Urinary incontinence is any involuntary leakage of urine – from a few drops when you cough to the bladder emptying completely before you reach the toilet. The problem is far more common than people admit: it affects roughly one in three women after the menopause, and in men it most often follows prostate surgery.
Many people put up with it for years and rely on pads because they are embarrassed to talk about it. Yet incontinence is not a normal part of ageing – in most cases it responds well when its type is identified accurately and the treatment matches the cause.
What urinary incontinence is
Holding urine depends on a balance between the bladder, which stays relaxed while it fills, and the sphincter and pelvic floor muscles, which keep it closed. A problem in any part of this system leads to leakage. The main types are:
- Stress incontinence – leakage during effort that raises the pressure in the abdomen: coughing, sneezing, laughing, lifting something heavy. The cause is a weakened pelvic floor or a sphincter that does not close well enough.
- Urge incontinence – leakage after a sudden, urgent need to pass urine that cannot be held back; it is usually a sign of an overactive bladder.
- Mixed incontinence – a combination of both mechanisms, very common in women.
- Overflow incontinence – the bladder does not empty fully, becomes overfilled and urine dribbles out, often without any urge; it is typical of an enlarged prostate and of damage to the nerves that supply the bladder.
Symptoms
The circumstances in which the leakage happens point to its type:
- urine leaking when you cough, sneeze, laugh or exert yourself;
- a sudden strong urge, so that you do not make it to the toilet in time;
- passing urine often during the day and getting up several times at night;
- constant dribbling, a weak stream and a feeling that the bladder has not emptied completely.
Some signs cannot wait. If your bladder is overfull and painful and you cannot pass urine, this is acute urinary retention – go to an emergency department straight away. If leakage starts suddenly together with weakness or numbness in the legs and around the buttocks, or with loss of bowel control, call 112 (the European emergency number) – the nerves in the spinal canal may be compressed. Blood in the urine and leakage with a fever also need a prompt examination.
Causes and risk factors
In women, the main factors are pregnancy and vaginal births, which stretch the pelvic floor, and the menopause, when falling oestrogen levels make the tissues around the urethra thinner. In men, incontinence most often appears after a radical prostatectomy, less often after operations for an enlarged prostate, and the overflow type with long-standing untreated obstruction.
General risk factors are age, excess weight, chronic cough, constipation, heavy physical work, diabetes and neurological conditions – stroke, multiple sclerosis, Parkinson’s disease, spinal cord injuries. Diuretics, urinary tract infections and too much caffeine and alcohol can cause or worsen leakage.
Diagnosis
The aim of the consultation is to establish the type and the cause, because the treatment depends on them. Dr Penev starts with a detailed conversation – when and how the leakage happens, what births, operations and illnesses you have had, and what medicines you take. A three-day bladder diary recording your fluids, the times you pass urine and any episodes of leakage is very useful.
A physical examination follows – in women an assessment of the pelvic floor and a cough test, in men an examination of the prostate. A urine test rules out infection, and an ultrasound scan with measurement of the residual urine shows whether the bladder empties completely. If the stream is weak, uroflowmetry is added. Urodynamic studies and cystoscopy are needed only when the picture is unclear, when there is blood in the urine or before surgery.
Treatment
Treatment starts with the gentlest methods and is stepped up according to the result.
Changing habits. Reaching a healthy weight, treating constipation and cough, spreading fluids through the day and cutting down on caffeine and alcohol help with all types of incontinence.
Exercises and bladder training. For stress and mixed incontinence, the foundation is pelvic floor exercises done with the correct technique for at least three months. For urge incontinence, bladder training helps – gradually lengthening the intervals between visits to the toilet.
Physical methods. For suitable patients Dr Penev may also recommend magnetic stimulation of the pelvic floor – the muscles are stimulated with a pulsed magnetic field, painlessly and without undressing – as an addition to exercises for stress and mixed incontinence and after prostate surgery.
Medication. For urge incontinence, medicines that calm the bladder are used – antimuscarinics or beta-3 agonists – and for women after the menopause, local oestrogen therapy. For overflow incontinence, the underlying cause is treated.
Surgery. When conservative treatment is not enough, women with stress incontinence can have a suburethral tape (sling) fitted, and men after a prostatectomy a male sling or an artificial sphincter. For persistent urge incontinence, botulinum toxin or neuromodulation is used. The choice of procedure is individual; Dr Penev assesses which method is suitable and refers the patient for surgical treatment, if needed at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela) in Plovdiv.
When to see a urologist
Seek an appointment if leakage happens more than once a week or limits your daily life and sleep; if it started after childbirth or surgery and has not settled within three months; if it comes with burning, pain or blood in the urine; or if your bladder does not empty completely. The consultation for urinary problems takes place in Plovdiv and at Vita Med Medical Centre in Karlovo, by appointment.
Prevention
Keep to a healthy weight, do not smoke, stay active and treat constipation. Do pelvic floor exercises during pregnancy and after giving birth, and at the menopause discuss local oestrogens with your doctor. Men should not put off treatment for difficulty passing urine.
Incontinence is a medical problem with a solution, not a cause for shame. Book an appointment with Dr Penev to establish its type and start the right treatment.
Frequently asked questions
Is it normal to leak urine after giving birth?
In the first weeks after childbirth this is common and usually settles as the pelvic floor recovers. If the leakage continues for more than three months or gets worse, it should be assessed by a specialist and targeted exercises should be started.
Do Kegel exercises help, and how long do they take to work?
For stress and mixed incontinence they are the first-line treatment. They need to be done every day for at least three months, and it is a good idea to have your technique checked by a specialist, because many people tense their abdomen instead of the pelvic floor.
Is leakage after prostate surgery permanent?
After a radical prostatectomy some leakage is expected, and in most men it gradually decreases during the first year with pelvic floor exercises. If it is still significant after the twelfth month, there are effective surgical solutions.
Should I drink less water so that I leak less often?
No. Severely restricting fluids makes the urine concentrated, irritates the bladder and makes the urges stronger. It is more helpful to spread your fluids through the day, cut down on caffeine and alcohol and not drink in the last two hours before bed.
Can the medicines I take cause leakage?
Yes. Diuretics, some blood pressure medicines, sedatives and sleeping tablets can cause or worsen incontinence. Bring a list of your medicines to the consultation – sometimes adjusting the dose or the time you take them is enough.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.