Incontinence

Overview

If you're leaking urine when you cough, laugh or sneeze, or you have sudden urges to go to the bathroom that are so intense you fear you won't get there in time, you're probably experiencing incontinence. The inability to control urination is frequently a treatable, and often curable, problem faced by millions of Americans, many of them women.

While at least half the elderly experience the condition, and it is a major cause of admission to nursing homes, it is often mistakenly thought of as a problem suffered only by older people. In fact, incontinence can occur at any age.

Although the majority of incontinence cases can be improved or cured, many of those afflicted never discuss their problem with a health care professional. Instead of recognizing incontinence as a treatable condition and pursuing treatment, many women view it as an embarrassing consequence of aging. They may wear absorbent products and do not seek treatment. Although health care professionals may recommend using absorbent products as part of treatment, this is very rarely the only treatment for incontinence.

Left untreated, incontinence can lead to skin rashes and infections, loss of self-esteem, emotional distress and self-imposed isolation. You don't have to suffer incontinence in silence, as there are several treatment options from which you and your health care professional can choose.

Incontinence is not a disease—it's a symptom that can be caused by a wide range of conditions, such as weak pelvic floor muscles from prior childbirth or an overactive bladder muscle from aging. Less frequently, diabetes, stroke and nerve diseases, like multiple sclerosis, may also cause leakage. Your urinary tract includes two kidneys, two ureters, the bladder and the urethra. Your kidneys remove waste and water from your blood to produce urine. Urine travels through muscular tubes called the ureters to the bladder. The bladder is a balloon-like organ composed of muscle, connective tissue and nerves that expands as it fills with urine. Urine is stored in the bladder until it is released from the body through a tube called the urethra.

Circular muscles, called the urinary sphincters, control the activity of the urethra. The sphincter muscles prevent the loss of urine. The sphincters close off the base of the bladder—like a rubber band at the base of a balloon—so you do not leak urine.

As the bladder fills with urine, you have an increasing urge to urinate. Sensory nerves in the bladder signal your brain when the bladder is full. Just before you urinate, the sphincter first relaxes and then the bladder muscle contracts, squeezing urine out through the urethra. When you stop urinating, the bladder muscle relaxes, and the sphincters contract.

Incontinence can worsen because of aging, illness or injury. A urinary tract infection, vaginal infection or irritation and constipation may result in temporary bouts of incontinence that are alleviated by treating the primary ailment. Additionally, some medications can cause incontinence, and changing or discontinuing a drug may bring relief. Bowel issues are frequently associated with urinary incontinence and are also part of the treatment of bladder problems. Women who are pregnant may also suffer from temporary bladder control problems, which are caused by hormonal changes and pressure exerted on the urinary tract by the growing fetus.

Most incontinence in women is triggered by problems with the bladder and sphincter muscles, which can weaken with age. A bladder muscle that is too active, weak pelvic muscles resulting from pregnancy and childbirth, hormonal imbalances in menopausal women, nerve disorders and immobility also can contribute to incontinence. Although these bladder control problems tend to be long-term, many women who seek treatment see an improvement or are cured.

To help you better understand your incontinence and better explain it to your health care professional, it's helpful to recognize what kind of incontinence you may have. Health care professionals classify incontinence by the symptoms displayed or the circumstances occurring at the time urine is involuntarily released. The following are types of urinary incontinence:

