Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Incontinence is a symptom with a wide variety of causes. The most common causes include the following:
Urinary tract infection
Side effect of medication: Examples include alpha-blockers, calcium channel blockers, antidepressants, antihistamines,
sedatives, sleeping pills, narcotics, caffeine-containing preparations, and
water pills (diuretics). Occasionally, the medicines used to treat some forms
of incontinence can also worsen the incontinence if not prescribed correctly.
Impacted stool: Stool becomes so tightly packed in the lower intestine and rectum that a bowel movement
becomes very difficult or impossible.
Weakness of muscles in the bladder and surrounding
area: This can have a variety of causes.
Many of the causes are temporary, such as urinary tract infection. The incontinence improves or goes away completely when the underlying condition is treated. Others are longer lasting, but the incontinence can usually be treated.
Risk factors: Underlying causes or contributors to urinary incontinence include the following:
Smoking: The connection with incontinence is not
completely clear, but smoking is known to irritate the bladder in many people.
Obesity: Excess body
fat can reduce muscle tone, including the muscles used to control urination.
Chronic constipation: Regular
straining to have a bowel movement can weaken the muscles that control
Diabetes: Diabetes can damage nerves and interfere with sensation.
Spinal cord injury:
Signals between the bladder and the brain travel via the spinal cord. Damage
to the cord can interrupt those signals, disrupting bladder function.
Disability or impaired mobility: People who have diseases such as arthritis, which
make walking painful or slow, may have "accidents" before they can reach a
toilet. Similarly, people who are permanently or temporarily confined to a bed
or a wheelchair often have problems because of their inability to get to a
Neurologic disease: Conditions such as stroke, multiple sclerosis, Alzheimer's disease, or Parkinson's disease
can cause incontinence. The problem can be a direct result of a disrupted
nervous system or an indirect result of having restricted movement.
Surgery or radiation therapy to the pelvis: Incontinence
can result from certain surgeries or medical therapies.
Pregnancy: One-third to one-half of pregnant women have problems controlling their bladder. In most of these women, incontinence stops after delivery. However, 4%-8% of pregnant women experience renewed incontinence after delivery (postpartum). Risk factors for postpartum incontinence include vaginal delivery, long second stage of labor (the time after the cervix is fully
dilated), and having large babies.
have not demonstrated a consistent increase in risk of incontinence following
menopause. The relationship between postmenopausal hormone replacement therapy and incontinence is unclear.
who have had a hysterectomy may have incontinence later in life.
Enlarged prostate: In men with an enlarged prostate, the prostate can block the urethra, causing urine leakage. However, less than 1% of men treated for benign (noncancerous)
enlargement of the prostate report incontinence.
Prostate surgery: Up to 87% of men whose prostate has
been removed report problems with incontinence.
Bladder disease: Certain disorders of the bladder, including bladder cancer, can sometimes cause incontinence.
In the practice of physical medicine and rehabilitation, voiding disorders are usually a result of neurologic conditions, such as spinal cord injury (SCI) or disease, cerebrovascular accident (CVA), traumatic brain injury (TBI), multiple sclerosis (MS), or dementia.