Urinary incontinence
Urinary incontinence means urine leaking when you do not want it to. It is common enough to affect millions of people and awkward enough that, on average…
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On this page
- Two main types, and why it is the doctor's first question
- When it is not just incontinence
- What happens at the appointment
- Pelvic floor exercises: technique matters more than effort
- Urge incontinence: bladder training and what to drink
- What else makes a difference: weight, bowels, medicines
- When medicines and surgery are added
- Online consultation
Medicines commonly prescribed for Urinary incontinence
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORALLY DISINTEGRATING TABLET/LIOTAB, 10 mgActive substance: vardenafilManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 5 mgActive substance: solifenacinManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: solifenacinManufacturer: Laboratorios Q Pharma S.L.Prescription required
Urinary incontinence means urine leaking when you do not want it to. It is common enough to affect millions of people and awkward enough that, on average, several years pass between the first episode and the first appointment. All that time is spent buying pads, giving up running, turning down trips and checking where the toilets are on the way in. It is worth saying plainly: incontinence is not an inevitable part of getting older and not the price of having children. It is treatable, and most people either get rid of it or reduce it to a minor nuisance. But you do not start with pads, you start with an assessment, because what helps depends on the type of incontinence, and there is more than one.
Two main types, and why it is the doctor's first question
Almost all incontinence falls into two forms, and the difference between them decides everything that follows.
- Stress incontinence: urine leaks at the moment pressure on the bladder rises suddenly — coughing, sneezing, laughing, lifting, running, jumping, sometimes simply standing up from a chair. "Stress" here means physical load, not nerves. The amount is usually small but comes at the worst moment. Behind it are weakened or damaged pelvic floor muscles and urethral sphincter: after childbirth, after surgery on the womb or prostate, with extra weight, with a chronic cough, around the menopause.
- Urge incontinence: a sudden, overwhelming need to pass urine, with only seconds between the urge and the leak. It is often set off by a trigger — running water, cold air, the key in the front door. It usually forms part of overactive bladder, where the bladder muscle contracts on its own, and then frequent trips to the toilet, including at night, are added to it.
The mixed pattern is the commonest of all: both are present and one predominates. Separate from these is overflow incontinence, where the bladder never empties completely, becomes stretched and dribbles constantly; it feels as though you have not finished, the stream is weak and you have to strain. This is not a small matter — a permanently full bladder puts the kidneys at risk, and it needs a doctor rather than exercises.
When it is not just incontinence
Usually there is no rush and the appointment can be planned calmly. But some situations will not wait.
- Blood in the urine, even once, even without pain. Painless blood in the urine always needs investigating: it can be the first sign of a bladder or kidney tumour.
- Pain on passing urine, a temperature, loin pain: that points to infection rather than weak muscles. In an older person, incontinence that suddenly gets worse alongside confusion can be the only sign of a urinary tract infection.
- Incontinence that starts abruptly along with neurological symptoms — weakness, numbness, an unsteady walk, double or blurred vision. This needs looking into quickly: that is sometimes how conditions of the nervous system begin.
- Retention with dribbling. If you cannot pass urine properly yet your underwear is constantly damp, this is most likely overflow and you need a doctor the same day. Being completely unable to pass urine with a painfully full bladder is an emergency: the bladder has to be drained with a catheter.
- Numbness of the perineum and inner thighs, weakness in the legs, loss of bowel control — this one is an ambulance, 112 across Europe, straight away and with no "I will see how it is in the morning". That combination means the nerves at the bottom of the spinal cord are being compressed, and recovery depends on how fast the person reaches theatre.
What happens at the appointment
Nothing to be embarrassed about: doctors hear this every day. The questions are simple ones — exactly when it leaks, whether you make it to the toilet in time, how many times you get up at night, what and how much you drink, what medicines you take, whether you have had children or operations.
Next you will usually be asked to keep a bladder diary for three days: what and how much you drank, when and how much you passed, how many leaks there were and what came before them. Filling it in is tedious, but it is what most often makes the diagnosis — the diary shows at a glance whether this is stress or urge incontinence, and whether two litres of coffee a day are going in.
The examination is short: in women a pelvic examination, to look for prolapse of the vaginal walls and assess how the pelvic floor works; in men an examination of the prostate through the back passage. Urine is always tested, to rule out infection, blood and sugar. If incomplete emptying is suspected, an ultrasound scan after passing urine measures what is left behind: painless and over in a minute. Urodynamic testing and cystoscopy are not for everyone — they are arranged if simple treatment has not worked or the picture is unclear.
Pelvic floor exercises: technique matters more than effort
These are the foundation of treatment for stress and mixed incontinence and they work for most people, on two conditions: done correctly and done for long enough. Done wrongly they achieve nothing, and that is where people give up.
The muscles you want are the ones you use to hold in urine and wind. Squeeze them and check: the tummy, buttocks and thighs stay relaxed and you do not hold your breath. If you are tightening your abdomen or pressing your knees together, the wrong muscles are doing the work. Train both quick and slow squeezes: several short sharp contractions in a row, then a hold that you build up gradually from two seconds to ten. A typical programme is around eight contractions three times a day, kept up for at least three months.
