Urinary incontinence occurs in both men and women, but much more so in women. Recent reports by the National Institutes of Health indicate 20 million adult women in the U.S. experience some form of urinary incontinence.

One of the myths about incontinence is that it only affects older people or women. Although more women are affected, particularly those who have had children, urinary incontinence can affect children and men as well. A number of causes of urinary incontinence in women include but may not be limited to the following: chronic cough or asthma, pregnancy and birth, constipation, obesity, medications, foods (particularly caffeine), hormonal changes, diabetes, diseases that affect the brain and smoking.

Here are different types of urinary incontinence.

Stress urinary incontinence: Stress urinary incontinence is leakage that occurs with a cough (and heavy, long-term chronic cough from smoking or asthma), a sneeze, a laugh, or when picking up something heavy and with some types of exercise. The pelvic floor muscles can weaken during pregnancy and delivery and no longer support the bladder and urethra (the tube from the bladder to the outside of the body). When the pelvic organs (uterus, cervix, bladder or walls of the vagina) prolapse or fall because of weak muscles, incontinence can occur.

Obesity can cause incontinence because of the increased weight placed on the pelvic floor muscles. This can increase the risk for pelvic organ prolapse and incontinence.

A hysterectomy can lead to incontinence. Removing the womb (uterus) changes the pelvic floor and can cause the muscles to weaken and sag, leading to a vaginal prolapse, which can cause incontinence.

During menopausal transition, estrogen levels naturally decline, which can lead to increased incontinence. At the start, during and immediately after the menstrual period is generally when estrogen levels are at their lowest, making incontinence potentially worse during that time. Estrogen helps the pelvic floor stay strong, supple and stretchy, which usually gives greater control over bladder and bowel function.

Some medication side effects can make incontinence worse by causing the body to produce additional urine, making it more difficult to control the increased amount and weakening the bladder's ability to empty.

Urge urinary incontinence (also known as overactive bladder): Urge incontinence may occur when sensations coming from the bladder decrease because of nerve damage. This leads to little or no warning before feeling the urge, and often there is not enough time to get to the bathroom.

Nerve damage can occur with illnesses like diabetes and multiple sclerosis. Stroke and illnesses that affect mobility may make it difficult to get to the bathroom regularly or in a timely manner. Those with mental impairment may have problems toileting themselves or communicating a need to go.

Diabetes can affect the bladder in a number of ways leading to overproduction of urine and high urine volume. Also, incomplete emptying of the bladder may lead to infection and "overflow incontinence." Or a person has no sensation to urinate when the bladder is overly full, and so urine just leaks out on its own.

Because different kinds of urinary incontinence exist, it is important to have a thorough evaluation and discussion with your health care provider.

Some of the treatments involve losing weight, stopping smoking, controlling asthma or illness, reducing your risk for diabetes, changing medications, and performing exercises that strengthen the pelvic floor and the body's core (Kegel and Beyond Kegels, core pilates and yoga). The exercises are also a good preventive measure against developing some forms of incontinence. They don't work for everyone, but can be a good place to start. Avoidance of foods that contribute to incontinence such as caffeine can make a difference. Hormone therapy may or may not help with incontinence. Vaginal pessaries, (silicone devices that support the pelvic floor), medications, nerve stimulation and surgery are some additional treatments.

Many people are reluctant to discuss this problem with their health care provider, but help can be found and treatment can sometimes be straightforward. Prevention comes from educating yourself and avoiding risk factors.

Marcia Hanks is an advanced practice registered nurse and a nurse practitioner at the Women's Care Center at St. Patrick Hospital.