Urinary incontinence

What is urinary incontinence?

Urinary incontinence is an inability to control the bladder, meaning that urine is unintentionally passed. This is a common problem and can cause embarrassment. It is more common in older people because urinary incontinence is an inevitable part of ageing and it affects both men and women.

What are the symptoms of urinary incontinence?

The symptoms can vary from a leak of light urine to the abundant and uncontrollable output of it. The type of urine loss will depend on the type of urinary incontinence experienced. The different types of urinary incontinence are:

  • Urge incontinence – a sudden urge to urinate with a sudden loss of bladder control and urination.
  • Stress incontinence – urine leaks when pressure is placed on the bladder (e.g. sneezing, coughing, laughing or lifting).
  • Overflow incontinence – a constant dribbling or urine because you are unable to fully empty the bladder.
  • Total incontinence – your bladder is unable to store urine at all, causing constant leakage.
  • Mixed incontinence – you can experience more than one type of urinary incontinence.

If you experience frequent bladder incontinence, you should see a specialist as it could be indicative of an underlying health problem, and it can be managed to improve your quality of life and overall confidence.

Women are more likely to suffer from stress incontinence, but men are more likely to have urge and overflow incontinence.

What causes urinary incontinence?

Most control problems occur because the muscles that hold the bladder are too weak or too active. If they are weakened, small amounts of urine are lost when performing actions such as laughing or coughing. However, urinary incontinence is a symptom of either an underlying medical condition, everyday habits or physical problems. Some cases of urinary incontinence are temporary, caused by alcohol consumption, caffeine or medications. It may also result from urinary tract infections or constipation.

Persistent urinary incontinence, however, can be caused by:

  • Pregnancy – increased size of the baby can put pressure on the bladder.
  • Vaginal childbirth – this can weaken the muscles needed for bladder control and damage bladder nerves and tissues.
  • Ageing – as we age, our bladder is less able to store urine.
  • Hysterectomy – pelvic floor muscles may be damaged during such a procedure.
  • Enlarged prostate in men – this obstructs the bladder, meaning it cannot empty properly.
  • Prostate cancer – either as a side effect of prostate cancer treatment, or a symptom.
  • Neurological disorders – some disorders can interfere with nerve signals that are needed for bladder control (e.g. Parkinson’s disease, multiple sclerosis).
  • Obesity – puts pressure on your bladder.

Can urinary incontinence be prevented?

Urinary incontinence is a problem that cannot always be prevented, but the following can reduce your risk of developing this problem:

  • Maintaining a healthy weight
  • Avoid consuming things that irritate the bladder (e.g. alcohol, acidic foods and caffeine)
  • Stop smoking
  • Doing pelvic floor exercises
  • High-fibre diet to avoid constipation

What is the treatment for urinary incontinence?

Treatment will depend on the type and cause of your urinary incontinence. Some types can be managed with lifestyle changes (e.g. weight loss or cutting out caffeine), bladder training (learning to wait longer to urinate, guided by a specialist) or pelvic floor exercises (to strengthen the pelvic floor muscles).

The following can also help to manage urinary incontinence:

  • Incontinence products (e.g. absorbent pads)
  • Medications (e.g. duloxetine for stress incontinence, antimuscarinics and mirabegron for urge incontinence)
  • Electrical stimulation (electrodes inserted into the vagina or rectum stimulate and strengthen the pelvic floor muscles)

You may be offered surgery if other treatments have been unsuccessful or unsuitable. The type of surgery will depend on your type of urinary incontinence:

  • Sling procedures – a sling is placed around the neck of the bladder to give support and to prevent leaks.
  • Colposuspension – the neck of the bladder is lifted in position to prevent leaks in women with stress incontinence.
  • Urethral bulking agents – a substance is injected into the walls of the urethra in women so that they increase in size, stopping leakages as the urethra is better able to stay closed.
  • Artificial urinary sphincter – an artificial urinary sphincter is fitted to stop incontinence.