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Urinary incontinence usually is caused by weakened or damaged pelvic muscles and tissue that prevent the urethra from closing tight enough to hold urine in the bladder.

To determine the type and cause of urinary incontinence, doctors take a complete medical history and conduct a thorough physical examination. Specialists such as gynecologists, urologists and urogynecologists may use a variety of testing methods to determine the cause and type of urinary incontinence.

Types of Urinary Incontinence

There are five basic types of urinary incontinence: stress urinary incontinence, urge incontinence, mixed incontinence, overflow incontinence, and functional incontinence. In many cases, individuals experience symptoms of more than one type of incontinence. Proper diagnosis of the type of urinary incontinence is an important factor in successful treatment.

  • Stress Incontinence—Occurs when you leak urine during a physical activity like lifting, exercising, sneezing and coughing. Stress urinary incontinence is typically a result of both hypermobility and intrinsic sphincter deficiency. Hypermobility is a result of significant shifting of the urethra and bladder neck from their normal positions and results in urine leakage during activities such as lifting, sneezing, coughing or exercising. Intrinsic Sphincter Deficiency (ISD) occurs when the urethral sphincter is unable to close tightly enough to hold urine in the bladder during exertion and typically results in continuous leakage.
  • Urge Incontinence—Is described as overactivity of the detrusor muscle surrounding the bladder. This overactivity causes your bladder to contract frequently and creates an overwhelming need to urinate—even if you just went. This condition often is called "overactive bladder" or "unstable bladder" and makes it difficult for you to hold your urine long enough to reach a toilet.
  • Mixed Incontinence—A combination of stress incontinence and urge incontinence, where you have symptoms of both conditions.
  • Overflow Incontinence—When your bladder never completely empties, causing urine to leak.
  • Functional Incontinence—Factors outside the lower urinary tract, such as weaknesses in physical and/or cognitive function, cause this form of urinary incontinence.

Causes of Urinary Incontinence

Urinary incontinence in women can be caused by any single condition or a combination of conditions. To effectively diagnose and treat urinary incontinence, a doctor must determine the cause.

  • Pregnancy and Vaginal Childbirth—Weakened or damaged pelvic muscles and tissue can be the result of pregnancy and childbirth, causing the bladder and urethra to relax from their normal positions. The bladder and urethra must be well supported by the pelvic muscles and tissue to allow them to work properly.
  • Aging and Genetic Factors—Aging tends to worsen all forms of muscular injury. Changes in pelvic muscles can contribute to urinary incontinence.
  • Medical Conditions—Certain medical and neurological conditions, such as hysterectomies, spinal cord problems (e.g., spina bifida, spinal cord injury, malformation of the lower spine), multiple sclerosis, Parkinson's disease, stroke and diabetes can make incontinence worse.
  • Infections and medications—Urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.
  • Obesity—While obesity does not cause incontinence, it does contribute to the condition due to the increased abdominal pressure. 
  • Smoking—While not a direct cause of incontinence, smoking may aggravate urinary incontinence.