If you’ve been quietly managing bladder leakage by adjusting your routines and limiting outings, you’re not alone. But you may be carrying a burden you don’t have to. Urinary incontinence is one of the most underreported and undertreated conditions in adult health, largely because many people assume nothing can be done, which isn’t true.
As Dr. Kwabena Nkansah-Amankra, MD, Urologist at Fisher-Titus, puts it, “Incontinence is not a normal part of aging. There’s always an underlying cause, and that cause can be managed.”
No matter how mild or severe your symptoms are, treatment options exist. This post walks through the types of incontinence, their causes and treatment options to help you take control of your bladder health.
What is Urinary Incontinence?
It’s the involuntary leakage of urine due to a loss of bladder control. Urinary incontinence occurs when something disrupts communication between your brain and bladder. That could be caused by changes in muscle function, anatomical shifts, nerve signals, and other underlying health factors.
It’s far more common than most people realize. Millions of adults in the United States experience some form of bladder leakage, and it affects men and women of all ages. Despite that fact, many people never bring it up with their doctor. Understanding the type of incontinence you’re experiencing can help you find the right solution.
Types of Urinary Incontinence
Stress Incontinence: Stress incontinence occurs when physical pressure on your abdomen causes urine to leak, such as coughing, sneezing, laughing, jumping, or climbing stairs. That happens because your urethra, the tube below your bladder, has lost some of its ability to stay closed under pressure. It’s one of the most common types, particularly in women.
Urge incontinence (overactive bladder): If you experience urge incontinence, your bladder sends insistent, uncontrollable signals to urinate even when it isn’t full. That sensation overrides your brain, causing a constant, intense need to go that often results in leakage before you reach the bathroom.
Mixed incontinence: Mixed incontinence is a combination of stress and urge incontinence. It’s common and can be addressed with various treatments.
Overflow incontinence: If your bladder doesn’t empty properly, it can fill to capacity and leak, resulting in overflow. This type of incontinence is more common in men due to an enlarged prostate blocking normal urine flow.
Functional incontinence: Functional incontinence occurs if you have difficulty reaching the bathroom in time. The issue isn’t your bladder but physical limitations or environmental barriers that prevent access, which you can resolve with behavioral changes.
Incontinence in Women: Contributing Factors
As a woman, you’re likely to experience incontinence at higher rates than men because of anatomical differences and events that affect your pelvic floor. That group of muscles and connective tissue supports your bladder, uterus, and bowels.
The following can increase your likelihood of developing bladder leakage:
Pregnancy and childbirth: Pregnancy places significant pressure on your pelvic floor, and vaginal delivery can stretch or weaken those muscles and connective tissue that support your urethra. Over time, your urethra may drop from its normal position, reducing its ability to stay closed when exposed to pressure.
Menopause: The decline in estrogen due to menopause affects the tissues around your urethra and bladder, making them thinner and less resilient. That can contribute to stress and urge incontinence and may cause symptoms to emerge even if you’ve never experienced bladder issues.
Causes of Incontinence in Men
Certain health conditions specific to men’s anatomy are among the leading contributors to incontinence, including:
Enlarged prostate (benign prostatic hyperplasia): Your prostate gland sits just beneath your bladder and surrounds the urethra. As you age, your prostate can enlarge, a condition called benign prostatic hyperplasia.
According to Dr. Nkansah-Amankra, “The urethra in a younger man works like a garden hose with good pressure, but an enlarged prostate gradually kinks that hose until flow is reduced to a trickle. This obstruction leads to incomplete bladder emptying, urgency, weak stream, frequent nighttime urination, and overflow incontinence.”
Prostate surgery: Procedures to treat prostate cancer, including radical prostatectomy, can affect your muscles and nerves that control your bladder. Post-surgical incontinence may be mild and temporary or more persistent, depending on the procedure. Treatment options are available if you experience incontinence following prostate surgery.
Treatment Options for Incontinence
Pelvic Floor and Bladder Training
Pelvic floor physical therapy is suitable for men and women dealing with stress, urge, and mixed incontinence. A trained therapist guides you through exercises designed to strengthen and retrain your bladder muscles and urethra. For urge incontinence specifically, you learn techniques such as quick-flick contractions that help you recognize signals early and delay the urge to urinate. Bladder training gradually extends the time between bathroom visits and complements pelvic floor exercises to restore normal voiding patterns.
Medication
When behavioral changes and pelvic floor therapy don’t fully resolve urge incontinence or overactive bladder, medication is the next step. Your bladder behaves similarly to a spasming muscle that contracts too frequently and intensely. Anticholinergic medications, such as oxybutynin, work by reducing the frequency and intensity of those involuntary contractions, allowing your bladder to fill more comfortably and giving you more time to reach the bathroom. Beta-3 agonists like Mirabegron offer an alternative mechanism with different effects. The right medication depends on your health history, and your urologist will determine which option makes the most sense.
Botox and Urethral Bulking Agents
If you have an overactive bladder and haven’t found relief through medication, Botox injections offer an effective and minimally invasive option. The botulinum toxin used cosmetically to relax facial muscles works the same way on your bladder by temporarily paralyzing the overactive muscle and reducing contractions. The procedure takes 10 to 15 minutes, and the results last approximately one year. Urethral bulking agents are another minimally invasive approach used primarily for stress incontinence. A small amount of material is injected around your urethra to add support and help it close, reducing leakage with physical activity and pressure.
Surgical Options to Treat Incontinence
Surgery is typically considered when other treatments haven’t provided adequate relief.
These procedures are available depending on the type of incontinence and your anatomy:
Sling procedures: A urethral sling involves placing a small strip of mesh or tissue under your urethra to prevent leakage during activity. It’s one of the most common surgical treatments for stress incontinence in women and is also available for men following prostate surgery.
Bladder neck suspension: This procedure lifts and secures your bladder neck and urethra to reduce incontinence. It fixes the anatomical dropping of your urethra that contributes to stress incontinence, especially in women.
Artificial urinary sphincter: This is an implanted device that mimics the natural function of your sphincter muscle. It’s primarily used in men experiencing incontinence after prostate surgery and includes placing a small cuff around your urethra that’s manually controlled to release urine.
Sacral neuromodulation: If your incontinence hasn’t improved with other treatments, sacral neuromodulation may be necessary. The procedure involves placing a small lead near the nerves that supply your bladder with signals from your brain. The device helps regulate that communication, reducing urgency, frequency, and leakage.
Aquablation therapy: As a man, if your incontinence stems from an enlarged prostate, Aquablation offers a different approach compared to traditional surgical options. The process involves using ultrasound imaging combined with a precise, water-based therapy to remove obstructive prostate tissue, similar to pressure washing. Your surgical team can see your nerves, sphincter, and surrounding tissue throughout the procedure, reducing the risk of collateral damage.
Traditional procedures for enlarged prostate, such as transurethral resection (TURP), carry risks of ejaculatory dysfunction, erectile dysfunction, and post-surgical incontinence. Aquablation lowers those risks, making it a viable option if you’re a younger, sexually active man and want to preserve those functions. Fisher-Titus is one of a few providers in Ohio, and the only one in the region, currently offering Aquablation therapy.
Urologic Care at Fisher-Titus
You don’t have to manage incontinence alone nor accept it as your new normal.
At Fisher-Titus, our urology team offers a patient-centered approach to diagnosing and treating incontinence in men and women. Whether you’re experiencing symptoms for the first time or have tried other approaches without success, our team can find a treatment option to meet your needs. Schedule a consultation with the Fisher-Titus urology team today.