• Stress incontinence is the most common form of incontinence in women. This occurs when any kind of pressure is put on the bladder, such as during sneezing, laughing, lifting, running, coughing, exercising, walking or even rising from a chair. Childbirth and weight gain are two common causes of incontinence because these conditions stretch the pelvic floor muscles. The pelvic floor muscles support the bladder, and when they are stretched, the neck of the bladder, or the place where the bladder and the urethra meet, drops and pushes against the vagina wall, preventing the sphincter muscles that force the urethra shut from tightening as well as they should. The result is urine leaks during physical stress. Stress incontinence also can occur when the sphincter muscles themselves weaken. Additionally, decreased estrogen levels may cause the lining of the urethra to thin, reducing bladder support.
• Urge incontinence is characterized by urgent needs to urinate, followed by sudden urine leakage. Occasionally, some women have no warning or urge sensation. You also may leak urine when you drink small amounts of liquid, or when you hear or touch running water. You may go to the bathroom as often as every two hours, and you may wet the bed at night or wake multiple times during the night to urinate. Involuntary bladder contractions are the most common cause of urge incontinence and are described by health care professionals as "overactive," "unstable" or "spastic" bladder. It is often difficult to assign a direct cause to the involuntary bladder muscle contractions. In rare instances, these can be caused by damage to the bladder muscle or nerves, or to the body's nervous system, including the spinal cord and brain. Such damage may be caused by diseases such as multiple sclerosis, Parkinson's, Alzheimer's, stroke, brain tumors or injuries, including those that can occur in surgery, but in many cases the cause may not be known.
• Overflow incontinence occurs when your bladder remains full and leaks urine. You may feel as though you need to empty your bladder but cannot. Or you may urinate a small amount, but feel like your bladder is still full. Frequent or constant dribbling of urine also is a sign of this type of incontinence, which is rare in women. A damaged bladder or a blocked urethra can cause an inability to empty the bladder. Diabetes and other diseases can cause nerve damage that weakens the bladder muscle. Urinary stones or tumors also can block the urethra, which can force urine to remain in the bladder and even back up the urinary tract.
• Functional incontinence is untimely urination because of physical disability, external obstacles or problems in thinking or communicating that prevent a person from reaching a toilet. This may occur with severe arthritis, after joint replacement or with dementia such as seen in Alzheimer's disease.
• Mixed incontinence is a combination of types of incontinence, usually stress and urge. In some studies, mixed incontinence is the predominant form of incontinence.

Diagnosis

If you're suffering from incontinence (the inability to control urination), don't be afraid to tell your health care professional what you're experiencing. By talking with your health care professional, you can find out why you're having bladder control and urinary leakage problems and what kind of treatment is best for you. Remember, incontinence is not a disease: it is a symptom of one or more of a wide range of conditions. Make sure you tell your health care professional what prescription and over-the-counter medications you are taking, as many drugs can contribute to incontinence.

To diagnose the cause of your incontinence, your health care professional will first ask questions about your urinary habits and medical history. You should receive a thorough physical examination, including a pelvic exam, in which your health care professional will look for medical conditions that may be causing leakage, such as infections, tumors or impacted stool.

Constipation, or infrequent bowel movements that pass small amounts of hard, dry stool, can cause the stool to pack the intestine and rectum so tightly that the normal pushing action of the colon cannot move and discharge the stool. This condition, known as impacted stool or fecal impaction, occurs most often in the elderly or nursing home populations. It can produce urinary incontinence as the packed intestine and rectum swells and presses against the urinary tract, blocking flow of urine. Loosening and removing the impacted stool, usually by taking softening medication and having a health care professional break up and extract the stool with a finger inserted in the anus, relieves the urinary incontinence. Constipation should be avoided in any woman seeking to improve continence.

You may be asked to keep a diary of your urinary patterns for at least three days and up to a week. In the bladder diary, you record what, when and how much liquid you drink; how many times you urinate and how much; how many leaks you have; whether you felt an urgency to urinate; and what you were doing at the time you experienced a leak.

Your health care professional may also perform some tests, depending on the type and suspected causes of your incontinence, including:

• Urinalysis, in which you will provide a sample of your urine that will be analyzed for the evidence of blood, infection, urinary stones and other abnormalities that can cause leakage.
• Cough stress test, in which you first relax and then cough while your health care professional looks for urine leakage. This test checks for stress incontinence and may be performed either lying down or an upright position.
• Post-void residual (PVR) measurement test that is performed to see how much urine remains in your bladder after urination. In this test, you drink fluids and urinate into a measuring pan. Then, your health care professional drains the remaining urine in your bladder for measurement by inserting a small, pliable tube, called a catheter, through the urethra into the bladder. Alternatively, your health care professional measures the urine remaining in the bladder by using bladder ultrasound, in which a machine directs sound waves at the bladder and produces shadowy images from which the amount of urine in the bladder can be determined. Your health care professional can explain what your PVR readings mean.
• Blood tests to check levels of substances in the blood that might be related to disorders or diseases that may cause incontinence.

