Urinary Incontinence
Urinary incontinence can be upsetting and inconvenient. In some cases, it can have a serious impact on your quality of life and make it hard to get out and enjoy yourself. There are lots of reasons you may pass urine accidentally. Some people are born with the condition while others develop it after childbirth or because of a blockage in the bladder. Either way, we can help. Our friendly team can recommend prescription-only medication that can stabilise and relax your muscles, giving you greater control over your bladder and making it easier to live your life to the fullest.
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Advice for Urinary Incontinence
What is Incontinence & what causes it?
- Obesity
- Pregnancy and vaginal birth
- Family history
- Increased age
What are the symptoms of Incontinence?
The symptoms of urinary incontinence will vary depending on what type of urinary incontinence is present. Approximately nine in every ten sufferers will have either stress incontinence or urge incontinence.
Stress incontinence does not relate to the mental state of feeling stressed. Stress incontinence is caused by pressure being exerted on the bladder. This can happen when you cough, sneeze or laugh. It can also occur during exercise or heavy lifting. Usually, the amount of urine passed is small, but sometimes larger amounts can leak through, especially if the bladder is full.
Urge incontinence is sometimes referred to as urgency incontinence. Typical symptoms include an intense sudden urge to pass urine, leaving the sufferer only a few seconds between urge and urination. Urge incontinence can be triggered by varying factors, such as the sound of running water, a sudden change in position or even during sex, particularly at the point of orgasm. Urge incontinence often occurs where Overactive Bladder Syndrome (OAB) is present. This condition is caused by the bladder muscle being more active than normal. As well as urge incontinence, OAB can cause the sufferer to pass urine more frequently, sometimes resulting in the sufferer having to get up many times in a single night to pass water.
Other forms of urinary incontinence include:
Mixed incontinence: This form includes symptoms of both stress and urge incontinence.
Overflow incontinence: Sometimes called Chronic Urinary Retention. This is when the bladder is unable to fully empty during urination, causing the bladder to swell. This results in frequent passing of small trickles of urine. There is usually an accompanying feeling of the bladder not being completely empty, regardless of how often you attempt to urinate.
Total incontinence: This form of incontinence presents as severe and continuous passing of urine, even at night. Alternatively, total incontinence can involve large amounts of urine being passed occasionally with small amounts being leaked in between.
How is Incontinence diagnosed?
It is important not to feel embarrassed about any form of incontinence.Urinary incontinence is a very common problem and one your GP would have encountered on many occasions.
To achieve a professional diagnosis, your GP will usually begin by asking you some questions about your symptoms and medical history. These may include:
- Does the urinary incontinence happen when you cough or laugh?
- Do you require frequent trips to the toilet both day and night?
- Is there any difficulty passing urine when you go to the toilet?
- Are you currently taking any medications?
- How much fluid, caffeine or alcohol do you drink?
Your doctor then may suggest that you keep a bladder diary. The intention being to track your bladder habits for at least three days. This will provide your GP with as much information about your condition as possible. A bladder diary will usually include information regarding:
- How much fluid you intake.
- What types of fluid you drink.
- How frequently you need to pass water.
- How much urine you pass.
- The number of occasions you feel an urgent need to go to the toilet
- The number of incontinence episodes you suffer.
A thorough diagnosis may include tests and/or examinations. This is so your doctor can rule out or confirm any underlying conditions that may be causing the incontinence. These can include; physical examinations, dipstick tests, residual urine tests, cystoscopy tests and urodynamic tests.
How can I treat Incontinence?
Before resorting to medication, lifestyle changes may first be recommended. This may involve reducing your fluid and caffeine intake. If you are overweight or obese then weight loss is an advised lifestyle change that can help reduce the occurrences of urinary incontinence.
Pelvic floor muscle training is a recommended exercise, designed to strengthen the muscles that control the flow of urine. Bladder training may also be combined with pelvic floor muscle training. Bladder training involves learning techniques that prolong the length of time between feeling the urge to urinate and passing water. This training is usually attempted for at least six weeks.
If these forms of treatment have proved unsuccessful then medication or surgery may be considered.
Stress Incontinence is usually treated with a medication called Duloxetine. This helps to build the muscle tone of the urethra, which should help to keep it closed. Duloxetine is taken twice daily and the effects are usually assessed after one month. Duloxetine is not suitable for everyone, it will be up to your GP to assess your medical history in order to determine whether Duloxetine is safe and potentially beneficial.
Urge Incontinence is normally treated with an Antimuscarinics. This medication is also effective at treating Overactive Bladder Syndrome. The most popular Antimuscarinics used to treat urge incontinence are; Oxybutynin, Tolterodine and Darifenacin. They are usually taken two or three times a day, orally. They work by reducing intestinal motility. Should Antimuscarinics prove ineffective or unsuitable then a medication called Mirabegron may be suggested. Mirabegron relaxes the bladder muscle, allowing it to fill with ease. It is usually taken orally, once daily.
How can I prevent Incontinence?
There are steps a person can take that will help prevent urinary incontinence. A healthy lifestyle can reduce the risk of the condition developing.
- Maintaining a healthy weight through a good diet and regular exercise can significantly reduce the risk of developing urinary incontinence.
- Depending on the type of bladder problem, your doctor may advise you on the amount of liquid you drink. If you need to urinate frequently during the night then a reduction of the liquid consumed before bed can be reduced. However, it is important to ensure you are drinking enough fluids during the day.
- The type of liquid is an important factor. Urinary incontinence can be adversely affected by alcohol and caffeine. These can cause the kidneys to produce excess urine that can irritate your bladder. Reducing the amount of alcohol and caffeine consumed can act as an effective preventative measure.
