Overview
Urinary incontinence means leaking urine by accident. It can be a few drops when you cough or laugh, or a sudden urge so strong that you cannot reach the toilet in time.
It is common in women and men. It becomes more likely with age, but it is not an unavoidable part of ageing, and it often improves with treatment.
Symptoms
The pattern of leaking points to the type:
- Stress incontinence: leaking when pressure is put on the bladder, for example when you cough, sneeze, laugh or lift
- Urge incontinence: a sudden, strong need to pass urine, with leaking before you reach the toilet
- Overflow incontinence: the bladder does not empty fully, so it overfills and leaks small amounts often
- Mixed incontinence: more than one type, most often stress and urge together
- Functional incontinence: being unable to reach the toilet in time because of arthritis, dementia or another limitation
When to see a doctor
Otherwise, see a doctor if leaking is a regular problem, limits what you do, or began after starting a new medicine. Even minor leaking is worth checking, because the right treatment depends on the type.
Causes
Different types have different causes:
- Stress: weak or damaged pelvic floor muscles, or a weak muscle ring (sphincter) around the urethra, for example after childbirth
- Urge: an overactive bladder muscle, a urinary tract infection, or a nerve condition such as multiple sclerosis or a spinal cord injury
- Overflow: a blockage such as an enlarged prostate or kidney stones, or diabetes or certain medicines that stop the bladder emptying
- Temporary: an infection or a new medicine, where the leaking clears once the cause is treated or removed
Risk factors
- Being a woman, especially after pregnancy, vaginal childbirth or the menopause
- Older age, as the muscles of the urinary tract weaken
- Prostate problems in men
- Obesity
- Diabetes
- Long-term constipation
- Smoking
- A family history of incontinence
Complications
Incontinence is not usually dangerous, but it can affect daily life, sleep and confidence. It can also be a sign of another problem, such as an infection, a blockage or a nerve condition, so it is worth having it checked.
Prevention
Incontinence cannot always be prevented, but these habits help keep the bladder healthy:
- Pelvic floor exercises, which strengthen the muscles that support the bladder, especially in pregnancy
- Keeping to a healthy weight
- Cutting down on alcohol and on caffeine in tea, coffee and cola, which can increase urine output and irritate the bladder
- Drinking enough through the day, and less in the hours before bed if night-time trips are a problem
- Treating constipation, and not smoking
Diagnosis
A doctor will ask about the leaking, your health and your medicines. You may be asked to keep a bladder diary for a few days, noting what you drink and when you pass urine or leak.
An examination may include a pelvic or rectal examination. Urine and blood tests, tests of how well the bladder works, or scans may follow. Some people are referred to a specialist.
Treatment
Treatment depends on the type, and the simplest steps come first:
- Lifestyle changes, such as those listed under prevention
- Pelvic floor exercises, done regularly
- Bladder training, which gradually lengthens the time between passing urine
- Absorbent pads and other products, to stay dry in the meantime
- Medicines, for example to calm an overactive bladder, or to shrink the prostate in men when it is the cause
- Devices, such as a vaginal ring or insert for some women, or a catheter if the bladder does not empty
- Injections around the urethra, nerve stimulation or surgery, such as a sling to support the urethra, if other treatments have not helped
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Leaking urine is a normal part of getting older, so nothing can be done.”What is true?
Fact
Incontinence is common and the muscles of the urinary tract do weaken with age, but it is not an unavoidable part of ageing. It can get better with the right treatment, so it is worth speaking to a doctor.
Myth“It only happens to women who have had babies.”What is true?
Fact
Pregnancy, childbirth and the menopause are common causes in women, but men are affected too, often because of ageing or prostate problems. Diabetes, obesity, long-term constipation and smoking also raise the risk.
Myth“Drinking much less water will stop the leaking.”What is true?
Fact
Cutting back on fluids does not treat the cause. The advice is to keep drinking enough through the day and, if night-time trips are the problem, to drink less in the hours before bed. Cutting down on alcohol and on caffeine in tea, coffee and cola is more likely to help.
Myth“Pads are the only answer.”What is true?
Fact
Pads can help you stay dry while the cause is found. But many people improve with pelvic floor exercises, bladder training and lifestyle changes, and medicines, devices and surgery are options if these are not enough.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is it normal to leak a little when I cough or laugh?
It is common, especially after childbirth or around the menopause, but it is not something you have to live with. Pelvic floor exercises and other simple steps often help, so mention it to a doctor.
Can men have urinary incontinence?
Yes. In men it is often linked to ageing or prostate problems, for example when an enlarged prostate stops the bladder emptying fully and urine leaks out. It can be treated once the cause is found.
Will cutting down on water help?
Usually not. Drink enough through the day. If night-time trips are the problem, drink less in the hours before bed. Cutting back on tea, coffee, cola and alcohol is more likely to help.
Will I need surgery?
Many people improve without it. Surgery, such as a sling procedure, is usually considered only after lifestyle changes, exercises, bladder training and other treatments have not worked.
