Female urinary incontinence over time: a wee guide

Written by: Mr Nikesh Thiruchelvam
Published: | Updated: 16/04/2019
Edited by: Cal Murphy

Little accidents happen to everyone. Urinary incontinence is surprisingly common at all stages of life, ranging from small leakages to bigger accidents. While some people accept it, believing it is simply a part of getting older, often there is something that can be done. Experienced urologist Mr Nikesh Thiruchelvam is here to explain how your bladder changes as you age and when you should see a doctor about incontinence.

What happens to your bladder as you age?

Urinary incontinence rates certainly vary over time. When you are born, you leak urine as soon as your bladder is full. You then learn social continence (potty training) when you pass urine when it is convenient or on demand. It may take slightly longer to get dry at night with bedwetting (or enuresis) present in 5-10% of 7 year olds and 1-2% of 12 year olds. Around 5-10% of women will experience urinary incontinence in their 20s and 30s. The prevalence of urinary incontinence then increases to around 30% in middle aged women and then up to 60% of older women.

 

How easy is it to notice change over time?

There are two main types of urinary incontinence.

Stress urinary incontinence refers to leaking urine with activity and is common after childbirth. It is thought that around 1 in 3 women will having ongoing, problematic stress urinary incontinence. How much this bothers an individual will partly depend on how active they are and how much urine they may leak. Some women find they curtail activities they may enjoy because of their leakage.

More bothersome to women and more prevalent is urge urinary incontinence. This is the type of leakage that occurs when you suddenly feel you need to pee and can’t get to the toilet in time. This maybe a small squirt leaving a damp patch on your underwear or a full flood, soaking your clothes. This type of leakage becomes more common with age.

It is also possible to suffer from both stress and urge urinary incontinence (mixed urinary incontinence).

 

Is incontinence a normal part of ageing?

No, although many people think it is and therefore simply put up with it. Stress urinary incontinence may persist after childbirth and some women just learn to live with it even when it can be treatable. Urge urinary incontinence is usually very bothersome and can stop people from working, travelling or socialising. This is also treatable and patients should seek help rather than feel it is a normal part of getting older.

There are some associated risk factors, which may be treatable, and may also cause urinary leakage. Pregnancy, labour and vaginal delivery can cause incontinence, as can HRT. Diabetes, urinary tract infection and cognitive impairment, such as with dementia, is linked with incontinence.

 

When should I go to see a doctor?

You should see a doctor if you leak urine and have any associated ‘red flags’ such as a urinary tract infection, blood in the pee or abdominal or pelvic pain. Even without these red flags, it is worth seeing a urologist to discuss ways to treat your urinary leakage.

There may be simple options to improve the leakage such as changing your diet or fluid intake, physiotherapy and bladder retraining. There are also medications that can be very helpful and finally, surgery may be used to treat bothersome urinary incontinence. This may involve discussing options of anti-stress urinary incontinence surgery or botox or sacral nerve stimulation for urge urinary incontinence.

By Mr Nikesh Thiruchelvam
Urology

Mr Nikesh Thiruchelvam is a highly-experienced consultant urologist based in Cambridge. He has a specialist interest in all aspects of urinary dysfunction and treatment, in addition to benign prostate enlargement, vasectomy, and reverse vasectomy. Mr Thiruchelvam is celebrated for performing the first Urolift procedure in Cambridge, and runs a specialist vasectomy reversal clinic using microsurgical techniques. He enjoys excellent reviews from patients praising his clear explanations and high level of care and attention.

Originally qualifying from St Bartholomew’s Hospital Medical College in London, Mr Thiruchelvam pursued specialist training at leading centres of urological excellence including St. Bartholomew’s, the Royal London Hospital, Ipswich Hospital and Great Ormond Street Hospital. Over the course of his career Mr Thiruchelvam has secured multiple fellowships to travel to the USA and Australia, studying cutting edge techniques in treating prostate enlargement and urinary incontinence. He completed an MD in London, and was appointed Consultant Urologist at Cambridge University Hospitals in 2009.

Widely published in textbooks, patient guides, and peer-reviewed journals, Mr Thiruchelvam is highly-regarded for his extensive knowledge in the basic science of urology as well as surgical best practice. He is a significant contributor to NICE consultations, NHS Horizon Scanning documents, NICE Eyes on Evidence and NIHR Design for Dignity. Internationally, Mr Thiruchelvam is a co-author to the European Association of Urology Guidelines for Urinary Incontinence, invited faculty of European School of Urology and is regularly invited to lecture at urology conferences abroad and undertake Visiting Professorships.

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