Urinary Incontinence

Urinary incontinence is a common problem which affects women more than men; older people are also more likely to experience problems leaking urine. Current estimates suggest around 3-6 million people in the UK experience some degree of urinary incontinence. The main symptoms people experience is leaking urine when you did not mean to (this can range from a small trickle or a larger ‘flood’ of urine). When and how urine incontinence occurs depends on the type of condition you have.

Urinary incontinence can cause emotional distress as well as being unhygienic. Making an appointment to speak with your GP is the first step to helping manage the issue and to improve your day to day life.

Common types of urinary incontinence

There are two main types of urinary incontinence and around 9 in 10 people will experience one or both of these at some point:

  • Stress Incontinence - this is the most common type of urine incontinence, which is often caused by weak pelvic floor muscles (sling shaped muscles which hold your pelvic organs in place). Urine will leak when the bladder is under sudden pressure for example when you cough, sneeze, exercise, laugh or lift heavy objects. It is important to remember that stress incontinence is not actually caused by stress and instead it refers to the stress certain activities place on your bladder. Other causes of stress incontinence include damage during childbirth (when a baby is born vaginally), extra pressure on your tummy from being pregnant or obese, damage to the bladder during surgery, neurological conditions ( a range of conditions which affect the brain and spinal cord) such as Parkinson’s disease or multiple sclerosis (MS).
  • Urge Incontinence - when you feel a sudden or very intense urge to pass urine with very little warning. You may not be able to delay going to the toilet or the urge may become so intense that urine will leak when you do not mean it to. Sometimes a change of position, running water or reaching climax during sex (orgasm) will trigger the urge to urinate. This type of incontinence is part of a group of symptoms referred to as over active bladder syndrome (OAB) where a group of muscles called the detrusor muscles in the bladder contract too early or are hypersensitive. Symptoms include a very frequent need to urinate (the average is 8 times a day and each urination should be more than a few drops passed) and having to get up several times in the night to urinate. Other causes of an overactive bladder include drinking too much alcohol or caffeine, poor fluid intake, constipation, conditions which affect the urethra and the bladder (known as the lower urinary tract) such as urinary tract infections (UTI’s) or tumours in the bladder and neurological conditions.Man and woman in a pose indicating they need the toilet

Certain medications can also affect your normal process for storing and passing urine, or even increase the amount of urine you are producing. It is not advised that you stop taking your medication as this could affect your health. Instead make an appointment to speak with your doctor who will be able to give you advice for dealing with medication side effects. Types of medication include:

  • Angiotensin converter enzyme (ACE) inhibitors – used in the treatment of high blood pressure.
  • Diuretics – used in the treatment of high blood pressure and also for fluid (water) retention.
  • Some antidepressants  or sedatives
  • Hormone replacement therapy (HRT) – used to relieve the symptoms of the menopause.

Other types of urinary incontinence

  • Overflow incontinence - also referred to as chronic urinary retention is caused by a blockage or obstruction to your bladder. Your bladder may fill up as usual but you may find you are unable to completely empty it; meanwhile pressure builds up behind the obstruction causing frequent leaks. This can happen as a result of; an enlarged prostate gland (in men), bladder stones or constipation. Medication may also affect urine output.
  • Total incontinence - is the inability to store urine at all as a result of bladder problems at birth (congenital birth disorder), as a result of injury or a fistula (in women, an abnormal connection between the urinary tract and vagina).

Diagnosing urinary incontinence

Making an appointment to visit your doctor is the first thing you should do if you are experiencing a form of urinary incontinence. He/she will be able to diagnose the form of urinary incontinence you are experiencing by asking questions about the symptoms you are experiencing, how often you are having trouble with urinating, what sort of things make the urinary incontinence worse or better and your family history. You may find it useful to keep a diary for a few days with details about the types of fluid and how much fluid you are taking on, how often you need to urinate and how much urine you produce when you pass it, how often you leak urine or have an urgent need to go.

