Urinary incontinence

Overview

Urinary incontinence affects an estimated 1:4 women during their lifetime. In older women it may be one of the main reasons for leaving independent living.

There are a number of different ‘types’ of incontinence, but the main two are known as ‘stress’ and ‘urge’ incontinence.

Stress urinary incontinence (SUI) is characterised by leakage with coughing, sneezing, laughing or exercise. The amount often depends on how much is in the bladder.

Urge urinary incontinence (UUI) is preceded by a sudden need to pass urine that cannot be controlled. If the bladder is full, this can lead to a big and embarrassing leak. This can be especially bothersome as it may be quite unpredictable.

Post-menopausal incontinence Many women with incontinence after menopause have a combination of both UUI and SUI, and this can also be in combination with prolapse and other issues. Therefore the management can be complex, but some improvements can be found for most women.

Possible causes

Stress urinary incontinence often occurs during and immediately after pregnancy; many will improve in the first few months after having a baby, but not all.

Exactly what occurs during vaginal delivery isn’t entirely clear but there may be damage to fine supporting ligaments and areas of muscle that support the urethra (the tube that drains urine from the bladder to the outside) and the back of the pubic bone.

Urge urinary incontinence occurs when the muscle wall of the bladder squeezes when it shouldn’t, and the pelvic floor is unable to react in time to prevent urine leaking out.

Some women have what is known as an ‘overactive’ bladder. In this situation, you need to go more often, go at night, and need to rush to get to the toilet. This can sometimes be associated with leakage.

UUI symptoms can sometimes be caused by infection or prolapse and we investigate these as possible causes.

Infection It is important to make sure there are no signs of infection, or rarely cancer of the bladder, before starting any treatment for an overactive bladder.

Prolapse Occasionally UUI symptoms can be found with a prolapse of the bladder, although just fixing the prolapse may not cure the symptoms and non-surgical approaches should be tried first.

What to do

Luckily there are a number of relatively simple strategies that can make a difference, and for some women, simple surgical procedures can be performed with an excellent chance of making a big difference.

If you are suffering from urinary incontinence you can be sure that you are not alone in this, and that there are a variety of treatments with a good chance of making a difference.

How we can help

If you are experiencing urinary incontinence and would like to talk to us about how we can help, please feel free to contact us. You can also request an appointment online.

Further reading

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Further information

Conditions

Infection

An infection is the invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection is a cause that is always considered in women with abnormal bleeding. Find out more

Prolapse

Prolapse occurs when the walls of the vagina lose support. This can cause the organs and spaces around the vagina to bulge downwards. The symptoms or complaints that an individual might have in this situation vary widely. Find out more

Stress urinary incontinence

Stress urinary incontinence (SUI) is characterised by leakage with coughing, sneezing, laughing or exercise. The amount often depends on how much is in the bladder. Find out more

Urge urinary incontinence

Urge urinary incontinence (UUI) is preceded by a sudden need to pass urine that cannot be controlled. If the bladder is full, this can lead to a big and embarrassing leak. This can be especially bothersome as it may be quite unpredictable. Find out more

Procedures

Treatment for infections

If an infection is the cause, treatment with antibiotics is required. This is generally given orally, but if an infection is severe, antibiotics given intravenously may be required.

Hysterectomy

A hysterectomy is when a woman's uterus is removed. This may be because methods to stop heavy bleeding are not successful, side effects of medications are intolerable, fibroids are problematic or endometriosis is severe enough that a more permanent solution is required. Find out more

Prolapse treatments

A variety of different procedures can be done to correct prolapse. These include vaginal surgeries using long lasting dissolving stitches to provide support. Permanent stitches and sometimes hysterectomy may also be required. Laparoscopic surgeries can also be done, including sometimes a laparoscopic mesh repair. Find out more

Incontinence surgery

This is surgery performed to re-create support of the urethra, and involves placement of a mesh tape (‘sling’) that sits between the urethra and the vagina. The procedure is coupled with a cystoscopy, where we look in the bladder to ensure there has been no damage during the surgery. Find out more

Treatment for urge incontinence

The treatment usually involves identifying any triggers, providing estrogen if past menopause, and physiotherapy to strengthen the pelvic floor muscles and resist the urge to go so often. Some women also use medications that help to reduce the number of spasm episodes.