Urinary Incontinence

Urinary incontinence is the unintentional leakage of urine and is a common problem affecting women at different stages of life. Although bladder leakage can be embarrassing or disruptive, it is not something you simply have to put up with. There are several types of urinary incontinence, and identifying the underlying cause is an important first step towards finding the right treatment.

Urinary incontinence can affect everyday activities, exercise, work, sleep, relationships and confidence. Some women experience occasional leakage when coughing or exercising, while others may have a sudden and difficult-to-control urge to pass urine. Some women experience both types of symptoms.

At Private Gynaecology, Mr Alak Pal provides assessment and treatment for women experiencing urinary urgency, urinary incontinence and other urinary symptoms. A private consultation can help establish the nature of your symptoms, identify possible contributing factors and determine whether further investigation or treatment may be appropriate.

What is urinary incontinence?

Urinary incontinence means passing urine unintentionally. The symptoms can vary considerably between women, depending on the type of bladder problem and its underlying cause.

For some women, urine leakage happens when there is increased pressure on the bladder, such as when coughing, sneezing, laughing, lifting or exercising. This is known as stress urinary incontinence.

For others, leakage is associated with a sudden and strong urge to urinate. This is known as urge urinary incontinence or urgency incontinence. It can be difficult to reach the toilet before urine begins to leak.

Some women have symptoms of both stress and urge incontinence, known as mixed urinary incontinence. Other urinary symptoms can include increased urinary frequency, needing to get up several times during the night, difficulty emptying the bladder or feeling that the bladder has not completely emptied.

Understanding the pattern of your symptoms is important because treatment for urinary incontinence depends on the type of incontinence, its severity and any underlying conditions.

Types of urinary incontinence

Stress urinary incontinence

Stress urinary incontinence occurs when urine leaks because pressure on the bladder increases. Common triggers include coughing, sneezing, laughing, running, jumping, lifting or other forms of physical activity.

Stress incontinence can develop when the muscles and tissues supporting the bladder and urethra are not providing sufficient support. Pregnancy and childbirth can contribute to pelvic floor changes, although stress urinary incontinence can affect women who have never been pregnant or given birth.

If urine leakage is mainly associated with physical activity or pressure on the bladder, an assessment can help determine whether you have stress urinary incontinence and which treatment options may be suitable.

Urge urinary incontinence

Urge urinary incontinence involves a sudden, strong need to pass urine that is difficult to postpone. Leakage may occur before reaching the toilet.

Urge incontinence is commonly associated with overactive bladder, which can also cause urinary frequency and waking during the night to pass urine. Triggers can vary from woman to woman and may include changes in position, hearing running water or arriving home and approaching the toilet.

Treatment may include bladder training, lifestyle measures and, where appropriate, medication or other specialist treatments.

Mixed urinary incontinence

Mixed urinary incontinence occurs when a woman experiences both stress and urge symptoms. For example, you may leak urine when coughing or exercising while also experiencing sudden urges that are difficult to control.

When symptoms are mixed, treatment is generally tailored according to which symptoms are causing the greatest difficulty. NICE recommends considering appropriate non-surgical treatment for both components, including supervised pelvic floor muscle training and bladder training where indicated.

What causes urinary incontinence?

There is not one single cause of urinary incontinence. Bladder control can be affected by changes to the pelvic floor, bladder function, hormones, pregnancy and childbirth, ageing and certain medical conditions.

Pregnancy and vaginal birth can place considerable strain on the pelvic floor muscles and supporting tissues. However, urinary incontinence is not an inevitable consequence of childbirth or getting older.

Other factors can include being overweight, constipation, persistent coughing, certain medications and conditions affecting the bladder or nervous system. Urinary symptoms can also occur alongside urinary tract infections and other bladder problems.

Some women develop urinary symptoms around the time of menopause. Hormonal changes can affect the tissues of the lower urinary tract and pelvic floor, although urinary incontinence should still be assessed rather than automatically attributed to menopause.

Because there are many possible causes, an individual assessment is important when urinary leakage is persistent, troublesome or changing.

Symptoms of Urinary Incontinence

Urinary incontinence can present in different ways. Symptoms may include:

Leaking urine when coughing, sneezing or laughing
Leakage during exercise, running or lifting
A sudden and difficult-to-control urge to urinate
Urine leakage before reaching the toilet
Needing to pass urine more frequently than usual
Waking during the night to urinate
Feeling that your bladder has not completely emptied
Small amounts of urine leaking repeatedly
A combination of stress and urgency symptoms

You should not feel embarrassed about discussing these symptoms with a healthcare professional. Urinary incontinence is common, and assessment can help determine whether there is an underlying condition that needs treatment.

When Should You Seek Medical Advice?

It is sensible to seek medical advice if urinary leakage is persistent, becoming more frequent or affecting your quality of life.

You should seek prompt medical assessment if urinary symptoms are accompanied by blood in the urine, difficulty passing urine, an inability to empty the bladder or symptoms suggestive of a urinary tract infection.

Early assessment does not necessarily mean that you will need medication or surgery. In many cases, treatment begins with conservative measures designed to improve bladder control and reduce symptoms.

How Is Urinary Incontinence Diagnosed?

A consultation for urinary incontinence usually begins with a detailed discussion about your symptoms.

What May Be Discussed During Your Consultation?

You may be asked:

When the leakage occurs
How often you need to pass urine
Whether you experience urgency
Whether symptoms occur during exercise or coughing
How often you wake during the night
Whether you have difficulty emptying your bladder
Whether you have previously had pelvic surgery or childbirth
Whether you have experienced urinary tract infections
How the symptoms are affecting your daily life

Bladder Diary

A bladder diary can be useful when assessing urinary symptoms. It records information such as when and how often you pass urine, episodes of leakage, urgency and your fluid intake.