Three common mistakes. The first is stopping after a fortnight because "it is not working": the first changes appear at about six weeks and the full effect after several months. The second is practising by stopping the stream on the toilet; as a one-off check that is fine, as a habit it is not, because the bladder learns not to empty fully. The third is doing it blind. If nothing changes after a month, or you are not sure you can feel those muscles at all, ask to be referred to a pelvic floor physiotherapist, who will confirm that the right muscle is contracting and set the programme. For people who feel no contraction whatsoever, biofeedback devices and electrical stimulation help.
Urge incontinence: bladder training and what to drink
Exercises help here too, but the main treatment is different: bladder training. The idea is to stretch out the gap between feeling the urge and going, a little at a time. The programme runs for at least six weeks. When the urge comes, do not run: stop, squeeze the pelvic floor quickly several times, distract yourself and wait for the wave to pass, then walk there calmly. Going "just in case" does the opposite of good: the bladder gets used to small volumes and starts asking more often.
Caffeine and alcohol make urgency worse, and this is the easiest thing to change today. Coffee has the biggest effect, but there is caffeine in tea, including green tea, in cola and in energy drinks. Many people also notice fizzy drinks, sweeteners and spicy or acidic food. Take things out one at a time and use the diary to see which one is yours.
What you must not do is cut fluids sharply. It is the first thing people try on their own and it is a mistake that makes things worse. Concentrated urine irritates the bladder more, so urgency becomes more frequent, not less; and it brings on constipation, which worsens incontinence in its own right. Drink normally, roughly six to eight glasses a day unless your doctor has said otherwise. If getting up at night is the problem, move most of your fluids to the first half of the day, but do not go without.
What else makes a difference: weight, bowels, medicines
- Losing weight is one of the most effective measures in stress incontinence. Abdominal fat presses on the bladder all the time; even a moderate loss noticeably reduces leaking and sometimes stops it.
- Constipation makes everything worse at once: straining stretches the pelvic floor and a loaded rectum presses on the bladder. More fibre, enough fluid, movement, never ignoring the urge to go — and a conversation with a doctor if that is not enough.
- Smoking. A smoker's chronic cough hits the pelvic floor several hundred times a day, and no amount of exercise offsets that.
- The kind of exercise. Jumping, running and traditional sit-ups are better swapped during treatment for pilates, swimming and core work. And before lifting anything heavy, tighten the pelvic floor first and lift second.
- Medicines. This is precisely what almost nobody checks on their own. Diuretics, some blood pressure drugs, sleeping tablets and sedatives, some antidepressants, and medicines with a drying effect that make the bladder harder to empty can all cause or worsen incontinence. Never stop them yourself: bring your doctor the full list, including anything bought over the counter — sometimes changing the timing or swapping to an alternative is all it takes.
- Pads and absorbent underwear are support for the time being, not treatment. Using them is sensible and convenient, but if nothing else is being done the incontinence stays for good. And use proper urology pads rather than menstrual ones: they are built differently and control odour better.
When medicines and surgery are added
If conservative treatment has not achieved enough over a few months, the next step follows, and here the two types part company completely.
For urge incontinence, drugs that relax the bladder muscle are prescribed: antimuscarinics or beta-3 agonists. They do not work instantly; the effect is reviewed after about a month. Antimuscarinics typically cause a dry mouth, constipation and blurred vision, and in older people they can worsen memory and mental clarity, so at older ages the other group is usually preferred. Women past the menopause often benefit from local oestrogen as a cream or pessary. If tablets do not suit, there are botulinum toxin injections into the bladder wall and techniques that stimulate the nerves controlling the bladder.
For stress incontinence the next step is usually surgical: sling operations, colposuspension, bulking injections and, in men after prostate surgery, an artificial sphincter. For those unsuited to or unwilling to have an operation, a medicine that increases sphincter tone is sometimes offered. Two things are worth knowing about surgery. If you are planning a pregnancy, it makes sense to postpone it: childbirth can undo the result. And the use of mesh implants is restricted in a number of countries, so ask in advance which material will be used and what the alternatives are. Keep the discharge letter naming the exact operation: you will need it if something goes wrong years later.
Online consultation
Incontinence is often easier to raise without a doctor sitting opposite you, and this is exactly the situation where an online appointment removes the main barrier. From your answers a doctor can work out whether this is stress, urge or mixed incontinence, say which tests are worth doing and go through the bladder diary with you. Do show the list of medicines you take: one of them may be the cause. Online is a good setting for checking exercise technique, building a bladder training plan, deciding which drinks to remove and judging whether it is time to talk about medication or surgery. Blood in the urine, a temperature with loin pain, being unable to pass urine and sudden incontinence with weakness or numbness need a face-to-face appointment, and an urgent one; numbness of the perineum with weak legs needs an ambulance.
This material is for information only and does not replace medical advice.
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