- Pelvic floor exercises will act to strengthen the pelvic floor muscles, which will provide a greater control over the flow of urine from your bladder. A good pelvic floor exercise programme should involve doing a minimum of eight muscle contract ions at least three times a day. This exercise should be continued for at least three months. If they are proving beneficial then it is recommended to continue performing them.
- Bladder training is another preventative exercise that involves increasing the length of time between feeling the urge to urinate and passing urine. A bladder training course will usually last for a minimum of six weeks.
Though not a preventative measure, urinary incontinence products are very useful for helping to manage the condition. Products available range from; absorbent pads/pants, hand-held urinals, catheters and other devices that are placed into the vagina or urethra to help prevent any leakage.
Alternatives
Non-medicinal alternatives for Urinary Incontinence
There are some non-medicinal alternatives you can try before going down the route of medication. These include;
- Lifestyle changes such as reducing fluid and caffeine intake. If you are overweight or obese then it is advisable to lose weight which will reduce occurrence's of urinary incontinence.
- There are also exercises you can try like pelvic floor muscle training.This exercise is designed to strengthen the muscles that control the flow of urine. This be can also be combined with bladder training. Bladder training involves learning techniques that can prolong the length of time between feeling the urge to urinate and passing water. The training itself is usually attempted for around 6 weeks.
Urinary Incontinence FAQs
Urinary incontinence is a condition whereby urine involuntarily leaks out from the bladder. It can occur either in short episodes or long-term. Some people with incontinence will have to make changes to their lifestyle, so it can have a significant impact on daily life.
Bladder control problems are very common, especially in women. In most cases, it can be treated effectively. It affects women of all ages but is most prevalent in those who have reached menopause. It will often affect young women who are pregnant or have recently given birth. In some cases, it will not develop until a woman is over the age of 70.
Apart from gender and age, there are a number of other risk factors for urinary incontinence. One is family history. You will tend to have a higher risk of incontinence if people in your immediate family have also had bladder problems.
Incontinence is also connected to a group of medical symptoms called lower urinary tract symptoms (LUTS). These become more common with age and tend to affect older men more than older women. In men, LUTS can sometimes occur due to problems with the prostate, though this is not necessarily the case.
The bladder is controlled by a muscle called the detrusor and supported by the pelvic floor. To release urine from the urethra, the detrusor contracts, and the pelvic floor relaxes. This normally occurs voluntarily, and only when the bladder is nearly full.
Incontinence occurs when the detrusor contracts earlier than normal. This results in an urge to urinate, even though the bladder is not full.
Stress incontinence occurs when there is a sudden increase in the pressure on the muscles around the bladder. Normally, the pelvic floor prevents the leakage of urine by supporting both the bladder and the urethra. A lack of urethral support can cause urine to leak, as can a weakness in the urethral wall itself. Obesity, menopause, and pregnancy can all weaken these muscles. Muscle or tissue weakness due to these conditions is called ‘genuine stress incontinence’.
Less frequently, a small amount of urine may leak when there is sudden pressure on pelvic muscles from activities such as heavy lifting, coughing, laughing or sneezing. Although this usually only causes a small leakage, a bigger amount of urine may leak if the bladder is nearly full.
Urge incontinence is caused by uncontrollable spasms in the detrusor muscle which is located in the bladder. These involuntary contractions cause the bladder to empty, usually without warning.
In many cases, stress and urge incontinence will result in similar symptoms. So, it may be difficult at first to identify what is causing your incontinence.
Generally, urge incontinence is leakage that follows a sudden desperate need to pass urine – this can happen during the day or at night. It can involve a large amount of urine. Stress incontinence involves only a small amount of urine and tends not to occur at night. However, because severe stress incontinence can resemble the symptoms of urge incontinence, they are difficult to conclusively identify based on symptoms alone.
A ‘cough test’ might help you to see whether pressure such as coughing causes leakage. Again, however, this will not be conclusive.
If your incontinence persists following some basic treatments, your GP might recommend further tests to identify the nature and cause of the incontinence. This can include an ultrasound of the bladder or the creation of a frequency/volume chart. You might also be advised to have a urodynamics test – this involves small instruments being placed in the bladder and the rectum in order to measure the pressure in each.
In many cases, incontinence is a sudden condition which resolves itself after a short while. There are a number of possible causes of temporary incontinence, such as:
- Pregnancy
- Prostate problems
- Medications, including antidepressants, diuretics, tranquilizers and antihistamines
- Constipation and other bowel problems
- Sudden weight gain
- Urinary tract inflammation or infection
- Bedrest
Stress incontinence occurs due to a weak pelvic floor, which can come about due to obesity. Consider losing weight if you think it might be partially causing your incontinence.
Otherwise, there are a number of exercises that can help build up the strength of the pelvic floor. These need to be done regularly and correctly to remain effective. Some aids, such as biofeedback machines, are available to enhance these exercises. Research these exercise and aids thoroughly, and consider seeing a physiotherapist for further assistance.
Women with urge incontinence may be prescribed medications such as:
- Detrusitol (tolterodine)
- Lyrinel (oxybutynin)
- Regurin (trospium)
- Propiverine
- Solifenacin
Each of these medications will be most effective if you also reduce your alcohol and caffeine consumption. Side effects may include dry mouth or constipation.
There are three types of operation that can enhance urethral support and hence treat incontinence. They may improve symptoms of incontinence, but each may cause complications. It is important that you thoroughly consult your GP before pursuing surgery.
The most popular involves surgically implanting transobturator tape, a thin strip of synthetic material, to cradle the urethra and remove pressure.
The more traditional method for women is Burch colposuspsions, a procedure whereby stitches are inserted near the neck of the bladder to provide support and ensure that it remains closed under pressure.
Finally, there are some procedures that involve injections which increase the strength of the urethral wall.
Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.