Urinary Incontinence

The bladder usually stores urine until you choose to empty it. Urinary incontinence occurs when you pass water involuntarily. It can happen to people at any age. In the United Kingdom, at least 3 million adults cannot control their bladders as they would wish.

The condition affects far more women than men. It affects one in five women over 40 years old. Although incontinence is not a life-threatening problem, it can be very embarrassing for those who suffer from it, severely affecting confidence.

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Urinary Incontinence symptoms

The main symptom of incontinence is involuntary loss of urine, but the circumstances can vary depending on the type of incontinence you have.

Urge incontinence

  • Happens when your bladder contracts without you wanting it to.
  • You may get an urgent feeling that you want to urinate and may get some leakage.

Stress incontinence

  • May happen when you cough, sneeze, laugh or exercise vigorously.
  • The pressure on your abdomen may cause you to leak urine.
  • This type of incontinence mostly affects women and is thought to be due to the stretching of the muscles from childbirth or ageing.
  • In men, stress incontinence is usually associated with surgery.

Mixed incontinence

  • Usually a combination of urge and stress incontinence.

Overflow incontinence

  • Occurs when the bladder overfills because it is not emptied properly (e.g. because the muscles controlling bladder emptying are too weak or the urethra is blocked).
  • Pressure causes urine to overflow into the urethra, leading to continuous leakage.
  • As an enlarged prostate is one of the most common causes of a blocked urethra, overflow incontinence affects more men than women.
  • People with diabetes, heavy alcohol consumers, and people with decreased nerve function are also at risk.

Sometimes you may leak urine without any warning at all. This is the most common type of incontinence in children who have a day or night wetting problem, and in the elderly. It can also occur at other ages, in a variety of circumstances.

Urinary Incontinence

Urinary Incontinence diagnosis

Your doctor will ask you lots of questions to find out if the incontinence follows any pattern. He or she will also check past medical history and other factors that may play a role. In some cases, you'll be asked you to keep a diary of your toilet trips. Following this you may need:

A physical examination

  • Checking your abdomen, rectum, genitals, and pelvis.
  • You may need to cough forcefully to check for urine loss, which would suggest stress incontinence.

A urine test

  • Tests for medical conditions that might be causing your incontinence.
  • For example, bacteria in your urine suggests a urinary infection.

If your incontinence has not got better after initial treatment, you may be sent to a urologist who will carry out more detailed tests of the lower urinary tract, including:

Postvoid residual volume (PRV)

  • Measures the amount of urine left in your bladder after you have finished urinating.
  • Highlights urine flow problems, such as difficulty starting to urinate, straining to pass urine or interrupted flow.

Urodynamic testing or cystometry

  • Measures pressure and volume of fluid in the bladder during filling, storage and urination.
  • Uses a thin tube inserted into the urethra. The bladder is gradually filled with water, saline solution, carbon dioxide gas or a harmless dye for X-ray analysis.
  • Once the bladder is completely full, you will be asked to begin urinating. Pressure and volume measurements are taken again including flow rate and flow pressure.

Endoscopic tests

  • A thin camera tube is inserted into your urethra to check the bladder lining.

Imaging tests

  • X-rays and ultrasound may also be used to look more closely at your urinary tract system.

Urinary Incontinence treatment

Sometimes, such as with a mild bacterial infection, your UTI symptoms will disappear following a course of antibiotics. However, if there is no obvious underlying cause, then treatment will focus on the incontinence itself.

Non-medical management

There are several things that you can do to help improve your bladder control:

  • Avoid caffeine-related drinks (such as tea and coffee), alcohol, antidepressants, antihistamines, and cough or cold preparations, as they can all increase urine production, putting a strain on the bladder.
  • Practice daily pelvic exercises to strengthen the pelvic muscles.
  • Practice stop-start urination (urinate, stop, wait a few seconds, urinate again).
  • Eat fruit, vegetables and whole grains daily to prevent constipation.
  • Retrain your bladder to pass urine less frequently (try to urinate only every 3 to 6 hours).
  • Stop smoking (nicotine irritates the bladder).
  • Become more aware of the muscles around your bladder and the signals they send when under stress. Known as “biofeedback”.

Medication and incontinence aids

Some medicines can help, depending on the type of incontinence. Medication can:

  • Tighten sphincter muscles, to prevent leakage of urine.
  • Relax muscles, to allow more efficient emptying of the bladder during urination.
  • Enhance normal functioning of muscles involved in urination.

Hormone replacement therapy may also relieve stress incontinence through its effect on muscle function.

In the case of stress incontinence, the following two treatments may be offered to you. Both of these methods work on the principle of applying pressure around the urethra, so that urine is less likely to leak out. 

Pessary

  • A stiff ring inserted into the vagina to press against the vaginal walls and the urethra.
  • Appropriate if there is any prolapse (or displacement) of the front wall of the vagina.

Collagen and fat implants

  • Injected into the area around the urethra to add bulk and help compress the urethra.

Catheterisation

For cases of overflow incontinence, catheterisation is an option. A thin flexible tube is inserted through the urethra and into the bladder. The tube is held in place, and the bladder is emptied through the tube into a bag.

For information about living with a urinary catheter from people who know, go to:http://www.healthtalkonline.org/chronichealthissues/Living_with_a_urinary_catheter

Surgery

Surgery is rarely a first-choice treatment for urinary incontinence. It is usually offered if other treatments have been unsuccessful. 

Colpo-suspension

  • The most common operation to treat stress incontinence.
  • Under general anaesthetic, the bladder neck is lifted and stitched to a nearby ligament, which helps to stop leaks from the bladder.
  • Success rate of between 50% and 70%.

Tension-free vaginal tape (TVT)

  • Suitable only for women who have had their menopause or who are not considering children.
  • Tape is inserted through two vaginal incisions and runs between the vagina and the urethra, lifting the middle of the urethra.
  • Reduces the effect of sudden abdominal stress, which is the cause of stress incontinence.

Protective devices

A number of protective devices can help to manage accidental urination, including:

    • Bed pads
    • Combination pad-pant systems
    • Full-length absorbent undergarments
    • Male incontinence drip collectors
    • Underwear liners (pads, guards, shields, inserts)

If you use absorbent pads, they should be applied correctly and changed often to prevent skin irritation and urinary tract infection.

Need more information?

Speak to your GP if you have any concerns about urinary incontinence symptoms and treatment options. You can also find other useful websites via our links section.

Kidney

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Bladder

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Prostate

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Male reproductive organs

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