Urinary Incontinence

What Is Urinary Incontinence?

Urinary incontinence — loss of bladder control — may feel embarrassing and inconvenient, but it doesn’t have to disrupt your daily activities. At Penn Medicine, our specialized team has years of focused experience caring for people with all types of urinary incontinence.

Urinary incontinence (UI) is loss of bladder control that causes problems ranging from small leaks to sudden accidents without warning. Although UI is more common in older people, it’s not a normal part of aging. Rather, it’s usually a symptom of another condition, and treatment can help or even stop UI.

Our highly trained urinary incontinence team provides comprehensive care. We offer the most advanced treatment options for UI that can help you even if other treatments haven’t worked.

Urinary Incontinence Types and Symptoms

UI has several types, each with different causes that require specific treatments. When you come to Penn Medicine, we do a thorough evaluation to determine the exact causes. With an accurate diagnosis, we can recommend the right treatment options for you.

The types of UI include:

Stress incontinence: Urine leaks when movements, such as laughing, coughing, sneezing or exercising, put pressure on your bladder. Stress incontinence is the most common type of UI.
Urge incontinence: You feel a strong, sudden urge to urinate, then the bladder squeezes and you urinate. Sometimes, you don’t have time to get to a toilet before urinating. You may feel the urge often, including during the night or when you hear running water. Urge incontinence is sometimes called overactive bladder (OAB).
Mixed incontinence: Some people have both stress and urge incontinence.
Overflow incontinence: Your bladder might not completely empty when you urinate, causing the bladder to become too full. Overflow UI can cause frequent or constant dribbling (urine leakage).
Functional incontinence: A physical or mental limitation can prevent you from getting to the toilet or removing clothing in time.

Causes of Urinary Incontinence

UI is often a symptom of another health condition, or it can result from certain lifestyle factors. UI can be temporary or long-term (chronic), and causes include:

Foods or medications:

Beverages and foods that increase urine production and stimulate the bladder
Constipation
Medications, such as diuretics (water pills), certain antidepressants, antihistamines and cold medications

Hormonal changes or weakened pelvic floor (in females)

Hysterectomy and other surgery that affects the female reproductive organs
Menopause because lower levels of the estrogen hormone can weaken pelvic muscles
Pregnancy and childbirth

Prostate conditions or surgery (in males)

Benign prostatic hyperplasia (BPH) or enlarged prostate
Surgery to remove prostate

Health conditions

Mental health conditions that affect cognition (thinking), such as dementia, anxiety or severe depression
Neurological disorders or injuries that affect the central nervous system (brain, spinal cord and nerves) such as multiple sclerosis, Parkinson's disease, stroke or a tumor
Obesity
Obstruction (blockage) in your urinary tract, such as a tumor or urinary stone
Urinary tract infections (UTIs)

How Is Urinary Incontinence Diagnosed?

It can feel awkward to talk about urinary incontinence — we understand, and we’re here to help. In a private, comfortable setting, we do a detailed evaluation to find the underlying causes of your symptoms.

We begin by asking you about your medical history and symptoms. We then do a physical exam with an internal pelvic exam to check your pelvic organs. We may ask you to keep a bladder diary for a few days to track urine leaks and other details that can help us determine the causes.

We can often diagnose the type and causes of UI with our thorough evaluation. If we need more information to confirm a diagnosis, you may need one or more tests, such as:

Bladder stress test: If you experience urine leaks with certain movements, such as coughing or running, we ask you to do some of those activities. This test can provide more details about loss of urine.
Cystoscopy: We examine inside your urethra and bladder using a thin, tube-shaped scope with a tiny camera inserted through the urethra. Cystoscopy can show bladder inflammation, stones or tumors.
Pelvic ultrasound: This imaging test uses sound waves to create pictures of internal organs. We use ultrasound to check the bladder, urethra and other pelvic organs for anything unusual that may be causing UI.
Urine test: We take a sample of your urine to test for blood, signs of infection, kidney problems or other causes of UI.
Urodynamic testing: These tests check bladder capacity, urine flow, pressure inside the bladder and other functions.

Urinary Incontinence Treatment at Penn Medicine

Your treatment options depend on the type of UI, what’s causing it and how severe it is. That’s why it’s important to get an accurate diagnosis.

Our specialists work closely with you to develop a treatment plan that addresses underlying causes. You may need more than one treatment, and we begin with the least invasive options that improve your symptoms. Your treatment team may include:

Urogynecologists: These doctors are specialists in female pelvic medicine, gynecology and reconstructive surgery. Our urogynecologists have years of experience treating females with all types of incontinence and pelvic floor conditions. Meet our urogynecology team.
Urologists: These doctors specialize in conditions that affect the urinary system (bladder, kidneys) and the male genitals. They provide care for both males and females. Our urologists have completed the highest level of training to ensure you get specialized, expert care.
Nurse practitioners: Our nurse practitioners work specifically in urinary incontinence care. They provide nonsurgical treatment and support for you throughout your treatment.