Keeping a bladder diary for several days can provide useful information about your bladder habits and help your specialist understand the pattern of your symptoms.

Further Investigations

Depending on your symptoms and medical history, further investigations may be recommended. These can help distinguish between different types of urinary problems and guide treatment.

Urinary Incontinence Treatment

The most appropriate urinary incontinence treatment depends on the type and severity of your symptoms.

Pelvic Floor Muscle Training

Pelvic floor muscle training is an important treatment for stress urinary incontinence and mixed urinary incontinence.

Pelvic floor exercises aim to strengthen and improve the function of the muscles that support the bladder, urethra and other pelvic organs. Correct technique is important, and some women benefit from assessment and supervision by a healthcare professional with specialist pelvic floor expertise.

Bladder Training

Bladder training can be particularly useful for women experiencing urgency, urinary frequency or urge urinary incontinence.

The aim is to gradually improve bladder control and increase the interval between needing to pass urine and going to the toilet.

Bladder training may be recommended as part of a structured treatment programme for women with urgency or mixed urinary incontinence.

Lifestyle Measures

Simple changes may help improve urinary symptoms. Depending on your individual circumstances, these can include reviewing caffeine intake, adjusting fluid intake if it is particularly high or low, addressing constipation and maintaining a healthy weight where appropriate.

Drinking too little can also be unhelpful, so it is important not to significantly restrict fluids without appropriate advice.

Medication and Specialist Treatment

If conservative treatment does not provide enough improvement, medication or other treatment options may be considered depending on the type of urinary symptoms.

For women with overactive bladder or urge urinary incontinence, medicines may sometimes be used when bladder training alone has not provided sufficient benefit. The choice of treatment depends on your symptoms, medical history, other medications and individual circumstances.

Some women with stress urinary incontinence may require assessment for procedural or surgical treatment if symptoms remain troublesome despite appropriate non-surgical management. The suitability of any intervention should be considered on an individual basis.

Urinary Incontinence and Pelvic Floor Problems

Urinary incontinence can sometimes occur alongside pelvic organ prolapse or other pelvic floor problems.

Pelvic organ prolapse occurs when one or more pelvic organs move downwards from their usual position. It can involve the bladder, bowel, uterus or upper vagina and may be associated with urinary symptoms.

The treatment depends on the type and severity of the prolapse and the symptoms it causes.

Urinary Symptoms and Pelvic Organ Prolapse

For this reason, a comprehensive gynaecological assessment can be useful when urinary symptoms occur alongside a sensation of pressure, vaginal bulging or other pelvic floor symptoms.

Private Urinary Incontinence Assessment

Choosing private care can allow you to discuss your symptoms directly with a specialist and explore appropriate investigations and treatment options.

Mr Alak Pal is a senior Consultant Gynaecologist at London North West
University Healthcare NHS Trust and has extensive experience in the management of urinary symptoms, including urinary urgency and incontinence.

Private Gynaecology provides consultations for women experiencing urinary problems. Patients can self-fund their appointment or use private health insurance, subject to the relevant insurance arrangements and pre-authorisation requirements.

Take the Next Step

Urinary incontinence can be frustrating, but effective treatment begins with understanding what is causing your symptoms.

Whether you experience occasional leakage when exercising, frequent urinary urgency or a combination of symptoms, an individual assessment can help identify the most appropriate next steps.

If urinary leakage is affecting your confidence, exercise, work, sleep or everyday activities, consider arranging a private consultation to discuss your symptoms and treatment options.

Book a consultation with Mr Alak Pal to discuss urinary incontinence and other urinary symptoms.

Frequently Asked Questions About Urinary Incontinence

Is Urinary Incontinence Normal for Women?

Urinary incontinence is common, but that does not mean you have to accept troublesome symptoms as an unavoidable part of ageing, pregnancy or childbirth. Different forms of urinary incontinence can often be managed with appropriate treatment.

What Is the Most Common Type of Urinary Incontinence?

Stress urinary incontinence and urge urinary incontinence are among the main types of urinary incontinence. Some women experience both, which is known as mixed urinary incontinence.

Can Urinary Incontinence Be Treated Without Surgery?

Yes. Depending on the type of incontinence, treatment may include lifestyle measures, supervised pelvic floor muscle training and bladder training. Medication or other treatments may be considered when conservative treatment does not provide enough improvement.

Can Pelvic Floor Exercises Help Urinary Leakage?

Pelvic floor muscle training is recommended as a first-line treatment for women with stress or mixed urinary incontinence. Correct technique and consistent training are important for achieving the best possible results.

What Is the Difference Between Stress and Urge Incontinence?

Stress incontinence usually causes leakage when pressure is placed on the bladder, such as during coughing, sneezing, laughing or exercise. Urge incontinence occurs when there is a sudden, strong need to urinate that is difficult to postpone and may result in leakage.

Should I See a Doctor About Urinary Leakage?

If urinary leakage is persistent or affecting your daily life, it is worth discussing it with a healthcare professional. Assessment can help establish the type of incontinence and identify appropriate treatment options.

Can Urinary Incontinence Happen After Childbirth?

Yes. Pregnancy and childbirth can affect the pelvic floor and contribute to urinary incontinence. However, urinary leakage after childbirth should not simply be accepted as something you have to live with, particularly if symptoms persist or interfere with everyday activities.

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