It’s often embarrassing and uncomfortable, but it can usually be improved says Dr Mel Wynne-Jones
Up to a third of women ‘leak’ occasionally, and over three million regularly experience urinary incontinence (UI), especially as we get older. But we tend not to talk about it, even to our doctors, which is a shame as it can often be cured, or made easier to cope with.
Our bladders gradually fill until our nervous systems tell us they need emptying and control the process, ideally, when it’s convenient.
When we pass urine, our bladder wall (detrusor) muscle contracts, while the outlet sphincter (valve), supported by our pelvic-floor muscles, relaxes and urine flows down our urethral pipes.
Types of incontinence
An overactive bladder (OAB) makes us feel like we need to urinate long before it’s full. The signals become stronger and harder to resist so we go little and often, or lose control completely as it suddenly leaks or empties without warning (detrusor instability).
‘Urge incontinence’ can also be caused by neurological conditions, such as multiple sclerosis, irritation by infection, bladder conditions or low hormone levels after the menopause.
Stress urinary incontinence (SUI) occurs when the sphincter opens under sudden pressure, such as coughing or laughing. It’s commoner in women who’ve had prolonged or difficult labours, who are overweight, or have pelvic-floor weakness or prolapse.
Both types can occur together or during lovemaking. Pressure from an enlarged womb (for example, pregnancy or fibroids) or ovary (a cyst or, rarely, cancer) can also affect bladder function, while ‘overflow’ incontinence may be due to urine retention caused by urethral narrowing.
Continuous incontinence occurs if a false passage (fistula) develops between the
bladder and vagina.
Tests you may need
Fewer than half of women with moderate/severe UI don’t ask for help, but it’s important to know what’s wrong, as it could get worse.
You’ll need a tummy and internal (pelvic) examination, with a chaperone if you’d like one.
Your doctor will test your urine for infection, blood, diabetes and kidney damage, and perhaps take blood tests.
She may ask you to measure how much urine you pass or leak, and how often, to see how your bladder behaves, arrange an ultrasound scan or refer you to a specialist for a cystoscopy (bladder telescope examination) or X-rays to measure urine flow.
Pelvic-floor exercises almost always help, if you do them properly, several times a day. Ask for advice or visit nhs.uk. Allow three months to work.
Lifestyle changes help too (see box, right), but restricting your fluid intake can cause problems. If you take diuretics (water tablets) your GP may suggest an alternative. If you have severe pelvic-floor weakness, surgery may be needed.
The urologist or gynaecologist can explain the pros and cons of different operations.
An overactive bladder often improves with bladder training (learning to ‘hold on’ for longer) or medication to stabilise your detrusor muscle.
You may need to try more than one brand. Oestrogen cream, used in the vagina, or HRT tablets can remedy hormone deficiency.
But even if UI can’t be cured, the NHS can provide lots of advice and practical aids. Ask to be referred to a continence adviser or clinic.
5 ways to regain control
1 If you’re overweight, shedding the pounds can reduce pressure on your bladder.
2 Don’t smoke – it weakens supportive tissues, as well as making you cough.
3 Drink plenty of water, but limit caffeine and alcohol, which can irritate the bladder.
4 Cut out curries, citrus fruits and other spicy/acidic foods if they make UI worse.
5 Avoid constipation, which can interfere with normal bladder emptying.