This article was written by London-based GP – Dr Nirja Joshi
What is incontinence?
Incontinence is the unintentional passage of urine and is a very common problem affecting millions of people in the UK (1). It can happen for a variety of reasons which are outlined below, and can affect both men and women. Incontinence can be a tricky subject as people can find it embarrassing to discuss with their doctor, however it is very important to discuss any signs of incontinence with your doctor to ensure that you are receiving the correct treatment and support with your symptoms – it may be common, but it’s not normal.
What are the different types of incontinence? (1, 2)
Stress incontinence: this is often due to a weakened pelvic floor and occurs when urine leaks when there is increased downward pressure for example during coughing, laughing, sneezing and during exercise – especially running or skipping.
Urgency and urge incontinence: Urgency is when you feel a sudden and very intense need to pass urine and you’re unable to delay going. Urge incontinence is when you leak urine before making it to the toilet. These are often symptoms of an overactive bladder.
Overflow incontinence: This occurs when your bladder is full and is not able to empty completely and hence you can develop an overflow of urine.
Total incontinence: This occurs when you lose control of your bladder completely and may have a constant leakage of urine.
Functional incontinence: this occurs when you are physically unable to make it to the toilet in time for example patients with severe mobility issues may struggle to get to the toilet in time and hence become incontinent.
It is of course possible to have a mixture of the above in terms of types of incontinence. It is also possible to have temporary urinary incontinence due to several factors such as caffeine, alcohol, urinary tract infection and constipation (2). It is also important to remember that some medications can increase the risk of urinary incontinence and hence if you are suffering with urinary incontinence please do check if you have been started on any new medications.
There are of course physical health conditions which can lead to urinary incontinence such as pregnancy, childbirth, prostate problems, obstruction of the urinary tract and other illnesses (1, 2).
Incontinence may be temporary and can in some cases be more permanent and hence it is important to ascertain the cause of the incontinence and any relevant treatment.
Risk factors for incontinence
There are several risk factors for urinary incontinence, although it can affect anyone at any age – it also will depend on the type of incontinence Incontinence is more common in women, and overall risk increases with age given that muscles weaken with age. Other risk factors include pregnancy and vaginal delivery, obesity, constipation, prolapse, previous pelvic surgery, lack of oestrogen after the menopause, smoking, certain medical conditions and medications, and also family history (so women whose mother or sisters are incontinent are more likely to develop stress urinary incontinence.)
Stress incontinence is one of the more common forms of incontinence. In the UK 4 in 10 women over the age of 60 suffer with some sort of incontinence, more likely due to stress incontinence. This is because stress incontinence is caused when there is a urinary leakage due to increased pressure on the abdomen. This can be caused by things such as coughing, sneezing, laughing and exercise (3). This is made more likely due to weakened pelvic floor muscles which women are more likely to have encountered after childbirth. Women who have had vaginal deliveries are more susceptible to pelvic floor weakness. It is important to keep a diary of your symptoms to help your GP to diagnose what type of incontinence you have. If you are diagnosed with stress incontinence there are a few things that you’re able to do.
The most important thing is pelvic floor exercises, which you should practice 2-3 times per day if symptomatic.
- Make sure you are comfortably lying, sitting or standing
- Take an inhale through your nose and as you exhale through the mouth, squeeze your anus as if you’re trying to stop yourself passing wind
- Try to hold this squeeze for a few seconds and then let go and relax. As you’re holding this position try to breathe normally
- After relaxing, repeat the exercise 10 times – aiming to hold for 10 seconds each time (it may take some weeks to build up to this)
After your longer holds follow with 10 short squeezes. Make sure that you slowly release and relax between each squeeze.
If symptoms are not improving with pelvic floor exercises alone, then you may benefit from an appointment with a pelvic health physio to help with technique.
Check out the NHS app SQUEEZY for pelvic floor exercise regimes, daily reminders – plus a directory for pelvic health physiotherapists
There are also medications which can help to treat stress incontinence in women such as duloxetine. There are other surgical options which can be helpful which all aim to help to relieve pressure on the pelvic floor muscles and help to suspend the bladder (3).
Urge incontinence is the second most common type of urinary incontinence. It commonly affects women more so than men. it occurs when you have a sudden urge or desire to pass urine. Normally the bladder becomes half-full and your brain receives a signal that you may need to pass your end. There is also a condition called overactive bladder syndrome) where the bladder sends the signal to the brain much earlier and hence you feel that you need to pass urine although there may not be much urine there to pass (4). Low levels of oestrogen after the menopause can also be linked to urge incontinence (4). With urge incontinence it’s common to need to go to the bathroom several times a day as well as a few times during the night. There are several treatments available for urge incontinence including bladder retraining, medication, botox injection into the bladder and surgery (4).
Places to go for support
It is important that if you have any symptoms of urinary incontinence that you speak to your GP in the first instance it will be able to help by taking a history and examining you to see if there is any particular cause for urinary incontinence. They may also ask you to keep a fluid and bladder diary to see the times and the amount of fluid that you’re drinking and see how this impacts on your incontinence.
You can take the ‘bladder health’ quiz by the NHS.
There are great tips on managing incontinence here.
Also suffer should be aware that they may be able to get a RADAR key (5), which grants access to 9000 disabled toilets in the UK to help for when you’re out and about.
- NHS. Urinary Incontinence [Internet]. 2019 [cited 2022 Jul 26]. Available from: https://www.nhs.uk/conditions/urinary-incontinence/
- Mayo Clinic. Urinary Incontinence [Internet]. [cited 2022 Jul 26]. Available from: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808
- Tidy C. Stress Incontinence [Internet]. Patient UK. 2021 [cited 2022 Jul 26]. Available from: https://patient.info/womens-health/lower-urinary-tract-symptoms-in-women-luts/stress-incontinence
- Hazell T. Urge Incontinence [Internet]. Patient UK. 2022 [cited 2022 Jul 26]. Available from: https://patient.info/womens-health/lower-urinary-tract-symptoms-in-women-luts/urge-incontinence
- Blue Badge Co. RADAR KEY [Internet]. [cited 2022 Jul 26]. Available from: https://www.bluebadgecompany.co.uk/blogs/disability-topics/radar-keys-locked-disabled-toilets-explained#:~:text=A%20RADAR%20Key%20(sometimes%20called,disabled%20toilets%20in%20the%20UK
Incontinence was last modified: August 9th, 2022 by