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. * Many women leak urine when they exercise, laugh hard, cough, or sneeze. * Often women leak urine when they are pregnant or after they have given birth. * Women who have stopped having their periods—menopause—often report bladder control problems. * Female athletes of all ages sometimes have urine leakage during strenuous sports activities. Urine leakage may be a small bother or a large problem. About half of adult women say they have had urine leakage at one time or another. Many women say it’s a daily problem. 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. How does the bladder work? Anatomical drawing front view of the female urinary tract. Labels point to pelvic floor muscles, sphincter muscles, bladder muscle, urethra, and urine. Parts of the bladder control system.The bladder is a balloon-shaped organ that stores and releases urine. It sits in the pelvis. The bladder is supported and held in place by pelvic muscles. The bladder itself is a muscle. The tube that carries urine from your body is called the urethra. Ring-like muscles called sphincters help keep the urethra closed so urine doesn’t leak from the bladder before you’re ready to release it. Several body systems must work together to control the bladder. * Pelvic floor muscles hold the bladder in place. * Sphincter muscles keep the urethra closed. * The bladder muscle relaxes when it fills with urine and squeezes when it’s time to urinate. * Nerves carry signals from the bladder to let the brain know when the bladder is full. * Nerves also carry signals from the brain to tell the bladder when it’s time to urinate. * Hormones help keep the lining of the bladder and urethra healthy. Bladder control problems can start when any one of these features is not working properly. What are the different types of bladder control problems? 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. What causes bladder control problems? 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 * stroke Trauma that can damage the nerves includes * pelvic or back surgery * herniated disc * radiation # Medicines, alcohol, and caffeine. 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. Talking about bladder control problems is not easy for some people. You may feel embarrassed to tell your doctor. But talking about the problem is the first step in finding an answer. Also, you can be sure your doctor has heard it all before. You will not shock or embarrass your doctor or nurse. 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. 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. Pelvic Muscle Strengthening Many women prefer to try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don’t require any equipment. Once you learn how to “Kegel,” you can Kegel anywhere. The trick is finding the right muscles to squeeze. Your doctor or nurse can help make sure you are squeezing the right muscles. Your doctor may refer you to a specially trained physical therapist who will teach you to find and strengthen the sphincter muscles. Learning when to squeeze these muscles can also help stop the bladder spasms that cause urge incontinence. After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control. Changing Habits Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident. You can use that information to make planned trips to the bathroom ahead of time to avoid the accident. Once you have established a safe pattern, you can build your bladder control by stretching out the time between trips to the bathroom. By forcing your pelvic muscles to hold on longer, you make those muscles stronger. Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control. You can choose the decaf version of your favorite drink. Make sure you are not drinking too much fluid because that will cause you to make a large amount of urine. If you are bothered by nighttime urination, drink most of your fluids during the day and limit your drinking after dinner. You should not, however, avoid drinking fluids for fear of having an accident. Some foods may irritate your bladder and cause urgency. Talk with your doctor about diet changes that might affect your bladder. Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.