In this article
Urinary incontinence is seldom openly talked about as it is an embarrassing issue. However, it is a very common problem affecting around 300 million people worldwide; this equates to about 5% of the population.
It is estimated by Incontinence UK that, to date, around 7 million people in the UK have urinary incontinence, which is 5-10% of the population. The fact that many incontinence sufferers do not even see a doctor means this proportion could be even higher.
Bladder problems and urinary incontinence can affect anyone at any time, regardless of age. However, urinary incontinence is most prevalent in those aged 60 and over, and research finds that it is twice as prevalent in older women. However, over 10% of men over 65 have urinary incontinence to some degree. In the UK, 24% of older people are affected by urinary incontinence. Of those older people in institutional care, 30-60% are affected by urinary incontinence.
What is urinary incontinence?
Urinary incontinence is the uncontrolled leakage of urine from the bladder. The amount of urine leakage varies from person to person, as does the time of day or situation when it occurs. Common urinary incontinence problems include urgently needing to pass urine, bladder leakage and bed wetting.
It is widely understood that urinary incontinence is a sensitive health issue and many people can delay treatment for several years due to embarrassment or shame.
Urinary incontinence can be distressing and socially disruptive. It may be the cause of personal health and hygiene problems, and may restrict employment and educational or social and leisure opportunities.
What causes urinary incontinence?
The urinary system filters, stores and removes waste from the body, and consists of the:
- Kidneys – These filter the blood to remove waste products and produce urine.
- Ureters – The urine flows from the kidneys down through the ureters to the bladder.
- Bladder – This stores the urine. A ring of muscle, known as the sphincter, squeezes shut to keep urine in the bladder and relaxes when we need to urinate.
- Urethra – The urine passes through the urethra to the outside when urinating.
The bladder and urethra are supported and held in place by a sling of muscles called pelvic floor muscles that keep the bladder closed. The pelvic floor is made of layers of muscles stretching like a tight hammock from the pubic bone in the front to the base of the spine. There is an opening through the pelvic floor for the urethra. Surrounding the opening to the urethra is a tight circular band of muscle called a sphincter. This acts like a valve and is normally closed.
When the pelvic floor muscles are strong the bladder is well supported in the pelvis and the sphincter will control the flow of urine reliably. The bladder usually stores urine until a person chooses to empty it. Once the bladder is full, the brain sends a signal to the bladder that it is time to urinate.
If the pelvic floor muscles are weakened the sphincters may not close as tightly allowing leakage from the bladder. Urinary incontinence is the involuntary leakage of urine, where control over the urinary sphincter is either lost or weakened. This means that a person urinates when they do not want to.
What are the types of urinary incontinence?
There are several types of urinary incontinence:
- Urge incontinence, also known as overactive bladder – You have a sudden, intense urge to urinate followed by an involuntary loss of urine. Often, this happens too quickly for you to make it to a toilet and you end up leaking urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, weak pelvic muscles, nerve damage or a more severe condition such as a neurological disorder or diabetes.
- Stress incontinence – Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. In this type of incontinence, your pelvic floor muscles are weak and no longer support your pelvic organs as they should. This muscle weakness means that you’re more likely to accidentally leak urine when you move around.
- Mixed incontinence – You experience more than one type of urinary incontinence; most often this refers to a combination of stress incontinence and urge incontinence. It is often important to pay attention to what you are doing when you have leakage issues with this type of incontinence. Identifying what triggers mixed incontinence is usually the best way to manage it.
- Overflow incontinence – You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely. If your bladder doesn’t empty completely each time you urinate, usually this results in small amounts of urine dripping out over time instead of one big gush of urine.
- Functional incontinence, also known as disability associated urinary incontinence – This is when a person has a physical or mental impairment that keeps them from making it to the toilet in time, but the bladder is healthy.
They may be unable to:
– Recognise the need to go to the toilet.
– Locate the toilet.
– Access the toilet.
– Recognise the toilet.
– Manage their personal needs, for example, if they have severe arthritis, they may not be able to adjust their underwear quickly enough.
These urinary incontinence types have different causes, characteristics and triggers for urine leakage. Knowing the type of urinary incontinence is often an important part of the diagnosis and treatment plan for urinary incontinence.
What are the symptoms of urinary incontinence?
The main symptom of urinary incontinence is a leakage of urine. This could be a constant dripping of urine or an occasional experience of leakage. Some of the symptoms of urinary incontinence can be found in all the different types; however, many are unique to the specific incontinency type.
If you have urge incontinence or an overactive bladder, you may:
- Feel a sudden urge to urinate that is difficult to control.
- Experience unintentional loss of urine immediately after an urgent need to urinate.
