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Urinary incontinence in women

Published by Bupa's health information team, January 2008.

This factsheet is for women who have urinary incontinence, or people who would like information about it.

Incontinence is an unintentional leakage of urine that causes you problems. It's about twice as common in women than in men.

About urinary incontinence
Types of urinary incontinence
Causes
Diagnosis
Treatment
Further information
Questions and answers
Related topics
Sources

About urinary incontinence

Your urine is produced by your kidneys and collects in your bladder. When your bladder is full, it empties to the outside through your urethra.

When you urinate, the muscular wall of your bladder has to contract at the same time as the band of muscle at the outlet of the bladder has to relax. Most incontinence in adults is caused by a problem with one or both of these processes.

Urinary incontinence is when you leak urine unintentionally. There are several different types of urinary incontinence.

Illustration showing the position of the bladder and surrounding structures
The position of the bladder and surrounding structures

Types of urinary incontinence

Stress incontinence

Stress incontinence is when you leak urine because there is extra pressure on your bladder, for example when you cough, sneeze, do exercise or lift something heavy. It develops when the mechanism for keeping the bladder outlet closed is weakened. This can happen when the urethra moves out of the normal position (prolapses) due to weakened pelvic floor muscles.

Urge incontinence

Urge incontinence means you leak urine because you have an urgent need to pass urine frequently. It happens because the muscle of the bladder wall contracts too often, squeezing urine out before the bladder is completely full. This is also called overactive bladder.

Mixed incontinence

Some women get stress and urge incontinence together. This means you have involuntary leakage of urine associated with urgency as well as exertion, sneezing or coughing.

Overflow incontinence

Overflow incontinence causes dribbling both day and night. It happens when the bladder fills up to the point where it can't expand any more. It can be caused by a blockage in the urethra or damage to the nerves that supply the bladder.

Causes

You are more likely to have urinary incontinence if you:

have had a baby
are past the menopause
have a urine infection
have diabetes
have a problem with the nerves to your bladder
take certain medicines - some medicines can cause or worsen incontinence as a side-effect; these include diuretics, some medicines for high blood pressure, and muscle relaxants such as diazepam
have a fistula - this is an abnormal opening between the bladder and the outside, usually through the vagina, and can cause constant dribbling of urine

Diagnosis

There is no need to try to cope on your own if you have incontinence. Visit your GP, who will be able to help you.

Your GP will probably ask about the following things:

how long incontinence has been a problem
whether you leak urine when you cough, sneeze etc
whether you have pain when you pass urine
how many times and how much you urinate in 24 hours
whether you have an urgent need to go
whether you take any medicines
whether the problem is getting worse
what effect it's having on your life

It's a good idea to make a note of all the fluids you drink, how much urine you pass and when you leak for a week before you see your GP.

Your GP will test a sample of your urine for signs of infection, bladder stone or other problems.

Your GP may refer you to a urologist - a doctor who specialises in urinary problems or a gynaecologist - a doctor who specialises in problems with women's reproductive organs. The tests you need may include:

a physical examination - checking your bladder and pelvic organs by feeling your abdomen (tummy), possibly inserting a finger or speculum into your vagina and possibly inserting a finger into your rectum
checking for leakage when you cough
testing the sensation around the skin between your vagina and back passage
urodynamic studies - these are tests on the urinary tract that are carried out in a hospital

Treatment

Self-help

There are a number of lifestyle changes that can help with urinary incontinence. These include:

cutting down on your caffeine intake, as this can irritate your bladder; caffeine is found in tea, coffee, cola drinks and chocolate
losing weight if your BMI is over 30 - see our BMI calculator [please add link]
changing the amount of water you drink - it may be a good idea for you to drink more or less water, depending on your usual habits; your doctor will advise you about this

Absorbent pads and suitable clothing can help make leaks less embarrassing. You can buy some of these products from your pharmacist.

Physical therapies

There are a number of exercises and other physical therapies that may help. These include the following.

Pelvic floor muscle exercises (Kegel exercises)

These exercises can help reduce stress or mixed incontinence. The exercises involve contracting the muscles that start and stop the urine flow. You need to do at least eight contractions three times a day for three months. You will need to keep doing them if they work.

Vaginal cones

These are small plastic cone-shaped weights that you hold in your vagina when doing pelvic exercises. They force you to contract your pelvic floor muscles in order to hold the cone in place. You can buy these from some pharmacists. As your muscle strength improves, you can use heavier cones.

Bladder training

This involves you emptying your bladder at set times, gradually increasing the time between intervals. You need to follow this treatment for at least six weeks to see if it's going to work.

Biofeedback

This uses sensors to tell you when you are using the right pelvic floor muscles. Your doctor or nurse may recommend this if you are having trouble with pelvic floor exercises. This treatment isn't suitable for everyone.

Electrical stimulation

This involves applying a small electric current to help your pelvic floor muscles to contract, and so help with your pelvic floor exercises. Your doctor or nurse may recommend this if you are having trouble with your pelvic floor muscles. It may be carried out by a trained nurse or physiotherapist, or you can buy a small device that electrically stimulates your pelvic floor muscles and use it at home. This treatment isn't suitable for everyone, so always ask for advice from your nurse or doctor.

Medicines

Your doctor may prescribe medicines to treat your overactive bladder, urge incontinence or mixed incontinence if bladder training hasn't worked.

These work by making your bladder muscles less likely to contract involuntarily (when you don't mean them to). Some examples of these medicines are oxybutynin (eg Cystrin), tolterodine (eg Detrusitol) and duloxetine (eg Yentreve). There are some common but usually mild side-effects, which can include dry mouth, constipation, blurred vision and drowsiness.

Hormone replacement therapy (HRT) may be useful if you have been through the menopause and have an overactive bladder.

Surgery

If you have stress incontinence and other treatments haven't been effective, your doctor may recommend surgery to support your bladder neck and urethra.

There are several different surgical procedures - your doctor will explain the options with you.

Further information

The Cystitis and Overactive Bladder Foundation
01908 569169
www.cobfoundation.org
The Continence Foundation
0845 3450165
www.continence-foundation.org.uk
Incontact
0870 770 3246
www.incontact.org