Urinary incontinence is a very clinical problem, most often experienced by women, where urine is released unintentionally. Studies show it can affect up to 25% of women at some stage in their lives and understandably it causes distress and embarrassment.
What is urinary incontinence?
There are different types of urinary incontinence, including:
- Urge incontinence – you experience an abrupt and strong urge to urinate, and often leak urine before reaching the toilet
- Stress incontinence – leakage of urine with coughing, sneezing or exercise, generally caused by weak pelvic muscles, especially at the bladder neck.
- Overflow incontinence – your bladder won’t totally empty, so you experience recurrent leaking
- Functional incontinence – you are unable to reach the toilet in time to urinate because of a cognitive or physical condition (e.g. dementia, arthritis)
- Total incontinence – you experience recurrent or constant leaking because your bladder is unable to hold any urine
The commonest types of incontinence in women are stress and urge incontinence.
What are the symptoms of urinary incontinence?
The main symptom is urinary leakage. Women may also complain of rushing to the toilet (urgency), frequent urination or needing to get up at night to urinate.
What causes urinary incontinence?
The causes of urinary incontinence vary depending on what type of urinary incontinence you are experiencing.
Common causes of urinary incontinence can be:
- Pregnancy and vaginal childbirth
- The menopause
- Weakening of pelvic floor muscles
- Being overweight or obese
- Nervous system diseases (e.g. multiple sclerosis)
- Bladder damage caused by injury or surgery
- Chronic coughing
- Prostate problems (in men)
- Urinary tract infections
- Bladder stones
- Diet (e.g. drinking a lot of caffeine)
- Certain medications
How is urinary incontinence diagnosed?
If you have experienced urinary incontinence, the good news is that this usually treatable and you should discuss this with your consultant.
They will enquire about the circumstances of your incontinence (e.g. if you experience it when you sneeze, if it happens at night), your diet and any medications you may be taking to try to determine which type of urinary incontinence you may be experiencing.
They will also conduct a physical examination to check your urinary system and ensure that it is healthy. In women, a full pelvic assessment will be performed to look for any signs of an enlarged uterus putting pressure on the bladder, or vaginal prolapse which may lead to bladder problems.
If further investigation is needed for your consultant to determine the cause of your urinary incontinence, they may also recommend that you undergo further tests including:
- Urinalysis – a test that checks for signs of infection or blood in the urine
- Residual urine test – a test that identifies how much urine remains in your bladder after you urinate
- Urodynamic tests – a special investigation to check bladder function and urethra function
- Cystoscopy – a small procedure where a telescope is inserted into the bladder to visually check it and the urethra
- Bladder diary – your consultant may also ask that you keep a bladder diary where you record different items related to your urination patterns (e.g. the amount of liquids you’ve consumed, when you feel you need to urinate)
How is urinary incontinence treated?
There are both surgical and non-surgical methods of treating urinary incontinence and they depend upon what is causing the incontinence.
Non-surgical treatments include:
- Incontinence products (e.g. pads)
- Pelvic floor exercises, also known as Kegel exercises
- Lifestyle changes (e.g. weight loss, diet adjustments)
- Bladder training
- Prescription medications
- Urethral inserts
There are also a variety of surgical options that can help with urinary incontinence, including:
- Injections to the neck of the bladder to strengthen it – Bulking Procedures
- Sling procedures – to lift the bladder neck
- Colposuspension – a bigger operation to restore normal bladder anatomy
You and your consultant can discuss all options and whether they think they would be beneficial to you. In many patients, intensive physiotherapy with a trained physiotherapist can lead to significant improvements without the need for surgery.