Urinary incontinence in women

Urinary incontinence is when you pee by accident. You may find it can happen when doing exercise like running, or jumping on a trampoline. If this is something that happens to you, you are not alone.

Although it's common, it shouldn't be thought of as normal. There are things you can do to reduce the chance of this happening and improve your symptoms.

Prevention

You shouldn't wait for symptoms to start. There are things you can do that may help reduce the chance of urinary incontinence in the future.

Do

strengthen you pelvic floor muscles with simple pelvic floor exercises
stay active
maintain a healthy weight
avoid or cut down on alcohol and caffeinated drinks, such as coffee, tea and some fizzy drinks

How to exercise your pelvic floor muscles

Types of urinary incontinence

The 2 most common types of urinary incontinence are:

stress incontinence – when urine leaks out when your bladder is under pressure (when you laugh, cough, sneeze, are heavy lifting or exercising)
urge incontinence – when you feel a sudden and very intense need to pass urine and are unable to stop it

You may experience both types of incontinence.

Certain things can increase the chances of urinary incontinence developing, including:

pregnancy and vaginal birth
being overweight
a family history of incontinence
getting older – but incontinence isn't an inevitable part of ageing

When to speak to your GP practice

Urinary incontinence is a common problem, estimated to affect 1 in 3 people in their lifetime.

Non-urgent advice: Speak to your GP practice if:

you have any symptoms of urinary incontinence

Your GP will ask you some questions to understand what may be causing the incontinence and how bad it is.

They may ask you:

whether you leak when you cough or laugh or sneeze or exercise
whether you need the toilet a lot both in the day and during the night
whether you have difficulty passing urine when you do go to the toilet
how much fluid like water or juice, alcohol and caffeine you are drinking
about any medications you may be taking

Diagnosis

Your doctor may firstly look to rule out other things that could be causing your symptoms, such as a urinary tract infection. Depending on your symptoms they may refer you to a specialist, usually a physiotherapist.

Your doctor, nurse or physiotherapist might suggest that you keep a bladder diary.

They'll tell you how to keep a bladder diary and the information that they would like you to provide. This will give them more information about it's affecting your day to day life and what your best treatment options might be.

Your doctor may also undertake a pelvic examination. This may involve an internal examination to check your womb (uterus) and pelvis as well as your tummy (abdomen). As this is an intimate examination, the doctor may have another person (chaperone) present. You can ask for a female doctor if you prefer. If there isn’t a female doctor available, you can ask if there’s another female health professional who can carry out the examination. The internal examination is similar to a smear test and should only take a few minutes.

In some cases of incontinence, your doctor may find that you have a prolapse. They'll explain this to you at the time. The doctor may also ask you to squeeze during an internal examination so that they can check your pelvic floor muscles.

Treatment

Treatments which do not involve taking medication or having surgery are usually tried first.

Pelvic floor muscle training

Your doctor may refer you to a specialist, usually a physiotherapist, to start a programme of pelvic floor muscle training.

Your doctor may refer you to a specialist, usually a physiotherapist, to start a programme of pelvic floor muscle training. They'll assess your pelvic floor muscles and give you a programme of exercises that is specific to your needs. They'll help you to make sure you understand how to do the exercises correctly.

Bladder training

Bladder training is used in cases of urge incontinence. Bladder training involves learning techniques to increase the length of time between feeling the need to go to the toilet and peeing. A course of bladder training will usually last for at least 6 weeks, but often takes longer.

Lifestyle changes

Your doctor or healthcare professional may suggest that you make some changes to your lifestyle. For example:

reducing your caffeine intake (caffeine can increase the amount of urine your body produces – it's found in tea, coffee and some fizzy drinks like cola)
changing how much you drink (drinking too much or too little can make incontinence worse)
maintaining a healthy weight

Incontinence products

Incontinence products (like pads) aren’t a treatment for urinary incontinence. However, you might find them helpful day-to-day while you are waiting for assessment or for a treatment to take effect.

These products might help you feel more confident during everyday activities such as socialising or exercising.

Incontinence products t prevent leakage include:

absorbent pads or pants
devices that are placed into your vagina or urethra (the tube which carries urine from your bladder out of your body)

If these types of treatments don’t work for you, your healthcare professional may suggest trying other treatments such as medication or surgery. This will depend on the cause and type of incontinence you are experiencing.

Medication for urge incontinence

If bladder training isn't effective in treating your urge incontinence, your doctor may prescribe medication.

These medications are usually taken orally, but sometimes a patch which you place on your skin is also available. There are different medications available and your doctor will help you to find the one which works best for you.

Surgery

If other treatments have been unsuitable or unsuccessful in treating your incontinence, your doctor may discuss surgery with you.

It's ok to ask any questions about your care to help you get the information you might need.

Surgery for stress incontinence: urethral bulking agents

A urethral bulking agent is a substance that can be injected into the walls of the urethra. This increases the size of the urethral walls and allows the urethra to stay closed, preventing unwanted leakage.

A variety of different bulking agents are available. This a less invasive treatment as it doesn’t usually require any cuts. Instead, the injections are usually given through a cystoscope (thin viewing tube) directly into the urethra.

Surgery for urge incontinence: sacral nerve stimulation

The sacral nerves are located at the bottom of your back. They carry signals from your brain to some of the muscles you use when going to the toilet, such as the detrusor muscle that surrounds the bladder.

If your incontinence is the result of your detrusor muscle contracting too often, sacral nerve stimulation may be recommended to help stop this from happening.

Botox injections

Botox is not currently licensed to treat urge incontinence so it's important that you're fully informed of the risks before proceeding with this treatment. Botox can be injected into the sides of your bladder to treat urge incontinence. These work by helping you to relax your bladder. The long term effects of this treatment are not yet known.