Your doctor may decide to do an examination and some tests in order to make a diagnosis. This can include a physical examination of your pelvis (you will be asked to undress form the waist down). Your doctor may ask you to cough and will look to see if any urine leaks out. For women your doctor may also examine your vagina. He/she is looking to see whether your bladder is bulging into your vagina. Your doctor may also decide to check your pelvic floor, this is done by inserting a finger into your vagina and asking you to squeeze it – this will give your doctor an indication of how well your pelvic floor muscles (the muscles which surround the bladder and urethra) are working.  In many cases damage to the pelvic floor can lead to urinary incontinence.

If you are male your doctor may check to see if your prostate (the gland between your bladder and penis) is enlarged as this can cause symptoms of urinary incontinence. You may also need a digital rectal examination (DRE) to check your prostate. This is done by a doctor inserting a finger into your back passage. Read more about prostate health here.

Other tests may also be carried out a specialist team if your doctor feels it is necessary. These include:

  • An ultrasound - a painless procedure which involves a specialist sonographer (someone who is trained to carry out ultrasounds) placing a handheld probe on your body. The probe transmits high frequency radio waves which will help build a picture of a certain area inside your body. This procedure is usually carried out to see if you are experiencing overflow incontinence.
  • Cystoscopy - a thin flexible tube with a light and camera at the end (known as an endoscope) is passed into the bladder through the urethra (the tube which carries urine out of your body). A specialist will look for abnormalities inside your bladder to help make a diagnosis.
  • Urodynamic tests - a group of tests used to determine the functionality of your bladder and urethra.

Treatment for urinary incontinence will vary depending on the diagnosis and the individual. There are several options available within three categories; non-surgical, surgical and lifestyle.

Non–surgical treatments include:

  • Pelvic floor training (exercises given to you by a specialist who will assess your ability to squeeze and contract your pelvic floor muscles).
  • Electrical stimulation (a probe is inserted into the vagina in women or the back passage in men. An electrical current is passed through the probe to stimulate your pelvic floor muscles) Vaginal cones (a treatment specifically for women, a weighted cone is inserted into the vagina and you must hold it in place using your pelvic floor muscles).
  • Bladder training (if you suffer from urge incontinence you may be advised to follow a program which encourages you to go longer between urination).
  • Biofeedback (a form of monitoring the strength of your pelvic floor using either a probe or electrodes, sticky pads which adhere to your skin usually around your anus or stomach. The probe or electrodes then sends data to a computer)  – there is limited evidence to suggest biofeedback is more beneficial than simple pelvic floor exercises but it may help to encourage people to carry out their pelvic floor exercises.

There are also several forms of medication which can be prescribed by your doctor for your specific type of urinary incontinence – make an appointment to speak with your GP to discuss these.

Surgical options include:

There are various different types of surgery which you will be assessed on as an individual to decide whether you are suitable.  Surgical options are not suitable for everyone and you should discuss this with your doctor for specific advice. Read more about surgical options here.

Lifestyle options:

If your incontinence is caused by being overweight, controlling your weight is the best way to reduce the added pressure being put on your bladder. If you are struggling with controlling your weight, please visit our talkweight forum to share tips and advice. If you consume large quantities of alcohol or caffeine, avoiding or cutting down can improve your bladder condition. Pelvic floor exercises (Kegels) and keeping fit in general, is important when it comes to ensuring that your pelvic floor muscles are strong. Strong pelvic floor muscles can limit the number of incontinence episodes you have.

It is worth remembering that there is a wide range of incontinence products designed to keep you feeling in control and to help manage your condition.  They range from pads and pull ups which are designed to contain urine leaks to bed and chair protection products as well as catheters and penile sheaths (similar to a condom, the sheath fits over the penis and collects urine).

You can find further help and support from talkhealth’s bladder community in the talkbladder forum.

talkhealth also supports the work of Action Bladder Cancer UK, Orchid and Bladder and Bowel UK.

Sources used in writing this article are available on request.

Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence-based articles are certified by the Information Standard and our sources are available on request. The content is not, though, written by medical professionals and should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands, or treatments.

Information written by the talkhealth team

Last revised: 13 October 2016

Next review: 13 October 2019