If the results of the basic evaluation and initial tests fail to point to a definitive diagnosis, your health care professional may refer you to a specialist, such as a urologist, who treats urinary tract disorders, or a urogynecologist, who treats urinary tract problems in women. Your health care professional also may recommend the following additional tests:

• Urodynamic testing assesses bladder and sphincter function, including the pressure and volume of urine in the bladder and the pressure and flow of urine from the bladder through the urethra. One test, called cystometry, measures contractions of the bladder muscle as it fills and empties by inserting a catheter through the urethra into the bladder and filling it with water. As part of the test, another tiny tube is inserted into the rectum or vagina to measure pressure on your bladder when you cough or exert pressure. Urodynamic testing also may include imaging, such as X-rays or ultrasound, to examine changes in the position of the bladder and urethra during urination, coughing or straining.
• Cystoscopy, a test that uses a tiny telescope-like instrument that allows your health care professional to see inside the bladder and urinary tract and examine them for problems. You may be given some local numbing jelly and medication to relax you before the test, which involves inserting a thin tube that contains a miniature camera through the urethra and into the bladder.

Your health care professional may also perform additional tests to rule out pelvic weakness as the cause of your incontinence, including one called the Q-tip test. The Q-tip test measures the difference in the angle of the urethra when it is at rest versus when it is straining. If the angle changes more than 30 degrees, there is most likely significant weakness in the pelvic floor muscles.

Be sure to discuss with your health care professional which tests are best for you, the exact procedures that will be followed when they are conducted and what the results mean in assessing your bladder control problem and developing an appropriate course of treatment.

Treatment

The majority of incontinence conditions can be improved or cured with treatment, once the condition is brought to the attention of a health care professional and accurately diagnosed. Many women are too ashamed or embarrassed to discuss their incontinence condition with their health care team or think that treatment isn't available. In fact, a variety of treatment options are available for incontinence conditions, depending on which type of incontinence is diagnosed: stress incontinence, urge incontinence, overflow incontinence or mixed incontinence.

Incontinence is not a disease, though it can be a symptom of an underlying condition, such as diabetes. However, most incontinence in women is triggered by problems with the bladder and sphincter muscles, which can weaken with age and from childbirth.

Treatment options include:

• behavioral techniques
• pelvic muscle exercises
• medications
• Botox
• medical devices that block or capture urine
• electrical stimulation
• surgery

Your health care professional can teach you ways to control your bladder and sphincter muscles. Behavioral techniques generally are tried first because once you learn them, you usually can do them yourself at home; they have no side effects; and they don't preclude other treatment options. Types of behavioral techniques are:

• Pelvic muscle exercises, such as Kegel exercises, strengthen the muscular components of the urethral closing mechanism and are often used in stress incontinence therapy. Kegel exercises involve squeezing the muscles, holding the squeeze for a few seconds, then relaxing, and repeating the process. The basic recommended regimen is to do three sets of eight to 12 contractions, holding each contraction for eight to 10 seconds, performed at least three to four times a week (preferably every day) for 15 to 20 weeks. The keys to success with pelvic muscle exercises are accuracy (making sure you exercise the correct muscles) and compliance (sticking with the exercise program). Your health care professional can help you learn to identify the muscles. Sometimes biofeedback and electrical stimulation are used to improve exercise results.
• Biofeedback is a training technique that teaches you how to control physical responses, such as breathing, muscle tension, heart rate and blood pressure that are not normally controlled voluntarily. Biofeedback techniques may help you to gain control over your bladder and pelvic muscles and to strengthen the sphincter muscle. A monitoring device is placed on the muscles that let you know when you have contracted them, and how strong the contraction was. In one study of 222 women with urge incontinence, behavioral training combined with biofeedback led to a 63 percent reduction in incontinence. Over the years, mainstream health care professionals and insurers have increasingly accepted biofeedback techniques.
• Electrical stimulation stimulation involves using brief doses of electrical stimulation to strengthen muscles in the lower pelvis in a way similar to exercising the muscles. It may include use of devices such as a radiofrequency treatment (Renessa) or pelvic floor biofeedback. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This procedure will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence, though it is rarely used for primary stress incontinence. Some insurers may not pay for this procedure, so be sure to check on your coverage.
• Bladder training is is used to treat urge incontinence, but may also be used for other types of incontinence. Your health care provider teaches different ways to control the urge to urinate, such as through distraction (thinking about things other than having to go to the bathroom), taking a deep breath, contracting the pelvic muscles, or visualizing the urge as a wave that rises and falls. You also follow a urination schedule that gradually lengthens the time between bathroom visits.

Several medications can be used to treat incontinence and are sometimes used in conjunction with behavioral techniques. Because many drugs can have side effects, can interact with other medications, or should not be used by people with certain medical conditions, only you and your health care professional can determine which medications are right for you.

