You may think bladder control problems are something that happen when you get older. The truth is that women of all ages have urine leakage. The problem is also called incontinence. Men leak urine too, but the problem is more common in women. About half of adult women say they have had leakage at one time or another, and many say it’s a daily problem.

Leakage occurs in a number of circumstances: Many women leak urine when they sneeze, exercise, laugh hard or cough. Additionally, women often leak urine when they are pregnant or after they have given birth. Menopausal women often report bladder control problems, and female athletes of all ages may experience urine leakage during strenuous sports activities.

Urine leakage is more common in older women, but that doesn’t mean it’s a natural part of aging. You don’t have to “just live with it.” You can do something about it and regain your bladder control.

Incontinence is not a disease. But it may be a sign that something is wrong. It’s a medical problem, and a doctor or nurse can help.

Not all bladder control problems are alike. Some problems are caused by weak muscles, while others are caused by damaged nerves. Sometimes the cause may be a medicine that dulls the nerves.

To help solve your problem, your doctor or nurse will try to identify the type of incontinence you have. It may be one or more of the following six types:

Temporary incontinence. As the name suggests, temporary incontinence doesn’t last. You may have an illness, like a urinary tract infection, that causes frequent and sudden urination that you can’t control. Or you may find that a new medicine has the unexpected side effect of increasing your urination. These problems go away as soon as the cause is found and corrected.

Stress incontinence. If you leak urine when you cough, laugh, sneeze, or exercise, you have stress incontinence. Mental stress does not cause stress incontinence. The “stress” is pressure on the bladder. When your pelvic and sphincter muscles are strong, they can handle the extra pressure from a cough, sneeze, exercise, or laugh. But when those muscles are weak, that sudden pressure can push urine out of the bladder.

Urge incontinence. If you leak urine after a strong, sudden urge to urinate, you have urge incontinence. This bladder control problem may be caused by nerve damage from diabetes, a stroke, an infection, or another medical condition.

Mixed incontinence. Mixed incontinence is a mix of stress and urge incontinence. You may leak urine with a laugh or sneeze at one time. At another time, you may have a sudden, uncontrollable urge to urinate just before you leak.

Functional incontinence. Some people have trouble getting to the bathroom. If you have urine leakage because you can’t walk or have other mobility problems, you have functional incontinence.

Overactive bladder. If you have to urinate eight or more times a day, you may have an overactive bladder. Getting up to urinate two or more times each night is another sign of overactive bladder. With an overactive bladder, you feel strong, sudden urges to urinate, and you also may have urge incontinence.

Urine leakage has many possible causes.

Weak muscles. Most bladder control problems are caused by weak pelvic muscles. These muscles may become stretched and weak during pregnancy and childbirth. Weak muscles let the bladder sag out of position, which may stretch the opening to the urethra.

Nerve damage. Damaged nerves may send signals to the bladder at the wrong time. As a result, a bladder spasm may push out urine without warning. Sometimes damaged nerves send no signals at all, and the brain can’t tell when the bladder is full. Nerves can be damaged by diseases or trauma. Diseases and conditions that can damage the nerves include diabetes, Parkinson’s, multiple sclerosis and stroke.

Trauma that can damage the nerves includes pelvic or back surgery; a herniated disc; or radiation.

Medicines, alcohol, and caffeine may also be to blame. Leaking can happen when medicines affect any of the muscles or nerves. You may take medicine to calm your nerves so that you can sleep or relax. This medicine may dull the nerves in the bladder and keep them from signaling the brain when the bladder is full. Without the message and urge, the bladder overflows. Drinking alcohol can also cause these nerves to fail. Water pills (diuretics) -take fluid from swollen areas of your body and send it to the bladder. This rapid filling may cause the bladder to leak. Caffeine drinks such as coffee and cola also cause the bladder to fill quickly. Make sure your drinks are decaf.

Infection. A urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning. This type of incontinence goes away once the infection has been cured.

Excess weight. Being overweight can put pressure on the bladder and contribute to stress incontinence.

You can prepare for your visit to the doctor’s office by gathering the information your doctor will need to understand your problem. Make a list of the medicines you are taking. Include prescription medicines and those you buy over the counter, like aspirin or antacid. List the fluids you drink regularly, including sodas, coffee, tea, and alcohol. Tell the doctor how much of each drink you have in an average day.

