Little leaks getting you down? Here’s what to do if urinary incontinence is hampering your life – and your confidence.
By Mr Jeremy Ockrim
If you’re getting on with your day, feeling in control and confident, and then suddenly – perhaps after a sneeze or a cough, or laughing with a friend – you lose control of your bladder, this can cause panic and embarrassment.
Urinary incontinence is inconvenient and can feel humiliating, but there are lots of measures you can take to treat the problem.
Mr Jeremy Ockrim, Consultant Urologist at King Edward VII’s Hospital, looks at the different types of urinary incontinence that may be affecting you, along with the causes and, importantly, what you can do about it:
What is urinary incontinence?
Urinary incontinence is the unintentional passing of urine and in women is a very common problem. One in three women will have some degree of incontinence in their lifetime – and over 5 million woman suffer in the UK. But how do you treat incontinence? To start with you need to find out which type you suffer from. There are several types of urinary incontinence, including the following:
- Stress incontinence
Stress incontinence is caused by weakness of the urethral sphincter (valve) and pelvic floor. Pregnancy, childbirth, menopause, previous surgery, particularly hysterectomy, and obesity all contribute to pelvic floor weakness and stress incontinence. It can also run in families. Stress incontinence occurs on exertion, such as running, bending, coughing or sneezing.
- Urge incontinence
Overactive bladder (OAB) is defined by urinary urgency – a need to rush to the toilet and difficulty in postponing this need. Urinary urgency is often associated with urinary frequency, which occurs during the day and often at night (nocturia).
In some patients, OAB results in urge urinary incontinence (UUI), when urinary leakage occurs before a toilet can be accessed. Awareness of near availability of toilet facilities often leads to sudden peaks of urgency, most typically when reaching your front door. This is often termed “latchkey incontinence”.
- Overflow incontinence
Overflow incontinence can occur if the bladder does not empty properly. If the bladder becomes over full, then leakage may occur. This may be passive, when the patient is unaware of the leakage, or occur when the patient strains, for example when they cough or laugh.
- Mixed incontinence
Mixed incontinence describes a combination of stress incontinence and urge incontinence symptoms. In fact, the two causes of urinary leakage are often seen together.
When should you visit your GP about incontinence?
Any incontinence should be assessed. In many cases, simple lifestyle measures and pelvic floor exercises are sufficient to manage the problem.
For women with more significant incontinence, referral to a specialist to discuss alternative treatment is indicated. The majority of women can be made dry or significantly improved by a combination of medical or surgical treatment.
Dietary and lifestyle changes to help incontinence
Managing your general health is very important. Here are some lifestyle changes that can help to manage and ease incontinence issues:
✔️ Maintain a healthy weight. Weight loss can significantly reduce the incidence and severity of incontinence, with a 20-30 per cent reduction in leakage for patients who achieve significant weight reduction.
✔️ Eat plenty of fruit and vegetables, to avoid constipation.
✔️ Take regular exercise.
✔️ Avoid caffeine and alcohol, as these can stimulate your kidneys to produce more urine.
✔️ Do pelvic floor exercises daily.
✔️ Map out where the nearest toilets are when out and about.
✔️ Avoid clothing with fiddly buttons, which take a long time to remove.
Non-surgical measures to help incontinence
Here are the non-surgical measures you can take to manage and ease incontinence issues:
- Stress incontinence
Pelvic floor exercises help to strengthen the muscles of the pelvic floor. This helps to support the bladder, and tighten around the bladder neck and urethra (water-pipe) during times of increased abdominal pressure (for example, bending or running).
Specific exercise can be taught to try to tighten the muscle. These exercises can be augmented by the use of vaginal cones (weights), biofeedback monitors or electrical stimulation. Pelvic floor exercises are taught by physiotherapists and need to be practised regularly at home to be effective. Pelvic floor exercises can improve stress incontinence in up to 70 per cent of women, but only work if the exercises are continued.
There are currently no effective drug treatments for stress incontinence, although the antidepressant duloxetine (Yentreve) may have modest benefits for patients with mild stress incontinence, who are not suitable for surgical treatment.
- Urge incontinence
For many years, anticholinergic pills (or skin patches) have been the only available treatment for urgency symptoms. There are a number of different anticholinergic pillsavailable on the market and your consultant will advise you on the most appropriate for you. The most common side effects are dry eyes and dry mouth. There has been recent awareness that anticholinergic pills may affect cognitive function (concentration and memory) in elderly patients or those with impaired function for other reasons. It’s important to note that there is no evidence to date that anticholinergic medications are the cause dementia.
In 2013, a new class of drugs that treat OAB symptoms – the β3-adrenoceptor agonist – was launched. At present, only one medication is available on the UK market. Mirabegron has similar efficacy (benefits) to the anticholinergic medications but a different side-effect profile. Blood pressure monitoring is recommended when the drug is started.
- Overflow incontinence
For patients with overflow incontinence, bladder training to empty the bladder at regular time intervals can help. For patients that struggle to empty their bladders, intermittent catheterisation, when the patient is taught to pass a catheter tube to drain the bladder, three to four times a day can be very effective.
Surgical procedures to treat incontinence
There are a number of different surgical treatments for both stress and urge incontinence. The type of surgery recommended is dependent on careful assessment of your condition, typically with urodynamic study and/or x-ray or MRI imaging, plus an individualised discussion with your specialist.
➡️ For stress incontinence: the options available include bulking injections, mid urethral mesh slings, mid urethral native tissue (autologous) slings, colposuspension and artificial sphincter implants, depending on the type and degree of stress incontinence.
➡️ For urge incontinence: the options include Botox injections, percutaneous tibial nerve stimulation (electro acupuncture), sacral nerve stimulator (spinal) implants and augmentation cystoplasty, using a short segment of bowel to increase your bladder size. These interventions can be discussed with your specialist to find the best fit for your problem.
Net Doctor