Urinary incontinence

The cause of urinary incontinence will depend upon the type of incontinence, but certain factors may increase your chances of developing the condition.

Stress incontinence is usually the result of the weakening or damaging of the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.

Urge incontinence is usually the result of overactivity of the detrusor muscle, which controls the bladder.

Things that can increase the chances of developing urinary incontinence include:

• pregnancy and vaginal childbirth
• obesity
• a family history of incontinence
• urinary infections
• constipation
• increasing age (although incontinence is not an inevitable part of ageing)
• over-active bladder
• damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy), or removal of the prostate gland
• neurological conditions that affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis
• certain connective tissue disorders such as Ehlers-Danlos syndrome
• certain medicines

In addition to the causes mentioned above, there are some things that can increase your risk of developing urinary incontinence without directly being the cause of the problem. These are known as risk factors.

Some of the main risk factors for urinary incontinence include:

• family history – there may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have experienced the problem.
• increasing age – urinary incontinence becomes more common as you reach middle age and is particularly common in people over 80.
• having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra.

Find out more about the causes of urinary incontinence here.

Although you may feel embarrassed talking to someone about your symptoms, it’s a good idea to consult your GP or practice nurse if you have any type of urinary incontinence as this can be the first step towards finding a way to effectively manage the problem.

Urinary incontinence can usually be diagnosed and managed by your Primary Care team. You will be asked about your symptoms and may have a pelvic examination (in women) or rectal examination (in men). You may also be asked for a fresh sample of urine (a mid-stream urine or MSU) to test for possible infection or traces of blood (which can be an indication that further investigations are needed).

You may be asked to keep a diary in which you note how much fluid you drink and how often you need to urinate. You can download a bladder diary here.

Occasionally it may be necessary to refer you to a nurse-led clinic at the hospital to undergo what are known as Urodynamic tests or “flow studies”. These check the function of your bladder in more detail and can help identify precisely what the problem is so that the right treatment can be offered.

Other hospital-based investigations may include an ultrasound scan of your bladder or a cystoscopy in which a thin fibreoptic camera (endoscope) is inserted into your bladder via the urethra so that a specialist (“urologist”) can inspect the lining of the bladder to identify any abnormalities that might be contributing to your symptoms.

Non-surgical treatments

Initially, your GP or nurse may suggest some simple measures to see if they help improve your symptoms.

These may include:

• Lifestyle changes such as losing weight and cutting down on caffeine and alcohol.
• Pelvic floor exercises, where you strengthen your pelvic floor muscles by squeezing them. Please see section on Prevention and self-care below.
• Bladder training, where you learn ways to wait longer between needing to urinate and passing urine.
• Medication can be useful for a variety of types of urinary incontinence and can normally be prescribed by your GP.
• Incontinence products are not really a treatment for urinary incontinence but can be useful for managing the condition.

These include:

• absorbent products, such as incontinence pants or pads.
• hand-held urinals (urine collection bottles).
• a catheter, a thin tube that is inserted into your bladder to drain urine.
• devices that are placed into the vagina or urethra to prevent urine leakage, for example while you exercise.

Find out more about non-surgical treatments for urinary incontinence.

Surgical treatments

Surgery may also be considered. The procedures that are suitable for you will depend on the type of incontinence you have.

Surgical treatment for stress incontinence, such as a sling procedure, is used to reduce pressure on the bladder or strengthen the muscles that control urination.

Surgery to treat urge incontinence includes enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.

Find out more about surgery and procedures for urinary incontinence.

It is not always possible to prevent urinary incontinence, but there are some steps you can take that may help reduce the chance of it developing, such as:

• Controlling your weight.

Being obese can increase your risk of urinary incontinence. You may be able to lower your risk by maintaining a healthy weight through regular exercise and healthy eating. Use the healthy weight calculator to see if you are a healthy weight for your height.

Get more information and advice about losing weight.

• Avoiding or cutting down on alcohol.

If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee and cola. These can cause your kidneys to produce more urine and irritate your bladder.

The recommended weekly limit for alcohol consumption is 14 units.

A unit of alcohol is roughly half a pint of normal strength lager or a single measure (25ml) of spirits. Find out more about alcohol units.

If you need to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However, make sure you still drink enough fluids during the day.

• Keeping fit.

Visit the NHS fitness studio for more information

• Trying to keep your pelvic floor muscles strong.

Everyone may benefit from strengthening their pelvic floor muscles with pelvic floor exercises. Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you’re pregnant, strengthening your pelvic floor muscles may help prevent urinary incontinence.

Find out more about exercise during pregnancy.

Find out more about pelvic floor exercises.

The Royal Devon University Healthcare Trust has produced a helpful leaflet you can see here.

Useful information about urinary incontinence

• 10 ways to stop leaks – NHS UK
• Incontinence products – NHS UK
• Living with a urinary catheter – NHS UK
• Advice for men with incontinence – Depend
• Continence Product Adviser

Bladder and bowel UK

https://www.bbuk.org.uk/

University Hospitals Plymouth (UHP) – Constipation in Adults

Constipation in Adults – Patient Information Leaflet

University Hospitals Plymouth (UHP) – Loose Stool and Loss of Bowel Motions in Adults

Loose Stool and Loss of Bowel Motions in Adults – Patient Information Leaflet

University Hospitals Plymouth (UHP) – IBS

IBS – Patient Information Leaflet

Bladder and Bowel Community – Drinking for a healthy bladder

Drinking For A Healthy Bladder Leaflet

The British Association of Urological Surgeons (BAUS) – Bladder Training

BAUS Bladder Training

POGP (Pelvic, Obstetric and Gynaecological Physiotherapy) – Pelvic Floor Muscle Exercises for WOMEN

POGP Pelvic Floor Muscle Exercises for Women

POGP (Pelvic, Obstetric and Gynaecological Physiotherapy) – Pelvic Floor Muscle Exercises for MEN

POGP Pelvic Floor Muscle Exercises for Men

Referral

If you need more help with pelvic floor exercises, your GP may suggest referral to a Women’s Health Physiotherapist.

South Devon and Torbay NHS Trust has a self-referral service. You can find the details here.

Your GP may consider referring you to the local bladder and bowel service, or to a hospital specialist in urology or gynaecology.