- Urinate frequently, usually eight or more times in 24 hours.
- Wake up more than two times in the night to urinate (nocturia).
Even if you are able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and night-time urination can disrupt your life.
If you have stress incontinence you may:
- Experience unintentional loss of urine when you:
– Exercise vigorously.
– Bend over.
– Lift something heavy.
– Have sex.
- Feel pressure on your abdomen that may cause you to leak urine
You may not leak urine every time you do one of these things. But any activity that puts pressure on your bladder can make involuntary urine loss more likely, particularly when your bladder is full.
If you have mixed incontinence you may experience some or all of the symptoms above.
If you have overflow incontinence you may experience:
- The sudden release of urine.
- A feeling of fullness in the bladder even after urination.
- Leakage of urine while sleeping.
- A urine stream that stops and restarts during urination.
- Difficulty urinating even while feeling the urge to urinate.
Sometimes you may leak urine without any warning at all. This is the most common type of incontinence in children who have a day or night wetting problem, and in the elderly. It can also occur at other ages, in a variety of circumstances.
Functional incontinence is related to impaired cognitive functioning and mobility. The main symptom is an inability to reach a toilet in time. There are many temporary or long-term medical issues that can result in functional urinary incontinence, but usually the bladder is healthy. However, it is possible to have another type of bladder incontinence in addition to functional incontinence.
What are the causes of urinary incontinence?
There are some causes of incontinence that are common to all age groups and genders, whilst others are gender and/or age specific.
Urinary Incontinence in Women
Incontinence affects roughly twice as many women as men. This is due to common changes in a woman’s health and body, such as pregnancy, hormonal changes, menopause and ageing.
In pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and the pelvic floor muscles can be overwhelmed by this and become weakened. Increased uterine weight is another huge important factor affecting the frequency of leakages during pregnancy. During childbirth, these muscles are further stretched and weakened, leaving many women suffering from stress incontinence. Women who have a natural childbirth have a higher chance of developing incontinence later in life.
After menopause, women produce less oestrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence. Oestrogen deficiency is very common in older women and can cause urinary urge incontinence.
Urinary Incontinence in Men
Urine leakage and male incontinence can happen for a number of reasons, and bladder problems in men are more common than you might think. Naturally, urinary leakage differs from man to man; however, urge incontinence which is also known as an overactive bladder is the most common type of urine leakage in men.
Common causes specifically for male incontinence include:
- Temporarily weakened muscles due to prostate surgery. The prostate is a gland in men, which is located at the base of the bladder. Often in older men, the gland starts to grow larger and can obstruct the urine tube. Male stress incontinence is most common in those who have recently had prostate surgery.
- Changes in prostate size, for example a swollen prostate, can obstruct urine from passing.
- Intermittent flow of urine is usually caused by something obstructing the flow of urine, causing the bladder to overflow and then leak.
Men can experience after dribble, known as post-micturition dribble and terminal dribble, when a few drops of urine leak after they have been to the toilet, even if they have “waited and shaken”. Afterwards, dribble happens because the bladder doesn’t empty completely while urinating. Instead, the urine accumulates in the tube leading from the bladder.
Common after dribble causes are enlarged or weakened pelvic floor muscles. In men, pelvic floor muscles can be weakened by:
- A fragile bulbourethral muscle causing the inner part of the urethra behind the scrotum to sag slightly, and as a result, urine will gather after a trip to the toilet. When the muscles move, for example when walking away from the toilet, this urine is released.
- Operations for an enlarged prostate.
- Continual straining to empty the bowels, especially when constipated.
- Constant cough, for example, a smoker’s cough.
- Neurological damage.
- Persistent heavy lifting.
Male urinary incontinence is not inevitable and many will never experience the condition. For quite a few of those who do, it will only be temporary.
Urinary Incontinence in Children
Most bladder issues in children will be caused by a functional problem.
- Underlying constipation is a common cause of bladder issues and needs to be ruled out. A full bowel can affect the space that the bladder needs to fill and empty properly. Children with additional needs such as autism are more likely to be affected by constipation which can then cause problems with their bladder.
- Urine accidents are very common when children are potty training and learning how to manage their bladder. They usually clear up once the child goes to school.
- If children don’t drink enough, their urine can become concentrated. This can irritate their bladder and make it empty when it shouldn’t. Certain drinks can also irritate the bladder such as blackcurrant and drinks containing caffeine such as cola, energy drinks, hot chocolate etc.
- Putting off going to the toilet when they need to go, or reluctance to use the toilet, as many children are uncomfortable using public toilets, such as toilets at school. “Holding on” makes it more likely an accident will happen because the bladder is full.
