Urinary incontinence

Urinary incontinence and bladder problems

Urinary incontinence (UI) is the loss of bladder control and the involuntary passing of urine. This is a very common condition that affects millions of people in the UK but is thought of as an embarrassing subject for many patients. Due to the stigma around this condition, many go without a diagnosis or treatment, even though most forms of UI can be easily managed or corrected.

What is urinary incontinence?

Urinary incontinence is when a person urinates involuntarily. This is because their urinary sphincter (the muscular structure that regulates the outflow of urine) is weak, or when their bladder muscle is over active.

The unique health events encountered by women – such as menopause, pregnancy and childbirth – mean that the urinary tract and its surrounding muscles can be affected. This makes urinary incontinence more common in women than men.

What percentage of the population is affected by urinary incontinence?

Although many people associate bladder weakness as a symptom of old age, you can experience bladder problems at any age for a range of different reasons.

In the UK, an estimated five million adults have an overactive bladder, and it is estimated that as many as 9.6 million women have some form of bladder problem. Our expert urologists are on hand to provide discreet treatment options to help you regain your confidence.

Types of urinary incontinence

There are several different types of urinary continence, each with its own characteristics. These include:

Urge incontinence

Urge incontinence is the sudden and uncontrolled need to urinate. Urine either unexpectedly leaks at this moment, or some time afterwards. Urge incontinence is one of the main symptoms of genitourinary syndrome of menopause (GSM); the hypoestrogenic changes (estrogen deficiency) that occur during menopause, involving the bladder, urethra, vagina and other sexual organs.

Stress incontinence

This is when the bladder leaks under strain, such as when you sneeze, cough, laugh or lift heavy objects. When oestrogen levels decrease during menopause, stress incontinence symptoms can develop. As menopause is understood to have an adverse impact on musculoskeletal health, muscles can get weaker during menopause. This makes it harder for some women to prevent urine leakage under strain. Women can also experience a mixture of urge and stress incontinence.

Overflow incontinence

Overflow incontinence is also known as chronic urinary retention. When you have overflow incontinence, you aren’t able to empty your bladder and can leak urine regularly. For the same reasons as the types of urinary incontinence outlined above – including a drop in oestrogen levels and weakened pelvic muscles – menopause can cause overflow incontinence. It is especially prevalent in women who have a blocked urethra or damaged bladder.

Total incontinence

Total incontinence occurs when your bladder is unable to store urine, which results in the constant passing of urine or frequent leakage. This can be caused by trauma or injury to your spinal cord, congenital bladder issues, or a bladder fistula (a small hole that forms between the bladder and an area close by, like the vagina).

Symptoms of urinary incontinence

Common symptoms of urinary incontinence include:

• leaking urine during everyday activities: this can be a form of stress incontinence when normal activities such as bending down, lifting objects, exercising, laughing or coughing can cause you to leak urine
• leaking urine when you don’t need to pee: this may be from overflow or total incontinence
• a sudden, intense urge to urinate: this is urge incontinence; when the need to pee comes about suddenly, and you feel like you may not make it to the toilet in time
• wetting the bed: nocturnal wetting episodes are caused by bladder control problems

Precipitating factors for urinary incontinence

There are various precipitating factors for urinary incontinence for both men and women. Certain habits, conditions or problems may cause temporary urinary incontinence, and others may cause persistent urinary incontinence. For this reason, we’ll split up the causes into temporary and persistent:

Temporary urinary incontinence causes

• food, including chocolate and sugary foods, or spicy foods such as chilli
• drinks, such as alcohol, caffeinated drinks, carbonated drinks and drinks containing artificial sweeteners
• medications, including heart medications, drugs for high blood pressure, muscle relaxants and sedatives
• medical conditions, such as a urinary tract infection or constipation

Persistent urinary incontinence causes

• Unique health events experienced by women, including:
  • menopause (due to the drop in the oestrogen hormone that contributes to the health of the bladder lining)
  • pregnancy
  • childbirth (vaginal delivery can weaken the muscles that are used for bladder control)
• Age – as we get older, the bladder can gradually lose its storage capacity, and involuntary bladder contractions can become more regular.
• Medical conditions – including:
  • neurological disorders (including Parkinson’s disease, multiple sclerosis, brain tumour, spinal injury, or a stroke).
• Obstruction – a tumour in the urinary tract can block urine flow and result in overflow incontinence, while urinary stones in the bladder can cause leakage

Urinary incontinence treatment

“Many treatments are available for urinary incontinence. The treatment recommended to you is likely to depend on the type and severity of the condition that you have,” explains Mr Azar Khunda, consultant gynaecologist and subspecialist urogynaecologist. “It’s good to seek a diagnosis and speak to a medical professional before exploring different treatments as they will advise you on the best course of action.”

Some lifestyle changes may help to reduce urinary incontinence symptoms, such as:

• reducing caffeine intake
• reducing or increasing the number of fluids you drink each day
• maintaining a healthy weight

Pelvic floor exercises

Kegel exercises are used to strengthen the pelvic floor and reduce or prevent symptoms of urinary continence. They involve clenching your pelvic floor muscles and holding them, before relaxing. In order to start the exercises, you need to be able to find your pelvic floor muscles. You can locate them by trying to stop the flow of urine when going to the toilet by contracting your muscles. The tension you should feel will be emanating from your pelvic floor muscles.

Once you have located your pelvic floor muscles, sit comfortably and begin to squeeze the muscles 10 to 15 times. Try holding each squeeze for a few seconds but take a break between sets of squeezes. As time goes on, you should be able to add more squeezes. Try performing these exercises every week. After a few months, you should start noticing results.

You can also train yourself to hold more urine by only urinating at certain times of the day. Don’t go whenever your bladder tells you to, only go when you plan to. This will help build up a tolerance and train your bladder to hold urine for longer.

Urinary incontinence pads and products

A urologist may provide pads and other products to help with urinary incontinence or recommend you purchase some. These may include tampons, pads and pull-up pants, appliances and bedding.

Medication for urinary incontinence

The type of medication you may be prescribed will depend on the type of urinary incontinence you suffer from. This includes:

• duloxetine tablets, for stress incontinence
• antimuscarinics, for urge incontinence
• mirabegron, an alternative to antimuscarinics for urge incontinence

Surgery for urinary incontinence

Depending on the type of UI you suffer from, there are a variety of procedures for urinary incontinence that may be recommended by a urologist as a last resort. These include:

• colposuspension for stress incontinence: an open or laparoscopic (key hole) surgery that involves stitches that are placed inside the pelvis to support your bladder opening to prevent urine leakage
• sling surgery: this involves placing a sling around the top of the bladder to prevent urine leaking by making an incision in your vagina and lower tummy
• urethral bulking agents for stress incontinence: bulking agents that are injected around the urethra to narrow the tube and stop leakage
• Botox injections for urge incontinence: Botox is injected into the bladder to help the muscles relax, which gives the patient more time to go to the bathroom before urinating
• Sacral neuromodulation (SNM): also sometimes called sacral nerve stimulation (SNS). The procedure involves placing a wire in your lower back, near the nerves that control your bladder and bowel. This wire delivers small electrical pulses and helps to improve problems with bladder and bowel function. This procedure is usually performed by our functional urologist