Urinary Incontinence: Behavioral Changes That Can Make a Real Difference

Severity of incontinence is correlated with the degree of bother, so that the more frequent UI episodes are and the higher volume of urine that leaks out, the more interference with everyday life incontinence will cause.

Because UI is treatable, individuals should seek help with incontinence without embarrassment or delay.

Ask your health care provider about treatment options or a referral to a specialist in UI.

Causes and risk factors of UI

Incontinence may have one cause or, more often, several contributing factors. Here is a wide range of possible contributors to UI.

UI risks from medical conditions that affect men and women:

• Diabetes

• Urinary tract infections

• Obesity, metabolic syndrome

• Sleep apnea

• Neurologic diseases (for example, history of stroke, multiple sclerosis, Parkinson's disease, spinal cord injury)

• History of pelvic radiation treatments for pelvic organ cancers

• Lack of mobility

• Overall frailty/debilitation

• Excessive oral fluid intake

• Lack of easy access to the bathroom

• Stress and anxiety

UI risks that apply to men:

• Prostate enlargement (BPH), before and after treatments

• After prostate cancer treatments (radiation or prostate gland removal)

UI risks that apply to women:

• Childbirth

• Menopause

• Pelvic floor muscle weakness

How is UI diagnosed?

Doctors rely on a complete medical history, a thorough assessment of symptoms and a physical examination to make a diagnosis. Urine and blood laboratory testing is sometimes required to make sure no other medical conditions are causing the UI.

Sometimes supplementary tests such as bladder function testing (where a catheter is placed into the bladder through the urethral channel) and cystoscopy (looking inside the bladder with a thin, tube-like camera called an endoscope) are required to confirm or support a UI diagnosis.

What are behavior approaches for UI?

Several different behavioral approaches can decrease UI episodes.

• Regular and frequent timed voiding: This keeps the bladder emptied more frequently and regularly. This reduces the risk for accidents.

• Fluid intake: Drinking less fluid during times when more bladder control is needed (e.g. such as before meetings, before exercising, long car rides, plane trips, etc.) prompts the kidneys to make less urine. This, in turns, means it takes longer for the bladder to fill, so there is less chance of an accident.

• Bathroom mapping: By knowing exactly where the bathroom is located and how far it is, an individual can be more confident of reaching it in time before a UI episode occurs.

• Pelvic floor muscle exercises: Exercise can make pelvic floor muscles stronger. These exercises, known as “Kegel exercises,” involve squeezing and relaxing these muscles.

• Protective pads or garments: Using these can decrease anxiety and fear of UI episodes. Sometimes just having this form of protection gives an individual peace of mind and reduces the anxiety or embarrassment about potential UI events.

These behavioral modifications have no medical side effects, but may be inconvenient for some. Use of sanitary pads or garments incurs out-of-pocket costs to individuals.

How effective are behavioral approaches for UI?

Very little research has been done to compare behavioral approaches to traditional medical or surgical approaches. And the more severe or bothersome the UI is, the less likely behavioral approaches will be effective.

Nevertheless, behavioral modifications, rather than medications or surgeries, should always be considered the first option in treating UI.

Living with UI

On one hand, UI is not a mortal condition (no one dies from UI). On the other hand, as the severity of UI increases, the negative impact on socialization and quality of life increases to a point where UI is sometimes called a “social cancer.”

It is important to remember that while proper functioning of the bladder, urethra and pelvic floor muscles work together to make an individual continent of urine (not have UI), many other factors, such as those listed above, may contribute to UI.

So not all “treatments” for UI are directed at the bladder/urethra/pelvic floor, but may also be directed at these other contributors to UI.

Having a healthy bladder that includes urinary continence requires a holistic approach that requires a healthy body and mind.

About the expert

Dr. Toby C. Chai is an urologist and the Chief of Urology at BMC, and Chair of the Department of Urology at Boston University Chobanian & Avedisian School of Medicine. Chai has published more than 150 papers, reviews, and medical texts, and serves as an associate editor for the Journal of Urology and on the editorial board for the American Journal of Physiology – Renal Physiology. He is an expert in the treatment of urinary incontinence and urinary tract reconstructive surgery and has received multiple prestigious national urologic awards including the American Urological Association’s Victor Politano Award and Distinguished Service Award; the Zimskind Award and Distinguished Service Award from the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction; and the Continence Champion Award from the National Association for Continence. He received his medical degree from Indiana University School of Medicine and completed his residency in urology at University of Michigan Medical Center and a fellowship at University of Virginia. He is a trustee of the American Board of Urology.

What This Means For You

Urinary incontinence is common and treatable. Simple changes like timed bathroom trips, pelvic floor exercises and fluid planning can reduce leaks and improve quality of life without medication or surgery.