Pelvic floor rehabilitation

Our team offers an integrated pelvic floor rehabilitation program to treat UI, which you can do along with other treatments. The program focuses on self-care and behavioral techniques including:

Healthy eating plan: You can avoid foods and beverages that stimulate the bladder, and eat more fiber to relieve constipation.
Pelvic floor exercises: Physical therapy can help strengthen your pelvic floor muscles to better support your bladder and other pelvic organs. Our specialized pelvic floor physical therapists work with you to customize a plan, teaching you exercises to do at home. Find out more about pelvic floor outpatient physical rehabilitation at Penn Medicine.
Bladder training: These techniques help the bladder hold more urine and completely empty each time so you can better control the urge to urinate.

Nonsurgical treatments for urinary incontinence

Our urogynecologists and nurse practitioner offer additional nonsurgical treatments in the office, including:

Injections: For urge incontinence (overactive bladder), our urogynecologists can inject Botox^® to help relax bladder wall muscles. Injections of bulking agents, such as collagen, in tissues surrounding the urethra help prevent bladder leaks due to stress incontinence.
Medications: A wide variety of medications in pill form can relax the bladder, help prevent muscle spasms and increase bladder capacity.
Percutaneous tibial nerve stimulation (PTNS): To treat overactive bladder, we place a thin needle electrode under the skin of your ankle near the tibial nerve. A stimulator sends mild electrical pulses through the needle to the tibial nerve and then to other nerves that control bladder function.
Vaginal pessary: This small, reusable device goes into your vagina to support pelvic floor muscles and the urethra. Pessaries are an option for women with stress incontinence.

Surgery for urinary incontinence

If nonsurgical treatments aren’t working for you, our urogynecologists offer several surgeries and procedures to treat UI. As specialists in female pelvic medicine and reconstructive surgery, we have years of training and experience in the latest minimally invasive techniques. With smaller incisions, these procedures can help you recover faster and reduce your risk of complications.

We specialize in minimally invasive approaches including:

Laparoscopic: This approach uses a few small incisions on the abdomen (belly) to access the area for treatment.
Robotic-assisted: In a laparoscopic procedure, we use robotic equipment to operate surgical instruments, which make more precise movements than a human hand.
Vaginal (for females): We make small incisions in the vagina to access the area near the urethra.

Procedures include:

Sling procedures: These procedures use your own tissue, donor tissue or synthetic material to support the urethra and help it stay closed to prevent leaks.
Suspension procedure: This procedure secures the urethra and bladder neck to strengthen their ability to close and prevent leaks.
Neuromodulation device: Your doctor implants a small stimulator device under the skin in your buttock. It sends mild electrical pulses to the nerves that control bladder function.

Specialized care for new mothers

Penn Medicine offers a program focused on caring for women who experience pelvic floor disorders after childbirth. Learn more about our Postpartum Pelvic Floor Recovery Program.

Penn Medicine: Clinical Trials for Urinary Incontinence Treatment

Our Urogynecology program is one of a few research sites in the Pelvic Floor Disorders Network (PFDN), a research and clinical care network sponsored by the National Institutes of Health. Our urogynecologists are at the forefront of care through their participation in PFDN and other research.

Through clinical trials, eligible patients have access to promising new diagnostic technologies, nonsurgical therapies and surgical techniques before they’re available to the public.

Request An Appointment

Our urogynecologists and urologists see patients in our hospitals and clinics throughout Philadelphia, southeastern Pennsylvania and New Jersey. Call 800-789-7366 (PENN) or request a callback using our online form.

Diagnosis of Urinary Incontinence

Your physician will want to do a thorough history and examination to help diagnose the type of urinary incontinence you have an any underlying causes. Your physician may recommend a urinalysis to check for signs of infection. You may be asked to keep a bladder diary to record how much you drink and how often you urinate and how often you experience incontinence. To determine if there are any obstructions in your urinary tract or any issues with your bladder muscles, you may be asked to pee into a container that measures urine output. Afterwards, your doctor will use an ultrasound to see how much urine is left in your bladder.

Treatment at Penn

Specialists at Penn Medicine's Departments of Urology and Advanced Gynecologic Surgery and Urogynecology have years of experience helping people manage their incontinence and overcome some of the most complex gynecological conditions.

Penn Medicine surgeons and physicians offer new techniques in minimally invasive and robotic-assisted surgery. These methods lead to shortened recovery times, reduced pain and blood loss, letting you get back to your life in record time.

When you choose Penn, you choose to work with a dedicated team who continue to lead the field, advancing the science of gynecologic medicine.

Penn Programs & Services for Urinary Incontinence