Some of the medications are drugs that block production and use of a chemical that prompts bladder contractions. These medications are often used to treat urge incontinence, but they should not be taken by if you have urinary retention, certain types of stomach problems, or narrow-angle glaucoma. Here are some of the most common drugs for overactive bladder/urge incontinence.

• Oxybutynin blocks bladder muscle contractions and is recommended for treatment of urge incontinence. Oxybutynin is available in tablets (Ditropan), extended-release tablets (Ditropan XL), patch (Oxytrol) and gel form (Gelnique). The patch form recently was approved as the first over-the-counter treatment for overactive bladder in women (Oxytrol for Women). It became available OTC in fall 2013 for women but will remain available by prescription only for men. The patch is applied every four days. The prescription gel is applied daily. Common side effects of oxybutynin include mouth, nose and throat dryness; headache; constipation; nausea; dizziness and blurred vision. The patch and gel may also cause skin irritation.
• Tolterodine tablets (Detrol) is a drug for overactive bladder. Side effects include cause dry mouth, headaches, constipation, blurring of near vision, dizziness, upset stomach and abdominal pain.
• Trospium (Sanctura). This drug is approved for the treatment of overactive bladder. Side effects include dry mouth and constipation.
• Solifenacin (Vesicare) and darifenacin (Enablex). These drugs are also approved for the treatment of overactive bladder. Side effects include constipation and dry mouth.
• Imipramine (Tofranil). This is an antidepressant drug that may occasionally be prescribed together with other medications to treat incontinence. It works by causing the bladder muscle to relax while simultaneously causing the smooth muscles at the neck of the bladder to contract. Side effects include blurred vision, dizziness, dry mouth, fatigue, insomnia and nausea.
• Fesoterodine (Toviaz). This tablet is approved to treat overactive bladder with symptoms of urinary frequency, incontinence and urgency. It works by reducing spasms of the bladder muscles. Side effects may include allergic reactions, blurred vision, dizziness, constipation, upset stomach, insomnia and dry mouth, eyes or throat.
• Mirabegron (Myrbetriq). Mirabegron was the first beta-3 adrenergic agonist to be approved by the U.S. Food and Drug Administration (FDA) for incontinence caused by overactive bladder (OAB). It is a once-a-day pill that works by relaxing the bladder's detrusor muscle to regulate the filling and storage of urine. This increases bladder capacity and helps control the frequent urge to urinate, as well as urine leakage. Mirabegron can cause some side effects, including headache, high blood pressure, urinary infection and upper respiratory infection.

If you also have mild to moderate stress incontinence, your health care professional may prescribe one or more of the following medications, however, no drugs have been proven effective for treating stress incontinence:

• Anticholinergic drugs which may assist with mixed incontinence, such as oxybutynin (Oxytrol), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviax), trospium (Sanctura) or solifenacin (VESIcare)
• The tricyclic antidepressant imipramine (Imipramil, Tofranil), which can calm nerve signals and decrease spasms in bladder muscles.

Absorbent products may be used while treatments are under way or as part of a treatment plan, in combination with behavioral training, exercises, medications or other treatment options.

Surgery

Surgical procedures also may help women with stress incontinence when less invasive therapies do not improve symptoms. Surgery is a serious step that needs to be discussed with your health care professional so you clearly understand all the risks, as well as the chances that the surgery will relieve your urine control and urinary tract support problems. Although the procedures do have high success rates, complications can occur, including recurrence of incontinence.

For stress incontinence, the most popular procedure in the United States and Europe today involves a mid-urethral polypropylene sling. A surgeon uses the synthetic material to make a sling that compresses the bottom of the bladder and the top of the urethra, preventing urine leaks. Alternatively, the surgeon may use a piece of pelvic connective tissue to create a sling.

Surgery may also involve bladder neck suspension. Done through an abdominal incision using general or spinal anesthesia, this surgical procedure provides support to the urethra and bladder neck, an area of thickened muscle where the bladder and urethra connect.

