catheters
• Urethral plugs
• Condom catheters
• Vaginal slings
• Absorbent pads or underwear

Recent studies suggest that midurethral slings are the most commonly performed surgical treatments for stress incontinence.

Complementary and Alternative Therapies

Common alternative therapies include:

• Kegel exercises. To strengthen pelvic floor muscles, squeeze and hold the muscles, then release. To find the muscles, pretend you are trying not to pass gas or trying to stop the flow of urine without tightening your buttocks or abdominals. Hold the muscles tight for a count of 10, then relax for a count of 10. Work your way up to 20 repetitions, twice daily.
• Biofeedback. Using a machine that shows you when you are exercising the right muscles can help you learn to do the exercises properly.
• Relaxation techniques. May help you go longer without urinating.
• Bladder retraining. Helps your body get used to going to the bathroom on a regular schedule.

Other alternative therapies include:

• Acupuncture
• Hypnosis
• Yoga
• Herbal therapies

Always tell your doctor about the herbs and supplements you are using.

Nutrition and Supplements

• Cranberries and blueberries contain substances that keep bacteria from sticking to the bladder. This may help prevent urinary tract infections that can make incontinence worse. However, some people with overactive bladder may find that cranberries irritate their bladder because they are acidic. People who are allergic to aspirin, and those who take other medications, should not take large amounts of cranberry supplements.
• Avoid caffeine, alcohol, artificial sweeteners, and tobacco.
• Drink 6 to 8 glasses of filtered water daily. While you may think you should limit liquids, not drinking enough water can irritate the bladder and make incontinence worse.
• Some foods may make urge incontinence worse for some people, including citrus fruits, tomatoes, spicy foods, caffeine, and carbonated sodas. In one study, researchers linked caffeine consumption of about 2 cups of coffee daily (250 mg) with moderate-to-severe urinary incontinence among men.
• Exercise for at least 30 minutes daily, 5 days a week.

One study suggested that chondroitin sulfate helped with symptoms of urge incontinence and overactive bladder, as well as the medication Detrol. More studies are needed to know whether it really works. Avoid chondroitin sulfate if you are allergic to shellfish or have asthma. Chondroitin sulfate can increase the risk of bleeding, especially if you take blood thinners, such as warfarin or clopidogrel (Plavix). Pregnant or breastfeeding women should not take chondroitin sulfate. Men with prostate cancer should ask their doctor before taking chondroitin.

Homeopathy

According to the National Institutes of Health, there is little evidence to support homeopathy as an effective treatment for any specific health condition. Also, while most homeopathic remedies contain small amounts of the active ingredient, they may still have side effects and drug interactions. If you choose a homeopathic product to use on your own, it’s best to talk with your health care provider before you use it to check for possible side effects or drug interactions.

If you decide to work with a homeopath, choose someone with training and experience and discuss any potential treatments carefully.

A professional homeopath may recommend one or more treatments for urinary incontinence based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, which includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular person.

The following are some common remedies used for urinary incontinence.

• Causticum. For stress incontinence, especially with retention from holding the urine and frequent urges to urinate.
• Natrum muriaticum. For stress incontinence, vaginal dryness, and pain during sex, especially with a history of grief.
• Pareira. For retention of urine from an enlarged prostate.
• Sepia. For stress incontinence with sudden urge to urinate, especially with prolapsed uterus and vaginitis.

Acupuncture

Acupuncture may help, depending on what's causing the incontinence. Acupuncture may also strengthen the urinary system. In one study, women who received 4 weekly bladder acupuncture treatments had significant improvement in symptoms of urinary incontinence compared to women who received placebo treatments.

Exercise and behavioral therapy can help many people get rid of their symptoms. You have to stick with the changes for them to work, so it may help to have support from a loved one and close monitoring by your doctor.

If you are pregnant, consult with your doctor before taking any medication. For men, regular prostate examinations can find problems early. If the condition worsens, patients may suffer from depression, recurrent urinary tract infections, and social isolation. Stress urinary incontinence and urge urinary incontinence may lead to sexual dysfunction.

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