Causes – Urinary incontinence

The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.

What to Do When You Have Trouble Urinating

Urinating should be one of your body’s most natural functions, so you’re bound to be frustrated, when you can’t go. Read on to find out what may be causing the trouble.

For most of your adult life, urinating can be straightforward and simple. You feel the need to go, you find a place to go and then you’re done.

So, when you feel like you need to go only to find you can’t, it may cause concern. The inability to empty your bladder completely, called urinary retention, can result from:

• Nerve problems
• Medications
• Weakened bladder muscles
• Obstruction of the urethra
• Urinary tract infections

Nerve problems

Urinary retention can be caused by a problem with the nerves that control your bladder. This can happen as a result of diabetes, stroke, multiple sclerosis, brain or spinal cord infections or injuries, or pelvic injury.

If you’ve recently had surgery with anesthesia and IV fluids, it’s normal to have temporary issues with urinating, as they can impair your nerves. Normal urination should return as soon as the anesthesia wears off.

Medications

Many medications may interfere with bladder function, including antihistamines, antidepressants and medications used to treat muscle spasms.

Weakened bladder muscles

Both men and women may experience a loss of bladder muscle strength with age. Regular Kegel exercises can help strengthen the bladder muscles and resolve bladder issues.

Urinary tract stones

Stones made of urinary crystals can build up in your kidneys, bladder or ureter, obstructing the urethra and causing problems with your ability to urinate.

Urinary tract Infections (UTI)

UTIs can make you feel an urgent need to urinate frequently, only to go a little. Other symptoms include a burning feeling and pain, during urination, and blood in your urine.

For men who can’t urinate

As men age, their prostates continue to grow, which can cause a condition known as benign prostatic hypertrophy (BPH). It’s estimated that more than 70% of men in their 60s have BPH symptoms.

When a man has BPH, it can put pressure on his urethra. As a result, he may experience an inability to urinate, even when he feels the need to go, and he may try to go for several minutes, before actually urinating, or may produce only a weak stream of urination.

UroLift is an innovative, in-office procedure for men with BPH. During the procedure, the urologist implants tiny tines to “lift” or hold enlarged lobes of the prostate to the side (picture a curtain tieback). This relieves the pressure on the urethra and alleviates the problem.

“In the past, we would use electrosurgical current and energy, or we’d use lasers. They would have risks of bleeding and infection,” explains Leo R. Doumanian, MD, a urology specialist at Keck Medicine of USC and associate professor of clinical urology at the Keck School of Medicine of USC. “UroLift cuts down the risks. This increases the outpatient nature of the procedure; it decreases the time spent in the operating room, because you can hopefully use it in the office; and it’s getting great effects with quality-of-life outcomes.”

Other conditions that may prevent a man from urinating, when he feels the need, are bladder stones, prostate cancer and scarring of the urethra. If you are a man who frequently heads to the toilet only to find you cannot urinate, it’s important to see your doctor for a diagnosis and to learn your treatment options.

For women who can’t urinate

A woman may have trouble urinating, because of a condition called cystocele, which is a bulging of the bladder into the vagina. This happens when muscles and supportive tissues in the vagina and surrounding area weaken and stretch, most commonly after pregnancy and childbirth.

A woman also may experience trouble urinating, when her rectum bulges into her vagina, in a condition called rectocele.

Both conditions can be treated with pelvic muscle exercises, a vaginal pessary (a support device that fits into your vagina) or surgery.

Causes – Urinary incontinence

Certain factors may also increase your chance of developing urinary incontinence.

Some of the possible causes lead to short-term urinary incontinence, while others may cause a long-term problem. If the cause can be treated, this may cure your incontinence.

Causes of stress incontinence

Stress incontinence is when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Your urethra is the tube that urine passes through to leave the body.

Any sudden extra pressure on your bladder, such as laughing or sneezing, can cause urine to leak out of your urethra if you have stress incontinence.

Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or if your urethral sphincter – the ring of muscle that keeps the urethra closed – is damaged.

Problems with these muscles may be caused by:

• damage during childbirth – particularly if your baby was born vaginally, rather than by caesarean section
• increased pressure on your tummy – for example, because you are pregnant or obese
• damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy), or removal of the prostate gland
• neurological conditions that affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis
• certain connective tissue disorders such as Ehlers-Danlos syndrome
• certain medicines

Causes of urge incontinence

The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of your bladder.

The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.

Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is known as having an overactive bladder.

The reason your detrusor muscles contract too often may not be clear, but possible causes include:

• drinking too much alcohol or caffeine
• not drinking enough fluids – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
• constipation
• conditions affecting the lower urinary tract (urethra and bladder) – such as urinary tract infections (UTIs) or tumours in the bladder
• neurological conditions
• certain medicines

Causes of overflow incontinence

Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction affecting your bladder.

Your bladder may fill up as usual, but because of an obstruction, you will not be able to empty it completely, even when you try.

At the same time, pressure from the urine that’s left in your bladder builds up behind the obstruction, causing frequent leaks.

Your bladder can be obstructed by:

• an enlarged prostate gland (if you have a penis)
• bladder stones
• constipation

Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means your bladder does not completely empty when you urinate. As a result, the bladder becomes stretched.

Your detrusor muscles may not fully contract if:

• there’s damage to your nerves – for example, as a result of surgery to part of your bowel or a spinal cord injury
• you’re taking certain medicines

Causes of total incontinence

Total incontinence is when your bladder cannot store any urine at all. It can mean you either pass large amounts of urine constantly, or you pass urine occasionally with frequent leaking in between.

Total incontinence can be caused by:

• a problem with your bladder from birth
• injury to your spinal cord – this can disrupt the nerve signals between your brain and your bladder
• a bladder fistula – a small, tunnel like hole that can form between the bladder and a nearby area, such as the vagina

Medicines that may cause incontinence

Some medicines can disrupt the normal process of storing and passing urine or increase the amount of urine you produce.

• angiotensin converting enzyme (ACE) inhibitors
• diuretics
• some antidepressants
• hormone replacement therapy (HRT)
• sedatives

Stopping these medicines, if advised to do so by a doctor, may help resolve your incontinence.

Risk factors

In addition to common causes, some things can increase your risk of developing urinary incontinence without directly being the cause of the problem. These are known as risk factors.

Risk factors for urinary incontinence include:

• increasing age – urinary incontinence becomes more common in middle age and is very common in people who are over 80 years old
• family history – there may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have the problem
• having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra

Page last reviewed: 15 June 2023
Next review due: 15 June 2026

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