Urinary incontinence is leakage due to loss of bladder control. Stress incontinence and urge incontinence are the two main types. It is more common in women than men as the pelvic floor weakens over time. Urinary incontinence is not a normal part of aging, and it can be treated.

What is urinary incontinence?

The bladder stores urine made in the kidneys until you are ready to release it. If you didn’t have a bladder you would be constantly leaking urine! The bladder muscles tighten when you need to urinate. This forces urine out of your bladder through the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body.

If the bladder muscles tighten and the sphincter muscles can’t contract enough you will have a sudden need to urinate. Increased pressure caused by laughing, sneezing, or exercising can cause you to leak urine. Problems with the nerves controlling the bladder may also lead to incontinence. You may find you leak variable amounts of urine.

Anyone can develop urinary incontinence, but it is more common in older women as the menopause weakens the pelvic muscles. 40% of over women over 65 suffer from this problem.

What are the types of urinary incontinence that affect women?

The two most common types of urinary incontinence in women are:

Stress incontinence. This is the commonest type and most likely to affect younger women. It is caused by weakened pelvic floor muscles adding to the pressure on the bladder and urethra. Anything that increases pressure in the pelvis can cause you to leak urine including sneezing and laughing.

Urge incontinence. This causes you to have a sudden need to pass urine and you may leak before you can get to the bathroom. It can happen on many occasions throughout the day. You may not pass much urine when you get to the bathroom. This is also called overactive bladder. Urge incontinence is more common as we get older. It can happen when you don’t expect it and can be triggered by seeing or hearing running water.

Many women with urinary incontinence have both stress and urge incontinence. This is called “mixed” incontinence.

What causes urinary incontinence?

  • Increased weight. This increases the pressure on the bladder and weakens the muscles. A weak bladder cannot hold as much urine.
  • Constipation. Constipation, or straining to open your bowels increases pressure on the bladder and pelvic floor muscles. This can weaken them.
  • Nerve damage. This affects how the brain and bladder communicate. Damaged nerves may send the wrong signals to the bladder. Childbirth, surgery and conditions such as diabetes can cause nerve damage.
  • Surgery. Any operation in the pelvis can damage the pelvic floor. This may then affect how the bladder muscles work leading to leakage.
  • Medication. Diuretics “water tablets” can lead to incontinence which goes away when the medication is stopped.
  • Caffeine. This fills the bladder more quickly, which can cause you to leak urine. Studies suggest that drinking more than two caffeine drinks a day are more likely to have incontinence. Limiting caffeine may help as it puts less strain on your bladder.
  • Infection. Infections may cause temporary incontinence which gets better once the infection is treated.

How is urinary incontinence diagnosed?

You will be asked about your symptoms and medical history, the following questions are important:

  • How often do you empty your bladder?
  • How and when do you leak urine?
  • How much urine do you leak?
  • When did your symptoms start?
  • What medications are you on?
  • What your pregnancies (if any) were like.

You may need to be physically examined.

Investigations include:

  • Urine test.
  • Ultrasound scan of the renal tract.
  • Bladder stress test. During this test, you will cough or bear down as if pushing during childbirth as your doctor watches for loss of urine.
  • Cystoscopy. A thin telescope is passed into the bladder through the urethra to allow the doctor to see any problems and take biopsies if needed.
  • Urodynamics. A thin tube is passed into the bladder and it is filled with water. This allows the pressure in your bladder to be measured to see how much fluid your bladder can hold.

You may be asked to keep a bladder diary which helps us to identify patterns to understand what is causing your problem and how you may best be helped.

What steps can I take at home to treat urinary incontinence?

Pelvic Floor Exercises to improve pelvic floor muscles.

Bladder training. This helps overactive bladder or urge incontinence. Track how often you go to the bathroom each day in your bladder diary. Then add about 15 minutes between visits. Make sure you pass urine each time, even if you don’t feel you need to. Gradually increase the amount of time between visits and your bladder will learn to hold more urine before it signals the need to go again.

Lose weight. Extra weight puts more pressure on your bladder and nearby muscles, which can lead to problems with bladder control. If you are overweight, Integriti GP's and Allied Health Professionals can help to create a plan for weight loss by healthy diet choices and regular exercise.

Change your eating habits. Reduce caffeine, carbonated drinks and alcohol.

Stop smoking. Smoking can make urinary incontinence, worse.

Manage constipation. Eating foods with a lot of fibre can make you less constipated.

Pads and protective underwear. These are now widely available and can give you peace of mind whilst implementing other measures.

Next Steps:

Medications. Oestrogen creams and pessaries can help strengthen the muscles and tissues in the urethra and vaginal areas. This will promote bladder control. Learn more about menopause treatments by discussing the matter with your Integriti GP. Medications to treat urge incontinence relax the bladder muscle, increasing the amount of urine your bladder can hold. Side effects of these medicines include constipation and dry eyes and mouth.

Vaginal pessary. A reusable pessary is a small plastic or silicone device (shaped like a ring or small donut) that you put into your vagina. The pessary pushes up against the wall of the vagina and the urethra to support the pelvic floor muscles and help reduce stress incontinence. Pessaries come in different sizes, so your doctor or physio must determine the size that will fit you. Another type of pessary looks like a tampon and is used once and then thrown away. You can get this type of pessary at a chemist.

Surgery. Surgery for urinary incontinence is not recommended if you plan to get pregnant in the future. Pregnancy and childbirth can cause leakage to happen again. The two most common types of surgery for urinary incontinence are: Sling procedures and Colposuspension (your Integriti GP can discuss this and referral pathways if necessary).

Other treatments are potentially available. Please book a consultation with your Integriti GP.

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