Incontinence is the involuntary passing of urine and can cause considerable social discomfort, as well as personal hygiene problems. It is a common problem, which affects women more often than men. Some people are too embarrassed to seek help – don’t be: it is a treatable condition.

There are two main types of incontinence: urge incontinence and stress incontinence. Immobility, unfamiliar surroundings and faecal impaction (as a result of chronic constipation) can also lead to incontinence. In men, an enlarged prostate may lead to urine retention, which can cause some leakage or ‘dribbling’ of urine.

Urge incontinence

Urge incontinence is when a person experiences an urgent desire to pass water, followed by some leakage of urine. It is due to the inappropriate contraction of the bladder muscles. You may be unable to make it to the toilet and the urine may leak at unexpected times, including during sleep.

Urge incontinence can occur after spinal cord trauma, with spinal cord disorders or as a result of nervous system conditions such as multiple sclerosis. It can also occur with stroke and Alzheimer’s disease.

Stress incontinence

Stress incontinence is the leakage of urine in response to any physical activity that raises the pressure inside the abdomen, e.g. sneezing, coughing laughing, bending down and even walking. It occurs when either the sphincter or the pelvic muscles that support your bladder become weakened. The sphincter is the muscle surrounding the urethra, which is the tube that carries the urine from the bladder to the outside.

Stress incontinence can develop after pregnancy, childbirth and during the menopause. The physical changes that occur during the menopause (especially atrophic vaginitis orthinning of the skin of the vagina) mean that it is more common in this age group than in younger women. Obesity may worsen symptoms of stress incontinence.
Sometimes both stress and urge incontinence can exist together. This is known as mixed incontinence.

How is it diagnosed?

Your doctor will take a full medical history and perform a physical examination, which may include an examination of the nervous system. He/she will ask questions about how and when you pass urine, what brings it on, how many pads are needed, and the number of changes of underwear required.

A pelvic examination will be performed to check for prolapse of the womb (this gives a sensation of ‘something coming down’) and atrophic vaginitis.

You may be asked to keep a record of how many times you pass urine and how much urine you pass. Blood samples may be taken to check for the presence of diabetes and to check the kidney function. A urine sample may be checked for a urinary tract infection.

Urodynamics is a test that checks the pressure in the bladder and the flow rate of urine. The amount of urine left in the bladder after emptying it is also measured. Occasionally an ultrasound of the bladder and kidneys may be done or your doctor may recommend a cystoscopy, which involves the insertion of a camera into the urethra to get a picture of the bladder.

Is it treatable?

Mild symptoms from whatever cause may be managed with incontinence pads or by changing underwear during the day.

Restricting fluid intake, particularly caffeine, after 6pm may help. In elderly people a commode may maximise access to a toilet.

A pessary ring is a device that can be inserted into the vagina to treat womb prolapse, and oestrogen creams can help to treat atrophic vaginitis.

Management of stress incontinence

• Pelvic floor exercises are very important in treating this condition, as they allow the person to voluntarily contract their pelvic floor muscles. Vaginal cones may also be used to strengthen the pelvic muscles.

• Injection of bulking agents such as collagen, silicone and teflon into the area around the urethra can be done under local anaesthetic. Weight loss may also help if you are overweight.

• Surgery may be indicated when simpler treatment options fail. Surgery pulls the bladder base up to its normal position and prevents its descent during increases in intra-abdominal pressure. This can be done with an incision either through the abdomen or the vagina. After surgery, unnecessary heavy lifting or abnormal straining should be avoided for a while.

Management of urge incontinence

• ‘Bladder drill’ is where you are only allowed to empty your bladder after increasingly long intervals of time, starting at half hourly intervals and increasing by half hourly increments each day.

• Drugs, e.g. oxybutynin, may be prescribed which help to inhibit the bladder’s ability to contract. Side effects include dry mouth, blurred vision, drowsiness and flushing.

• If your symptoms are very severe, an operation may be required.