It can be one of the more embarrassing and distressing health conditions, but urinary incontinence needn’t take over your life.
Urinary incontinence, the unintentional passing of urine, is such a common problem that as the population ages, not even the NHS has a clear idea how many people are now affected; a 2003 study estimated it at 24 percent of people over 60 worldwide, while a 2015 estimate gave a figure of 14 million in the UK. So if you do suffer, you’re certainly not alone.
Part of the problem in diagnosis and treatment is that there are at least four forms of urinary incontinence, including the stress, urge, overflow and total types.
Just as there are many different types of urinary incontinence, there can be many causes. Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter, either through childbirth, obesity, neurological conditions such as Parkinson’s or some medications.
Fight The Urge
Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder, so-called ‘overactive bladder’. Causes range from urinary tract infections to inadequate fluid intake.
The Four Forms of Incontinence
- Stress incontinence – When urine leaks out at times when your bladder is under pressure, for example, when you cough or laugh
- Urge incontinence – When urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards
- Overflow incontinence (chronic urinary retention) –When you’re unable to fully empty your bladder, which causes frequent leaking
- Total incontinence – When your bladder can’t store any urine at all, which causes you to pass urine constantly or have frequent leaking
Overflow incontinence is often caused by an obstruction or blockage to your bladder, which prevents it emptying fully, including an enlarged prostate gland in men, bladder stones, constipation or nerve damage from bowel or spine surgery.
Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or in women a bladder fistula.
Certain factors can increase the chances of urinary incontinence developing, including pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age (particularly in the over-80s)—though incontinence is certainly not an inevitable part of ageing.
Any of the common types of urinary incontinence can be embarrassing and uncomfortable but most are manageable, so the first step is to overcome any possible feelings of embarrassment and see your GP for an examination, which should be the first step towards effective treatment.
Diagnosis is normally done by discussing the symptoms and possibly keeping a journal of fluid intake and how often you urinate; then a pelvic examination for women or rectal examination for men.
What Treatmens Are There For Incontinence?
The most straightforward treatments for urinary incontinence are in your own hands—they can include lifestyle changes such as losing weight and cutting down on caffeine and alcohol, exercising the pelvic floor muscles by squeezing (Kegel exercises) and bladder training, where a specialist will teach you ways to wait longer between needing to urinate and passing urine.
In practical terms, you may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.
Behavioural Solutions: The Kegel Way
First described in 1948 by American gynaecologist Arnold Kegel, pelvic floor muscle training can help strengthen the muscles that hold up the bladder and stop it from leaking. A specialist will assess whether you'll be able to contract you pelvic floor muscles, and by how much. An individual exercise programme will be developed based on your assessment and should consist of a minimum of eight muscle contracts at least three times a day, maintained for at least three months.
Standard Treatment Methods For Incontinence
The standard medication for stress incontinence, duloxetine, can help increase the muscle tone of the urethra, which should help keep it closed. Unfortunately, it has some possible side-effects, including nausea, dryness of the mouth, tiredness and constipation, so it isn’t for everyone. There are also possible side-effects of sudden withdrawal, so duloxetine prescription will be assessed after two to four weeks to see if it is beneficial.
For urge incontinence or overactive bladder syndrome, your GP may prescribe an antimuscarinic such as oxybutynin, either as tablets or in a patch.
A low-dose version of a medication called desmopressin may be used to treat nocturia, which is the frequent need to get up during the night to urinate, by helping to reduce the amount of urine produced by the kidneys.
Botulinum toxin A (Botox) can be injected into the sides of the bladder to treat urge incontinence and overactive bladder syndrome.
Surgical Alternatives For Incontinence
In some cases, a course of EMS (Electrical Muscle Stimulation) may assist in in the treatment of urge urinary incontinence by strengthening weak pelvic floor muscles. Contraction of the pelvic floor muscles is stimulated by low-level electrical impulses delivered to the nerves that supply these muscles, as well as the bladder and bowel, through an internal vaginal or anal electrode.
If medication and EMS are ineffective, there are surgical options such as a colposuspension or tissue sling (where the neck of the bladder is lifted and fixed in place); enlargement of the bladder; or implantation of an artificial urinary sphincter or a device to stimulate the nerve that controls the detrusor muscles, or to stimulate the sacral nerves at the bottom of the back.
Some of these surgeries require use of a catheter afterwards—a continence adviser will teach you how to place a catheter through your urethra and into the bladder to drain it.
It’s not always possible to prevent urinary incontinence, but there are several steps you can take to reduce the chance of it developing.
- Controlling your weight
- Avoiding or cutting down on alcohol and drinks with caffeine
- Keeping fit—in particular, exercising your pelvic floor muscles
- Reduce drinking in the hours before bed
While surgery can be distressing, in some cases it is the only effective option.
A study in Sweden in 2017 concluded that surgery ranks well ahead of other methods, delivering success within three months in 82 percent of cases, while pelvic floor exercises rank second with 53 percent, followed by drug treatment with 49 percent.
Bottom of the pile was treatment using so-called bulking agents, which was only successful in 37 percent of cases. This method involves injections of fillers into damaged tissue around the urethra in order to keep the area tight.
Ian Milsom, Professor of Gynaecology and Obstetrics at the Sahlgrenska Academy and Head of the Gothenburg Continence Research Centre (GCRC), said “Unfortunately we are not actually curing the condition in that many cases.
“Surgery aside, the results delivered are poor. And the problems are only going to get worse in the future because the population, as we know, is ageing.”
Tips for Women
The British Association of Urologicla Surgeons (BAUS) gives the following advice for women doing pelvic floor exercises.
- Get into the habit of doing your exercises regularly and linking them to everyday activities such as speaking on the phone
- Use the exercises to prevent leakage before you do anything which might make you leak
- Drink normally – Six to eight cups (two litres) per day, avoiding caffeine and alcohol if you can
- Avoid going to the toilet “just in case” – Go only when you feel that your bladder is full
- Watch your weight – Extra weight puts more strain on your pelvic floor muscles and your bladder
- Avoid constipation – Straining can put excessive pressure on your bladder and bowels
- Allow three to six months before you expect to see results, but continue them for life to prevent problems recurring or worsening