Other treatments for incontinence include:

• A pessary is a device inserted by a health care professional into the vagina to support pelvic organs. It either presses against or supports the vagina wall and the urethra, leading to less urine leakage in stress incontinence. It has to be removed, cleaned and reinserted regularly to prevent possible urinary tract infections and vaginal ulcers. There are different kinds of pessaries, and you may have to try several to obtain a good fit. Some patients may be able to remove and clean the pessary by themselves.
• Catheters may be used either constantly or occasionally for overflow incontinence not caused by a blockage, or in women who cannot empty their bladders because of muscle weakness, previous surgery or spinal cord injury. Your health care professional can teach you how to insert the catheter through the urethra into the bladder yourself so you can drain urine. If you use a catheter long-term, the tube will be connected to a urine collection bag that you can wear on your leg underneath clothing. You also need to be on the alert for urinary tract infections, which are possible with long-term catheter usage.
• Percutaneous tibial nerve stimulation (PTNS) is an option for women with urge incontinence who don't respond to lifestyle changes or medications, as well as for those who don't want to or cannot have surgery. The procedure involves delivering electrical stimulation to the sacral nerve that controls the bladder via the tibial nerve in the ankle that leads to nerves that control the pelvic floor.
• Also for urgency incontinence, sacral nerve stimulation is an electronic stimulation therapy that involves a surgically implanted sacral nerve stimulator resembling a pacemaker. More invasive than PTNS, it involves sending small, electrical impulses directly to the sacral nerve. The continuous electrical stimulation reduces or eliminates urgency, frequency and urge incontinence.
• Botulinum toxin type A (Botox) has been approved by the FDA to treat women with incontinence from overactive bladder who have not responded to medications, as well incontinence in people with neurological conditions, such as multiple sclerosis or spinal cord injuries. Botox works to control incontinence by relaxing the bladder, increasing storage capacity and decreases leakage. Possible side effects may include urinary tract infections, painful or difficult urination and urinary retention.

Prevention

Although there is no scientifically proven regimen to prevent urinary incontinence, maintaining your general health is always a good step to head off illnesses and disease that might cause incontinence. Healthy eating and weight control may be preventive measures, as there have been links between obesity and incontinence. Indeed, even modest weight loss has been demonstrated to dramatically improve incontinence symptoms. Activities that exert pressure on pelvic muscles should be avoided, such as straining during bowel movements or heavy lifting. Persistent coughing from smoking also can stress pelvic muscles, giving smokers yet another reason to quit.

Performing pelvic muscle, or Kegel, exercises, especially during and after pregnancy, and using topical forms of estrogen may play a role in possibly preventing or treating incontinence. Your health care professional can advise whether such therapies are appropriate for you.

Reducing caffeine and alcohol consumption can improve the body's ability to retain urine. Both substances can inhibit production of a hormone that concentrates and decreases the volume of urine by increasing reabsorption of fluid by the kidneys.

Your health care provider may suggest you keep a chart to track your urinary frequency to help determine whether your fluid intake is reasonable. Emptying your bladder four to eight times in 24 hours is normal, as is urinating about every three to four hours during the day, as well as getting up once at night to go to the bathroom.

Although there is no specific diet to prevent incontinence, it is thought certain foods and drinks can irritate the bladder and should be avoided if consuming them appears to produce or increase symptoms:

• carbonated beverages
• coffee or tea, including decaffeinated forms
• yogurt
• citrus juice and fruits
• tomatoes and tomato-based products
• bananas
• artificial sweeteners
• chocolate
• spicy foods
• vinegar
• processed meats and fish

Some medications may contribute to incontinence. Talk with your health care professional if you experience urinary leakage while taking these drugs:

• diuretics, or "water pills," that increase urine flow, including bumetanide (Bumex), forosemide (Lasix), and theophylline (Bronkodyl)
• sedatives and sleep aids, including diazepam (Valium), flurazepam (Dalmane) and lorazepam (Ativan)
• antihistamines and cold and allergy medications, such as benztropine (Cogentin)
• antidepressants and antipsychotics, including amitriptyline (Elavil), desipramine (Norpramin) and haloperidol (Haldol)
• angiotensin-converting enzyme (ACE) inhibitors, which are often prescribed for high blood pressure and congestive heart failure, including benazepril (Lotensin) and captopril (Capoten)

