Around 3 million people in the UK regularly experience urinary incontinence and have to struggle with the discomfort it can cause.
Dr Rhianna McClymont, Lead GP at Livi, explains how common bladder problems in women are and how easy some can be to treat – or in most cases, see a significant improvement from treatment.
‘We know that as many as 1 in 5 women over the age of 40 have some kind of urinary incontinence, but unfortunately many do not ask for help - possibly due to embarrassment,’ says Dr Rhianna McClymont.
‘Treatment will depend on the type of female incontinence – from simple lifestyle changes, daily exercises to medication – and so it’s a good idea to speak to a GP about your symptoms as soon as you can.’
Who can get urinary incontinence?
While this is a medical condition that can affect anyone, leaking urine and dribbling after urination is much more common in women, mostly because of the physical effects of childbirth and the menopause.
In the UK, 3 million women have regular incontinence – which is about 4 in 10 women. Over half of cases involving bladder control for women are linked to stress incontinence. The second most common type is urge incontinence.
Other less common forms of incontinence include overflow incontinence, when you're unable to fully empty your bladder (this causes dribbling after urination), and total incontinence – when your bladder cannot store any urine at all (this also causes frequent leaking).
What is stress incontinence?
Stress incontinence means you experience a leaking of pee from physical pressure on your bladder, and this could happen from sneezing, coughing or exercise. It usually happens when your pelvic floor muscles become weaker (the muscles you need to support and control your bladder).
1 in 4 women experience a level of stress incontinence at some point in their life, but incontinence in women tends to be more common with age.
What is urge incontinence?
Urge incontinence is slightly different, and means that you have a much more sudden urge to pee, and feel like you’re not able to wait to use the toilet. If you find that you’re leaking urine before getting to the toilet when you have the urgency, this is a symptom of urge incontinence.
If you regularly experience urge incontinence, you’re likely to pee more often than normal. This is known as urinary frequency and can make you need to pee several times during the night as well as during the day. Some women may find that they’re leaking urine during sex too.
What’s the main cause of stress incontinence?
‘Most of the time, stress incontinence is a result of weakened pelvic floor muscles. And this cause of leaking urine is most commonly found in women after childbirth,’ explains Dr Rhianna McClymont.
‘The pelvic floor muscles wrap around the bladder and rectum, and naturally become weaker if a woman has had one or more vaginal deliveries.’
As well as childbirth, pelvic floor muscles weaken with age, especially after the menopause. Other risk factors include obesity, chronic constipation and certain treatments for prostate cancer in men.
How to treat stress incontinence
The most popular and effective stress incontinence treatment is exercises to strengthen the pelvic floor muscles. Around 6 in 10 people with stress incontinence can be completely cured or see a big improvement from this treatment.
Simple lifestyle changes are usually recommended before considering medication or surgery. These are some of Dr McClymont’s top recommendations.
Maintain a healthy weight - if you’re overweight or obese, losing a modest amount of weight can make a huge difference to urinary incontinence (even just 5% of your body weight.
Cut down or quit smoking - as this is a habit that can cause you to cough more, it will inevitably make your incontinence symptoms worse.
Referral to a local urinary continence service - they can give tailored advice on treatments and pelvic floor exercises. And if you’re not seeing any improvement, they can give lots of advice on how to make your life easier and less stressful (supplying aids like incontinence pads).
Adaptations for your home- it’s important to make it as easy as possible to get to the toilet quickly, especially if you’re less mobile. There are plenty of adaptations available like a handrail or a raised toilet seat that can help with incontinence, or even considering a commode in your bedroom for the middle of the night.
What’s the main cause of urge incontinence?
‘This type of incontinence happens when the bladder muscle becomes overactive, and squeezes out urine when you don't want it to. Doctors may refer to the condition as overactive bladder syndrome,’ says Dr McClymont.
Our bladder muscle should stay relaxed as it gradually fills up – and then when it’s about half full, you’ll start feeling the urge to pee. For people with urge incontinence, the bladder muscle sends a message to the brain that it’s full too early. And so the bladder starts contracting too early, which makes you feel like you need to pee urgently.
The actual cause of an overactive bladder is unknown, but can get worse with stress or after the menopause due to hormonal changes. There are also several common triggers like caffeine and alcohol. Less common causes of urge incontinence include nerve problems from brain damage or disease, or excessive bladder irritation that can develop after a severe urinary tract infection (UTI).
Treating urge incontinence
Like with other types of urinary incontinence, a doctor will recommend similar lifestyle measures and pelvic floor exercises. If these don’t seem to help, they may suggest other options:
Bladder retraining – a technique designed to help you hold more urine for longer periods of time (by gradually increasing the time between each visit to the loo), that’s shown to work well in around half of people with urge incontinence.
Medication – often prescribed with bladder retraining to be more effective.
Surgery – rarely used to treat urge incontinence, and as a last resort.
10 ways to prevent a leaky bladder
Here are ten expert tips to start with to reduce the risk of peeing when we don’t mean to.
- Practise daily pelvic floor exercises
- Give up smoking
- Empty your bladder before any strenuous exercise
- Avoid lifting heavy objects
- Maintain a healthy weight
- Treat constipation promptly
- Cut down on caffeine
- Cut down on alcohol
- Drink plenty of water
- Eat the right foods including lots of fibre
When to speak to a doctor
It’s important to speak to a GP about any type of urinary incontinence, even if you’ve not had the symptoms for very long.
‘GP’s regularly speak to people with urinary incontinence, and there are lots of things you can do to see an improvement. Try not to feel embarrassed about speaking to a doctor about your incontinence symptoms, as this is the first step to finding a way to manage the problem,’ reassures Dr Rhianna McClymont.
Female incontinence or other bladder problems in women can usually be diagnosed after a consultation with a GP discussing your symptoms. If the symptoms are unclear, they may need to do a pelvic or rectal examination.
A GP might suggest keeping a ‘bladder diary’ - making a note of how much fluid you’re drinking and how often you’re needing to pee. This can help to spot whether the symptoms have got any better or worse too.