Why can’t I control my bladder?

Dear Readers, 

Props to both of you for sharing your stories, even if you feel embarrassed talking about it. You’re certainly not the only people who’ve had experiences of urinary incontinence (UI) or involuntary loss of urine. Reader 1, your history of stress incontinence may have resulted in nocturnal enuresis (NE), or involuntary urination while sleeping. And Reader 2, you may be happy to hear that there are several behavioral therapies and potential medications out there to aid with a urinary leakage problem. 

Urinary incontinence is a common condition where the bladder loses control, potentially leading to leaking as Reader 2 described, or larger volumes of urine as Reader 1 discussed. Some types of UI are: 

• Stress incontinence: caused by physical pressure on the bladder 
• Urge incontinence: an intense need to urinate and an inability to control it 
• Overflow incontinence: leaking due to a bladder that didn’t empty all the way 
• Functional incontinence: caused by an inability to make it to the toilet in time to urinate 
• Mixed incontinence: a combination of UI types, particularly stress incontinence and urge incontinence 

List adapted from Mayo Clinic.

The exact cause or type of UI you’re experiencing can’t be determined without speaking with a health care provider. However, Reader 1 mentioned stress incontinence in their past. This form of urinary continence tends to be more common in those assigned female at birth than those assigned male at birth (based on binary categorization). Studies have concluded that, for those born with a vagina, stress incontinence is a factor in the development of nocturnal enuresis. Stress incontinence can be unrelated to psychological stress and is instead usually the result of muscle weakness. In fact, it often occurs when the muscles and other tissues that support the bladder and regulate the release of urine become weak. Typically, this occurs as you grow older. Additional factors that can worsen stress incontinence include illnesses (such as those accompanied by an intense cough), obesity, smoking, or high-impact activities (like working out or a sneeze or jerk). 

Reader 1, a few causes that may be behind your adult bed-wetting could include a urinary tract infection, bladder problems, obstructive sleep apnea, diabetes, an enlarged prostate, medication side effects, or neurological disorders. More generally, UI can be caused by conditions like constipation, pregnancy, childbirth, or menopause which put pressure on the pelvic area. UI can also be affected by foods and drinks that increase urine production, so being mindful of what you’re consuming before bed may help alleviate this issue. 

If UI is affecting your quality of life, consider speaking with a health care provider about getting checked out for underlying concerns. If none can be found, reaching out to another provider or specialist for a second opinion may be helpful. In this case, urologists are specialists who focus on treating issues with the urinary system. They may ask you to record a log of your drinking and urinary habits, take some physical measurements, perform a pelvic exam, or run other urine-related analyses as necessary. If you have a vagina, some urogynecologists work at the intersection of urology and gynecology. These specialists may be able to do a more thorough evaluation to determine the cause of your incontinence and recommend next steps. 

In the meantime, your health care provider may recommend: 

• Pelvic floor exercises: Also called Kegel exercises, which work to strengthen and train the muscles in your pelvic floor that control urine flow. 
• Bladder training: Involves working out a schedule for urination to reduce involuntary urges or to train the bladder to store more urine for a longer time. 
• Prescription medications: One such medication, desmopressin, appears to help control the amount of urine a person produces. While this medicine is usually used to control symptoms of a certain type of diabetes, it’s been shown to be helpful for people with NE. In Europe, an antidepressant called duloxetine has also been used for stress incontinence. Other medicines may even target the bladder’s ability to store or release urine. 
• Lifestyle modifications: Since smoking and obesity can both contribute to the problem, your provider may recommend making lifestyle changes to improve symptoms. 
• Fluid intake: It can be helpful to pay attention to how much, what types, and when you consume liquid. You may find certain patterns help or hinder instances of leaking or bed-wetting. 

There are lots of reasons why you may be experiencing incontinence. While it may not be a full solution, there are small changes that you can make in your life to help navigate your day-to-day. If you're not noticing any changes, perhaps with the support of a health care provider, you'll be able to create a plan that might work best for you. 

Here’s to dry days (and nights) ahead!