What It Is
Urinary incontinence means urine leaks when you do not want it to. About one woman in three has it at some point. Most say nothing, because they think it comes with age or with having had children. It does not. There are good treatments, and starting early makes them work better.
The Four Types
- Stress: Leaks when you cough, sneeze, laugh, lift or exercise. The pelvic floor has weakened.
- Urge: A sudden need you cannot hold, and it leaks on the way. Part of an overactive bladder.
- Mixed: Both together. The commonest kind in older women.
- Overflow: The bladder never empties fully, so urine dribbles all the time. Less common in women.
Why It Happens
Several things weaken the muscles that hold urine in.
- Pregnancy and childbirth, especially a long or forceps delivery
- Menopause, which thins the tissue around the urine pipe
- Extra weight, which presses on the bladder
- A long-standing cough, from smoking or asthma
- Past pelvic surgery
- Nerve conditions such as stroke or Parkinson's disease
How It Is Checked
The check usually starts with a bladder diary. You note what you drink, when you pass urine, and when it leaks. Then a urine test, and an ultrasound to see how much is left in the bladder afterwards. A few people need a pressure study or a look inside with a telescope. Most do not.
What Can Be Done
- Pelvic floor exercises: The first treatment for stress leaking. They need doing properly and for at least three months. Most people who say they did not work either squeezed the wrong muscles or stopped too soon. Being taught the technique helps a great deal.
- Bladder training: For urge leaking. You slowly stretch the gap between toilet visits, and the bladder learns to wait.
- Tablets: Calm an overactive bladder. Dry mouth and constipation are the usual limits.
- Vaginal oestrogen: A cream or pessary that improves the tissue after menopause.
- A small tape under the urine pipe: A day-case operation for stress leaking, once exercises have had a fair trial.
- Bladder injections or nerve stimulation: For urge leaking that tablets have not helped.
Leaking started suddenly after a new medicine. There is pain or blood in the urine. You keep getting urine infections as well. Or three months of exercises have made no difference. Each of these needs looking into further.
A private consultation can work out which type you have and what will help most. Bring three days of a bladder diary if you can.
Read More
Full guide: urine leakage and overactive bladder → · Download the bladder diary and pelvic floor sheet →
