What Are the Different Types and Causes of Incontinence?

There are six common types of incontinence stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, functional incontinence, and reflex incontinence.

Urinary incontinence is a medical condition where you lose control of your bladder and urinate unintentionally. Urine is the byproduct of waste collected from your body. It comes from the kidney and passes down through your bladder. Tightening your bladder muscles forces the urine out of your bladder through your urethra. 

People with incontinence experience weakness in their bladder muscles, making them unable to generate enough strength to close their urethra. Some people find incontinence nothing more than a minor inconvenience, while others find their quality of life greatly affected.  

Urinary incontinence occurs at twice the rate in women versus men. That’s because women physically experience more trauma to organs like the urethra, bladder, and supporting muscles. Incontinence also tends to be more common in older women, most likely because of changes due to menopause. 

Urinary incontinence tends to be a symptom of other health problems, such as a weakening in the pelvic floor muscles. Some signs that can indicate a problem with urinary incontinence include:

• Continually feeling a strong urge to urinate
• Making frequent trips to the restroom
• An inability to make it to the bathroom before urinating
• Wetting the bed while asleep

There are six common types of incontinence.

1. Stress incontinence

Stress incontinence happens when urine leaks from the urethra when there is pressure on the bladder. You can experience stress incontinence while exercising, laughing, sneezing, or coughing. Lifting a heavy object or other physical activity can be enough to trigger stress incontinence. Many women find themselves dealing with stress incontinence when they begin menopause. 

2. Urge incontinence (Overactive bladder)

Urge incontinence causes you to feel a sudden urge to urinate. It makes it difficult for you to hold your urine and make it to a toilet. People with conditions like Parkinson’s disease, diabetes, and Alzheimer’s disease often experience problems with urge incontinence.

3. Mixed incontinence

People with mixed incontinence experience a mix of both stress incontinence and urge incontinence. Most women living with incontinence experience mixed incontinence, as do men who have had prostate surgery or had their prostate removed. Older Americans also often experience this type of incontinence.

4. Overflow incontinence

People diagnosed with overflow incontinence experience small amounts of urine leakage when something prevents their bladder from being fully emptied. Men with enlarged prostates that block the urethra can experience overflow incontinence. Other conditions that can lead to this form of incontinence include diabetes and spinal cord injuries. 

5. Functional incontinence

Functional incontinence occurs in people who are capable of controlling their bladder but experience other illnesses or conditions that prevent them from remaining continent. For example, people living with mental illness or dementia might not realize they need to use the restroom. 

People with mobility issues like arthritis can also experience functional incontinence because they have difficulty moving quickly enough to make it to a toilet in time. 

6. Reflex incontinence

Reflex incontinence occurs in people with serious neurological issues from multiple sclerosis, spinal cord injuries, damage caused by radiation or surgery, or other injuries. In this type of incontinence, the bladder muscle contracts and leaks without you experiencing any urge to urinate. 

There are many reasons that people are incontinent. You might find yourself with short-term incontinence because of a urinary tract infection or due to a medication you are taking. 

Long-term incontinence can develop because of:

• Weakening bladder muscles
• Overly active bladder muscles
• Nerve damage
• Weakness in the pelvic floor muscles
• Disorders like diabetes 
• Blockages caused by other health conditions
• Pelvic organ prolapse, where organs move from their normal position and protrude into the vagina
• Inflamed or enlarged prostate
• Damage caused by surgery

Your doctor will perform a physical exam and ask you questions about your incontinence and your medical history. They may ask you to keep a diary for two to three days to track your bouts of incontinence, including when and where they occur. 

Your doctor may have you perform a cough stress test to help confirm a diagnosis of incontinence. For this test, your doctor will have you sit or stand in various positions and cough when your bladder is full to see if urine leaks. 

Your doctor may also order additional tests to obtain more clarity about your incontinence, including:

• Urine test — Your doctor collects a sample of your urine and sends it to a lab to check for signs of an infection or other disorders that are causing your incontinence.
• Ultrasound — Your doctor uses an ultrasound wand to photograph the bladder, kidneys, and urethra to check for anything unusual. 
• Cystoscopy — Your doctor inserts a cystoscope, a thin tube with a small camera attached, into your urethra and bladder to check for signs of damage. 
• Urodynamic study — Your doctor inserts a tube into your bladder and fills it with water to measure how much liquid your bladder can hold.

Treatment plans for incontinence vary depending on your symptoms and the severity of the issue. Treatments include:

• Pelvic muscle exercises (also called Kegel exercises) to strengthen your pelvic muscles and give you more control over holding your urine. 
• Biofeedback using sensors that provide you with an awareness of signals coming from your body
• Urinating on a set schedule
• Making lifestyle changes like quitting smoking, drinking less alcohol, or losing weight

Women may also benefit from medications designed to strengthen the tissues and muscles around the urethra and vagina. Other specific recommendations for women include:

• Inserting a small device made of plastic or silicone called a pessary into the vagina to support pelvic floor muscles
• Injecting a bulking agent like collagen into the tissues around the urethra and bladder
• Surgery to provide more support to organs in that region