- Structural problems with the bladder, for instance, following correction of congenital (present at birth) conditions, such as bladder exstrophy or if the ureters connect to the bladder in the wrong place.
- As a feature of other conditions such as spina bifida, there is a problem with the nerve supply to the bladder which may cause problems in recognising the need to urinate.
Causes of urinary incontinence that are not gender specific include:
- Certain drinks and foods may act as diuretics stimulating the bladder and increasing the volume of urine including:
– Carbonated drinks and sparkling water.
– Artificial sweeteners.
– Foods that are high in spice, sugar or acid, especially citrus fruits.
- Certain medications also have diuretic side effects such as:
– Heart and blood pressure medications.
– Muscle relaxants.
– Large doses of vitamin C.
- Ageing of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as people get older.
- Neurological disorders such as multiple sclerosis, Parkinson’s disease, a stroke, a brain tumour or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
- A tumour anywhere along the urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones, which are hard, stonelike masses that form in the bladder, sometimes cause urine leakage.
- Being overweight. Extra weight increases pressure on the bladder and surrounding muscles, which weakens them and allows urine to leak out when coughing or sneezing.
- Diabetes may increase the risk of incontinence.
- Multiple sclerosis (MS). If you have MS, you may experience a loss of control of your bladder, leading to leakage issues.
- If a close family member has urinary incontinence, especially urge incontinence, the risk of developing the condition is higher.
Some of the causes of disability associated urinary incontinence include problems with walking such as arthritis or cerebral palsy, and problems with memory or learning such as dementia and intellectual disability.
What are the treatments for urinary incontinence?
If urinary incontinence is frequent or is affecting your quality of life, it is important to seek medical advice from your GP. There are a number of options for treating urinary incontinence, some of which may be used in combination. Treatment will depend on the type of urinary incontinence you have and the severity of your symptoms. If urinary incontinence is caused by an underlying condition, you may receive treatment for this alongside incontinence treatment.
Treatments which do not involve medicines or surgery are usually tried first.
- Lifestyle changes such as:
– Reducing your intake of caffeine.
– Altering how much fluid you drink each day, as drinking too much or too little can make incontinence worse.
– If you are overweight or obese, losing weight.
- Pelvic floor muscle training – Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended. Your GP may refer you to a specialist to start a programme of pelvic floor muscle training.
- Electrical stimulation – If you are unable to contract your pelvic floor muscles, using electrical stimulation may be recommended. An electrical current runs through a probe, which helps strengthen your pelvic floor muscles while you exercise them.
- Vaginal cones may be used to assist with pelvic floor muscle training. These small weights are inserted into the vagina.
- Bladder training – It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. Bladder training may also be combined with pelvic floor muscle training if you have mixed urinary incontinence.
If urinary incontinence does not significantly improve with lifestyle changes or exercises, prescription medicines or surgery will usually be recommended as the next step. The type of medicine or surgery will depend on the individual, their symptoms and their past medical history.
There are quite a few medications that can reduce leakage. Some of these drugs stabilise the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing by relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involve replacing the oestrogen that is decreased during menopause and may also help restore normal bladder function.
Incontinence pads and other products and devices can make life easier whilst waiting for a diagnosis or for a treatment to work.
- Pads and pants.
- Bed and chair protection.
- Catheters and penile sheaths.
- Skincare and hygiene products.
- Specially adapted clothing and swimwear.
Avoid using sanitary pads for urinary incontinence as they stay damp and they can make the skin sore.
How to prevent urinary incontinence
Urinary incontinence isn’t always preventable.
However, to help decrease your risk:
- Maintain a healthy weight.
- Practise pelvic floor exercises.
- Avoid bladder irritants, such as caffeine, alcohol and acidic foods.
- Eat more fibre, which can prevent constipation, a cause of urinary incontinence.
Lifestyle changes to help improve urinary incontinence can include:
- Emptying your bladder on a regular basis. This is also called timed voiding, a practice of going to the toilet on a regular basis instead of waiting for the urge to go.
- Emptying your bladder before physical activities. If you are planning to exercise or do a physical activity, plan to empty your bladder before the activity starts to avoid leakage.
- Avoiding lifting heavy objects. If you need to move something large, grab an additional person to help you.
- Avoiding drinking caffeine or a lot of fluids before starting an activity. If you experience frequent urination and leakage at night, you might also want to avoid drinking beverages right before bed.
- Practising bladder training to help stretch out the amount of time between each trip to the toilet.
- Doing regular pelvic floor exercises to help strengthen your pelvic floor muscles.
As urinary incontinence is being spoken of more frequently now in comparison to ten years ago, people are more proactive in looking for treatment. If you or someone you know is affected by urinary incontinence, talk to your GP – they can help.