Urinary incontinence: Everything you need to know

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Many find urinary incontinence too embarrassing to talk about, leading many to suffer in silence.

By Dr Juliet McGrattan (MBChB)

Urinary incontinence (UI) is a subject many of us find too embarrassing to talk about, leading many to suffer in silence.

Even without the embarrassment factor, people tend to think it’s simply part of ageing and they have to put up with it.

This isn’t the case, because:

What is urinary incontinence?

Urinary incontinence is when you can’t control your bladder, so you pass urine when you don’t want to.

Urinary incontinence is a symptom rather than a disease. It can be caused by:

  • pregnancy or childbirth
  • pelvic surgery
  • injury to the pelvic region or spinal cord
  • neurological diseases such as multiple sclerosis
  • birth defects affecting the bladder
  • degenerative changes associated with ageing.

Men also suffer from incontinence, but in smaller numbers than women.

There is an increased risk of being affected by urinary incontinence if you are obese or if there is a history of it in your family.

Types of urinary incontinence

There are different types of urinary incontinence:

  • stress urinary incontinence (SUI)
  • urge urinary incontinence (UUI)
  • mixed urinary incontinence (MUI)
  • overflow urinary incontinence (OUI).

Stress urinary incontinence

Stress urinary incontinence (SUI) happens when you sneeze, cough, laugh, lift or exercise. These activities put high pressure onto the bladder. If the sphincter which keeps the bladder closed is weak, this sudden increase in pressure will cause urine to leak out.

Although sphincter weakness is more common during pregnancy, after childbirth and after the age of 40, SUI can happen to women of any age. One in three women experience SUI at some point in their lives. It is the most common type of incontinence in women.

Urge urinary incontinence

Urge urinary incontinence (UUI) happens when you feel an urgent need to empty your bladder, but can’t reach the toilet in time. You may be aware of the urge sensation but can’t stop the leak before getting to the toilet. You may also:

  • need to empty your bladder more frequently than normal, i.e. more than eight times a day
  • get up in the night several times to pass urine
  • leak when you hear running water.

Overactive bladder

Urge urinary incontinence is also known as ‘overactive bladder’ (OAB) and ‘detrusor over activity’. The detrusor is the muscle in your bladder wall. It relaxes to let urine into your bladder and contracts when you go to the toilet. When the bladder contracts uncontrollably it causes UUI. This is the most common bladder problem in men and older people.

Mixed urinary incontinence

Mixed urinary incontinence is a combination of stress urinary incontinence and urge urinary incontinence.

If you do have both types, you’ll find that one type creates more of a problem for you than the other. This is the one that will be treated first.

Overflow urinary incontinence usually happens when there’s a blockage (such as a narrowing in the outlet tube), so your bladder doesn’t empty completely.

When your bladder refills, it puts pressure on the obstruction, which gives way slightly and you get a small leak of urine.

Overflow urinary incontinence is less common in women than SUI. It’s the most common type of urinary incontinence in men and the blockage is usually caused by an enlarged prostate gland.

Urinary incontinence risk factors

Urinary incontinence is about twice as common in women as it is in men.

The NHS estimates that between 3 and 6 million people in the UK have some form of urinary incontinence but the true figures are likely to be higher than these, because people don’t tend to report urinary incontinence – partly because they’re too embarrassed to talk about it, and partly because they don’t think anything can be done for it.

survey of over three thousand women in GP practice waiting rooms revealed that nearly half of them had experienced some form of incontinence within the previous month and only a minority of them had sought help, even those who had moderate or severe symptoms.

Although urinary incontinence can affect women of any age, it becomes more common with age. A 1995 study by the Royal College of Physicians (RCP) breaks the figures down by age. According to its figures, UI affects:

  • 5 to 7 per cent of women aged 15-44
  • 8 to 15 per cent of women aged 45-64
  • 10 to 20 per cent of women aged 65 or over.

Stress incontinence is the most common type of incontinence in women. It is estimated that approximately one third of women in the UK have stress incontinence, according to the Bladder and Bowel Foundation.

Urinary incontinence diagnosis

Do seek help if you suffer from incontinence.

There is no need to be embarrassed, your doctor will have heard it all before and will want to help you access treatment. Your doctor will listen to your story, examine you (this may involve a vaginal or rectal examination) and test a sample of your urine. They may also ask you to keep a bladder diary for at least three days noting when you pass urine, how much you pass and when you leak, in addition to how much fluid you are drinking.

You may need to be referred for tests including a cystoscopy (camera into your bladder) or urodynamic tests which measure the pressure in your bladder and the flow of your urine.

The results will determine which type of incontinence you have and the best treatment options.

Urinary incontinence treatment

There is a range of treatments available for urinary incontinence.

The treatment your doctor recommends will be based on the type of UI you have and its severity. The main options are:

  • Lifestyle changes including losing weight if necessary, reducing caffeine and modifying fluid intake.
  • Pelvic floor exercisessupervised by a women’s health physiotherapist and carried out at least three times a day for three months.
  • Biofeedbackcan be helpful for teaching correct pelvic floor exercise methods.
  • Vaginal conesto help with pelvic muscle training
  • Electronic devicesfor women who cannot actively contract their pelvic floor muscles.
  • Behavioural therapyto retrain the bladder is used in urge or mixed incontinence.
  • Medicationuseful for urge incontinence but may take weeks to work and cause side effects.
  • Botulinum toxin type A injection (Botox) available in some centres to reduce urge incontinence.
  • Surgery can be considered when other techniques have not improved symptoms. A careful discussion of the risks and benefits must be undertaken with the surgeon.
  • Incontinence products such as pants, pads and catheters can help to manage incontinence but don’t replace treatment.

Urinary incontinence prevention

Whether you currently have urinary incontinence or not, these tips will make urine leaks less likely:

  • Pelvic floor exercises – do these daily.
  • Maintain a healthy weight – being overweight weakens pelvic floor muscles.
  • Stop smoking – coughing weakens the pelvic floor.
  • Drink well – avoid alcohol and caffeine and drink plenty of water to avoid bladder irritation.
  • Avoid constipation– plenty of fibre and fluids in your diet will keep your bowels moving smoothly and stop you weakening your pelvic floor by straining on the toilet.
  • Lift with caution – avoid lifting heavy objects if you leak and always tighten your pelvic floor muscles when you do need to do so.
  • Seek medical advice if you suffer incontinence, early treatment is more successful.

Net Doctor

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