Finding a Doctor

You will need to find a doctor who is skilled in helping women with urine leakage. If your primary doctor shrugs off your problem as normal aging, for example, ask for a referral to a specialist-a urogynecologist or a urologist who specializes in treating female urinary problems. You may need to be persistent, or you may need to look to organizations to help locate a doctor in your area.

Make a note of any recent surgeries or illnesses you have had. Let the doctor know how many children

You can use What Your Doctor Needs to Know and Your Daily Bladder Diary  to prepare for your appointment.

How is loss of bladder control treated?

Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.

Talk with your doctor about which treatments might work best for you. And ask your doctor whether lifestyle changes, such as losing weight or avoiding caffeine, can help.

No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch.

These medicines may cause your eyes to become dry, or result in dry mouth and . These medicines can also cause dry mouth and constipation. If you take medicine to treat an overactive bladder, you may need to take steps to deal with the side effects. Use eye drops to keep your eyes moist; chew gum or suck on hard candy if you’re bothered by dry mouth. Take small sips of water throughout the day.

Medicines for other conditions also can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling (edema) or high blood pressure may increase urine output and contribute to bladder control problems.

Talk with your doctor; you may find that taking a particular medicine solves the problem without adding another prescription.

Reprinted courtesy of the National Institute on Diabetes and Digestive and Kidney Diseases. For more information on these issues, click here to visit the agency’s website.

People with overactive bladder have a bladder muscle that squeezes too often or squeezes without warning. This can lead to troubling urinary symptoms such as:

The need to urinate too often (urinary frequency), which is defined as urinating eight or more times a day or two or more times at night (nocturia).

The need to urinate immediately (urinary urgency).

The involuntary leakage of urine as a result of the need to urinate immediately (urge urinary incontinence).

These symptoms affect more than 33 million Americans. Many people don’t seek treatment, possibly because they’re embarrassed or don’t know about treatment options. In the United States, 30 percent of men and 40 percent of women live with overactive bladder symptoms.

The good news is that there are therapies for these symptoms. They include oral medications, a patch or gel applied to the skin, the first over-the-counter (OTC) treatment for women with overactive bladder, and bladder injections for patients with more severe symptoms.

Causes

Some known causes of overactive bladder include neurological disorders, such as spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke. Often, however, the cause is unknown.

“Some conditions—such as urinary tract infection, early pregnancy, uncontrolled diabetes mellitus, prostate disease and bladder tumors—have symptoms similar to overactive bladder and should be excluded before a proper diagnosis can be made. Also, certain medications, especially diuretics, may cause overactive bladder symptoms,” says Suresh Kaul, M.D, M.P.H., a medical team leader for urology in FDA’s Division of Bone, Reproductive and Urologic Products.

The risk of overactive bladder increases with age. “This condition especially affects elderly women,” says Olivia Easley, M.D., a senior medical officer with the FDA Division.

Options for Consumers

There are several treatment options for overactive bladder that help the bladder muscle relax and stop it from contracting at the wrong times. Easley says that anticholinergics are a widely used class of medications for overactive bladder. These drugs contain oxybutynin, tolterodine, fesoterodine or solifenacin, and are believed to work by inhibiting involuntary bladder contractions.

Recently, FDA approved Myrbetriq (mirabegron), a medication that improves the bladder’s ability to store urine by relaxing the bladder muscle during filling. (Side effects of Myrbetriq include increased blood pressure and urinary tract infection. In certain situations, Myrbetriq may increase your chances of not being able to empty your bladder on your own, for example, if you are also taking other medicines to treat your overactive bladder.)

For women 18 and older, there’s also a patch, called Oxytrol for Women, that is applied to the skin every four days. This over-the-counter patch is available without a prescription and delivers oxybutynin. For men, an oxybutynin patch is available by prescription only and is called Oxytrol. (Side effects of the Oxytrol patch include skin irritation, sleepiness, dizziness and blurry vision.)

For adults who cannot use or do not adequately respond to anticholinergics, there are Botox (onabotulinumtoxinA) injections. Botox is injected directly into the bladder muscle under local or general anesthesia in a doctor’s office using a small camera that enables the urologist to see the inside wall of the bladder.