Facts to Know

1. Millions of Americans suffer from urinary incontinence, and many of them are women.
2. Although incontinence is most prevalent among older women, it can occur at any age and in both genders.
3. Many women with incontinence never discuss it with their health care professionals. In most cases, treatment can improve or cure incontinence, once the condition is brought to the attention to a health care professional.
4. Incontinence is a symptom, not a disease. It has a variety of causes. Urine leakage can be caused by problems that, when treated, stop the incontinence, including urinary tract infections, bladder irritations and constipation. Incontinence also can be the result of a serious illness or disease, such as diabetes, multiple sclerosis, Parkinson's, Alzheimer's, stroke or brain tumors. Long-term incontinence can be caused by weak pelvic, bladder, or urinary sphincter muscles or a bladder that contracts involuntarily and expels urine.
5. Stress incontinence is the most common form of incontinence among younger women. It consists of urine leakage when any physical pressure is placed on the bladder, such as sneezing, coughing or exercising. Another common type of urine control problem in women is urge incontinence, characterized by a sudden, strong urge to urinate but an inability to make it to the toilet in time. It can be caused by a disorder known as "overactive bladder." Women can have a combination of these problems, known as mixed incontinence.
6. Overflow incontinence, which is the feeling that the bladder is always full, accompanied by dribbling of urine, is rare in women. It can be caused by diabetes, all neurologic diseases or an obstruction in the urinary tract that can lead to serious illness, so if you experience such symptoms, see your health care professional.
7. With treatment, incontinence can be improved or cured in many cases. Treatment depends on the type of incontinence and its causes. Therapy options include simple behavior modification techniques women can learn to do themselves, medications, Botox injections, use of special devices and surgery. Talk with your health care professional about what treatments may help you.
8. Behavior modification techniques are often the first-line treatment for incontinence, but their success depends on your ability to stick to with them. Pelvic muscle exercises, such as Kegel exercises, strengthen weak muscles that support the urinary system. Studies show that when done correctly, Kegel exercises can be effective in helping to prevent stress incontinence. Bladder training may also change urination habits.
9. There are numerous surgical techniques for treating stress incontinence, and many of them have been highly successful. Some procedures are minimally invasive and can have quick recovery times. But surgery does carry risks and needs to be fully discussed with your health care professional before you choose it as a treatment option.
10. Absorbent pads and adult diapers are generally recommended by health care professionals for use while undergoing other treatments or for long-term use in conjunction with other treatments—not as the only option available.

Questions to Ask

Review the following Questions to Ask about incontinence/overactive bladder so you're prepared to discuss this important health issue with your health care professional.

1. Is an illness or disease I have causing my incontinence, and will the leakage stop with treatment?
2. What tests should I have to determine the cause of my incontinence?
3. Is my incontinence temporary or long-term? What kind of incontinence do you suspect I have? What kind of treatment do you recommend?
4. Are my prescription or over-the-counter medications contributing to my incontinence?
5. Can my diet affect my bladder control? Will losing weight help me?
6. Can pelvic exercises help me? How do I do them?
7. What is bladder training? Will it help me control my incontinence?
8. What medications are available to help me? What are their benefits and side effects? Will they interact with any other prescriptions or over-the-counter medicines I'm taking?
9. Is menopause affecting my ability to control my urine? Will estrogen or hormone therapy help me?
10. Can surgery solve my urine leakage problem? What procedure might help me, and what is its success rate? What are the potential risks of the procedure? What are the possible complications after the surgery?

Key Q&A

Lifestyle Tips

1. Get the right diagnosis.
   Keep a diary of what you eat and drink, how often you go to the bathroom and how often you lose urine every day for a week. This can help you and your health care professional figure out specific factors that might be affecting your bladder control. Know your symptoms (for example, leaking urine after coughing or laughing or feeling a sudden strong urge to urinate) so you can describe them accurately to your health care professional. Make a list of the medications you are taking, as some can cause or aggravate incontinence.
2. Eliminate bladder irritants from your diet.
   If you avoid alcohol, coffee and other sources of caffeine, carbonated beverages, fruit juices, certain fruits (such as strawberries, peaches, plums, grapes, pineapple and guava), and vinegar (such as that in salad dressing), you may make it easier for your body to maintain bladder control. These substances are known as bladder irritants.
3. Quit Smoking and Lose Weight.
   Don't smoke—nicotine is a bladder irritant, and smoking may cause you to cough, which in turn can cause you to lose urine. Additionally, tobacco is a urinary tract carcinogen. Lose weight if you are overweight, since the excess weight can put pressure on your bladder.
4. Don't delay a trip to the bathroom.
   Don't force yourself to delay a trip to the bathroom once your bladder is full. Make sure you have a place to go and can excuse yourself in social situations.
5. Empty your bladder completely.
   It's best if you don't strain your muscles to empty your bladder completely. Instead, after you have finished, stand up or shift your position, wait a minute or two, and then sit down and urinate again. This method, called double voiding, helps ensure that you don't have residual urine in your bladder after a trip to the bathroom.
6. Don't let incontinence hold you back.
   If embarrassment is keeping you from leaving the house or seeing friends or family, it's time to consult your health care professional. Most cases of incontinence can be cured or controlled with treatment. See your health care professional or a urologist or gynecologist (for women). Bring it up with words like, "I'm concerned because there have been several times when I couldn't control my bladder—and this hasn't happened to me before." Incontinence is not a normal part of aging. If your health care professional tells you so, find another who is better informed.