Botox causes the bladder to relax, increasing its ability to store urine and reduce urinary incontinence. When the effects of Botox wear off, more injections can be given, but no sooner than three months from the last set of injections.

(Botox may cause serious side effects that can be life-threatening, including problems breathing or swallowing, and spread of toxin effects. These problems can happen hours, days, to weeks after an injection. Call your doctor or get medical help right away if you have any of these problems after treatment with Botox. Less serious side effects of Botox include urinary tract infections and inability to empty your bladder on your own.)

“There are many treatment options for patients with overactive bladder. Not every drug is right for every patient. Patients need to take the first step of seeking help from a health care professional to determine whether the symptoms they are experiencing are due to overactive bladder or another condition, and to decide which treatment is the best,” Easley adds.

Reprinted with permission of FDA Consumer Health Information. This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products. Click here for more updates.

A reslease from the university quotes senior author said V. Reggie Edgerton, a distinguished professor of integrative biology and physiology, neurobiology, and neurosurgery at UCLA, as saying, “The big deal here is the immediate effect. There may be a way that when people have bladder problems, you can turn the stimulator on and they can release urine at will. This strategy could have a major impact in improving the quality of life and longevity of human patients.”

Nearly 1.3 million Americans have spinal cord injuries, and those with complete spinal cord injuries typically have two to six bladder infections per year. Edgerton said the advance could eventually treat or even cure one of their highest priority health concerns.

“We’re not saying it will restore this part of their lives to normal, but we think it will lead to a significant improvement in quality of life,” he said.

The researchers also found that after they filled a rat’s bladder with saline, and turned on an epidural electrical stimulator, the rat released urine within 90 seconds, said lead author Parag Gad, an assistant researcher in Edgerton’s laboratory.

The research was funded by the National Institutes of Health’s National Institute of Biomedical Imaging and Bioengineering (grants R01EB007615 and R01NS062009) and the Christopher and Dana Reeve Foundation. Other co-authors were Dr. Daniel Lu, assistant professor of neurosurgery at the David Geffen School of Medicine at UCLA; researcher Roland Roy and project scientist Hui Zhong, both of Edgerton’s laboratory; and Yury Gerasimenko, professor and director of the laboratory of movement physiology at Russia’s Pavlov Institute in St. Petersburg and a researcher in Edgerton’s lab.

Edgerton believes there is a connection between the neural networks that control walking and bladder function, and is planning to investigate the connection. To research bladder control with human subjects, his team plans to place electrodes on the skin over a critical part of the spinal cord and evaluating their improvement.

Edgerton and colleagues from the University of Louisville reported in the medical journal Brain in April a fundamentally new intervention strategy that enabled four young men who had been paralyzed for years to move their legs, hips, ankles and toes as a result of epidural electrical stimulation of the spinal cord, and were able to execute voluntary movements immediately following the implantation and activation of the stimulator.

In that study, researchers used a stimulator to deliver a continuous electrical current to the participants’ lower spinal cords, mimicking signals the brain normally transmits to initiate movement. The electrical current was applied at varying frequencies and intensities to specific locations on the lumbosacral spinal cord, corresponding to the dense neural bundles that largely control the movement of the hips, knees, ankles and toes. Once the signal was triggered, the men’s spinal cords reengaged their neural networks to control and direct muscle movements.

“The circuitry in the spinal cord is remarkably resilient,” said Edgerton, who has been conducting fundamental research in this area for 38 years and is a member of the Reeve Foundation International Research Consortium on Spinal Cord Injury. “Once you get them up and active, many physiological systems that are intricately connected and that were dormant come back into play.”

More information about epidural stimulation research is available through the Christopher and Dana Reeve Foundation (http://www.christopherreeve.org/site/c.ddJFKRNoFiG/b.9031137/k.F3D2/2014_Epidural_Stimulation_Center.htm).

While much is known about the central biological clock, little is known about the peripheral clocks in the body. This latest research challenges the long-held view that the central clock of the brain controls all the peripheral clocks in other parts of the body and that these in turn control the down-stream receptor molecules which generate specific cell activities, such as contraction, secretion and metabolism. However, researchers have found that receptors in the bladder, a muscular hollow organ in the body, exert control over the local clocks.

The control of organ function via an interaction between the peripheral clocks and the receiving receptors is an important finding for understanding the pathology and development of new treatments for common diseases of the bladder, such as bladder overactivity and irritable bowel syndrome.

The team also believes the study will help advance understanding of how aging affects organ function in the body as the normal control of daily rhythms by the clock is weakened in aging tissue.

A release from the university quotes lead author Dr Changhao Wu as sayin,g “Previously, people have believed that the brain ‘master’ clock controls the ‘slave’ peripheral clocks, but our study is the first to show that in a contractile organ, such as the bladder, its receptors also control these clocks. By influencing the receptors in the bladder, we can also change our clock genes. These clocks are crucial in maintaining our physiological rhythm and preventing unwanted activities associated with an overactive bladder.”

“There are two types of incontinence, ‘stress’ and ‘urge,'” Dr. Marie says. “The word ‘stress’ doesn’t refer to emotional stress. It means pressure on your bladder. If you have weak muscles, that pressure causes urine to leak. This can happen when you laugh, cough, or just wait too long to go to the bathroom.”

She went on to explain that urge incontinence — also called irritable bladder syndrome, overactive bladder, or spastic bladder – is a condition in which your bladder empties even if it’s not full in spite of your attempts to hold it. This disorder is sometimes caused by diabetic neuropathy but is most often simply related to aging.

Dr. Marie says she can’t promise you a 100 percent cure, but that she can certainly help you gain more control. She deals with the problem herself and advises that your first line of defense should be to make sure you always have access to a toilet. “Just do as I do and check out the location of the bathroom everywhere you are,” she says. “Also, go often even before you feel the need!” Beyond that, she has tips for keeping the leaks at a minimum.

Often referred to as Kegels after Dr. Arnold Kegel, the gynecologist who created them in 1948, these exercises are the single most effective treatment for stress incontinence. Just as with any other muscles, you either “use it or lose it.”

Finding the muscles is easy. When you’re urinating, imagine that somebody accidentally comes into the bathroom and startles you. Your instinct will be to squeeze your muscles to stop the flow.

Dr. Marie recommends doing your Kegels three to five times a week by squeezing and holding for five seconds, then releasing and repeating for a total of ten repetitions. She says you will notice improvement in six to eight weeks and that after three to six months you may be cured, or nearly cured.

She speaks from experience. “Once I got past an initial aversion to doing Kegels, they became a routine part of my life,” she says. “I’m proud that I had the power to strengthen the muscles and alleviate my problem to a great extent.”

You can buy weights in the shape of cones that are the size of a tampon. They come in sets ranging from twenty to seventy grams. Begin by inserting the lightest one and holding it for fifteen minutes twice a day for four to six weeks. Then move up to the next heaviest weight and finally the heaviest one. However, Dr. Marie says that no research has shown that the weights are any more effective than Kegels. “In fact Kegels are often shown to be more effective than using weights,” she points out.

You knew this was coming. In the same way that you experienced extra pressure on your bladder if you were ever pregnant, carrying excess weight after menopause can make incontinence worse. Consider getting support from groups such as Weight Watchers or Overeaters Anonymous if dieting is difficult for you.

“Prescription medications can help some women with urge incontinence,” Dr. Marie says. She cautions, though, that the drugs are expensive and may have side effects such as a dry mouth, headaches, fatigue or sleepiness, constipation, and tummy aches.

They work by relaxing the smooth muscle of the bladder and blocking certain nerve receptors to the urethra to help keep it closed. Paradoxically, although this is a positive result for urge incontinence, it’s a negative for stress incontinence. Some of the commonly prescribed medications for urge incontinence include Ditropan, Detrol, Urispas, Tofranil, Bentyl, Levsin, Sanctura, Vesicare, and Enablex.

“Twenty years ago I wouldn’t have recommended surgery for stress incontinence,” Dr. Marie says. “That’s because your only option would have been a urologist whose greatest knowledge and practice was almost without exception limited to men. Today, however, I would encourage you to have a consultation with a gynecologic urologist.” She goes on to say that surgical cases have doubled recently as baby-boomer women with the proactive attitude typical of that generation have aged and demanded better treatments. There are now over 250 techniques ranging from collagen injections to minimally invasive surgery to tacking up of the bladder, vagina, and urethra to the pubic bone. Yet Dr. Marie warns that not all of these procedures have been well evaluated. “Do your research and seek a second if not a third opinion if you are considering surgery,” she advises.