Organizations and Support

For information and support on coping with Incontinence, please see the recommended organizations, books and Spanish-language resources listed below.

American Urogynecologic Society
Website: https://www.augs.org
Address: 2025 M Street NW, Suite 800
Washington, DC 20036
Phone: 202-367-1167
Email: info@augs.org

American Urological Association
Website: https://www.auanet.org
Address: 1000 Corporate Blvd.
Linthicum, MD 21090
Hotline: 1-800-RING-AUA (1-866-746-4282)
Phone: 410-689-3700
Email: aua@auanet.org

National Association for Continence (NAFC)
Website: https://www.nafc.org
Address: P.O. Box 1019
Charleston, SC 29402
Hotline: 1-800-BLADDER (1-800-252-3337)
Phone: 843-377-0900
Email: memberservices@nafc.org

National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK)
Website: https://www.niddk.nih.gov
Address: Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892
Phone: 301-496-3583

National Kidney and Urologic Diseases Information Clearinghouse
Website: https://www.niddk.nih.gov/health-information/communication-programs/information-clearinghouses
Address: 3 Information Way
Bethesda, MD 20892
Hotline: 1-800-891-5390
Email: nkudic@info.niddk.nih.gov

Simon Foundation for Continence
Website: https://www.simonfoundation.org
Address: PO Box 815
Wilmette, IL 60091
Hotline: 800-23-SIMON
Phone: 847-864-3913

Society of Urologic Nurses and Associates
Website: https://www.suna.org
Address: East Holly Avenue, Box 56
Pittman, NJ 08071
Hotline: 1-888-827-7862
Email: suna@ajj.com

Wound, Ostomy and Continence Nurses Society (WOCN)
Website: https://www.wocn.org
Address: 15000 Commerce Parkway, Suite C
Mt. Laurel, NJ 08054
Hotline: 1-888-224-WOCN (1-888-224-9626)

Books

7 Steps to Normal Bladder Control: Simple, Practical Tips & Techniques for Staying Dry
by Elizabeth Vierck

A Seat on the Aisle, Please!: The Essential Guide to Urinary Tract Problems in Women
by Elizabeth Kavaler

Conquering Bladder & Prostate Problems: The Authoritative Guide for Men & Women
by Jerry G. Blaivas, Jerry G. Blaivas

Ever Since I Had My Baby: Understanding, Treating, and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth
by Roger P. Goldberg

Irritable Bladder & Incontinence: A Natural Approach
by Jennifer M. Hunt

Overcoming Bladder Disorders: Compassionate, Authoritative Medical And Self-Help Solutions For Incontinence, Cystitis, Interstitial Cystitis, Prostate
by Rebecca Chalker, Kristene E. Whitmore

The Incontinence Solution: Answers for Women of All Ages
by William H. Parker, Amy Rosenman, and Rachel Parker

Urinary Incontinence Sourcebook
by Diane Kaschak Newman, Mary K. Dzurinko

Spanish-language resources

Beth Israel Deaconess Medical Center: A Teaching Hospital of Harvard Medical School: Causes of Urinary Incontinence
Website: https://www.bidmc.org/conditions-and-treatments/reproductive-and-sexual-health/urinary-incontinence
Address: Beth Israel Deaconess Medical Center
330 Brookline Ave
Boston, MA 02215
Phone: 617-667-7000

National Kidney and Urologic Diseases Information Clearinghouse
Website: https://www.niddk.nih.gov/health-information/informacion-de-la-salud/enfermedades-digestivas
Address: National Kidney and Urologic Diseases Information Clearinghouse
Bethesda, MD 20892
Hotline: 1-800-891-5390
Email: nkudic@info.niddk.nih.gov