Urinary incontinence

Urinary incontinence (UI) means any involuntary leakage of urine.

Different types of UI

There are different types of UI. The different types of UI are called stress UI, urge UI and mixed UI (a mixture of the symptoms of both stress and urge UI).

UI is the leakage of urine when coughing, sneezing, laughing, bending over, walking or during exercise. Urge UI is leaking urine due to an overwhelming urge to pass urine so that the person cannot reach the toilet in time. Someone with mixed UI would experience both of these patterns of involuntary leakage of urine.

How common is UI?

UI is a common problem, particularly for women. It has been estimated to affect between one quarter and nearly one half of women at some time in their life. There is a poor understanding about how common UI is because women are embarrassed to talk about it and health professionals may assume that if a woman does not raise the issue, it is not a problem.

What are the causes of UI?

There are some very specific causes of UI that include infection of the urinary tract, stones in the bladder, some neurological conditions and specific medications. However in many cases UI is not caused by any of these conditions but is associated with a range of risk factors. It is important to tell your doctor about your UI so specific causes of UI can be eliminated.

What are the risk factors for UI?

The different types of UI are more common in different age groups.

In healthy young women age 16-30 years who have never been pregnant an Australian study has shown stress UI is the most common, although all three types of UI can occur. The chances of experiencing UI in this age group are increased in women who have ever been sexually active, and reduced in women who are using the oral contraceptive pill, Stress UI is most common in women between the ages of 35 and 45. Risk factors include having had at least one child, having diabetes and also being obese. The mixed pattern of UI is generally seen in women aged 45 and over. The risk factors for having mixed UI are being either overweight or obese, having diabetes and having had a hysterectomy. Urge UI is more common in older women and the main risk factor is ageing.

What is the impact of UI on women's lives?

The impact that UI has on women is difficult to quantify and will be dependent on how severe the problem is. However our studies show that women with UI have a measurable reduction in their overall wellbeing, as measured by a validated questionnaire.

In our studies women with stress UI or mixed UI reported levels of wellbeing similar to those reported by women with back pain. So UI can have a marked impact on women's lives. Women may have to make major adjustments to their everyday lives to accommodate their UI such as planning their activities around access to a toilet, wearing continence pads or avoiding activities they know will result in urinary leakage.

UI may be associated with an increased frequency of urinary tract infections. It is important you discuss this with your doctor if you are having frequent urinary infections.
What can be done about UI?

The first thing is to raise the issue with your doctor. Some tests may be needed to eliminate the possibility of a specific cause for the UI.

How is UI assessed?

Assessment should include a full medical history including all the medications you are taking and a clinical examination including a pelvic examination.

If you are experiencing UI your doctor will most likely recommend the following tests:

  1. Urinalysis: this checks the pH of your urine and whether there are any traces of glucose, protein or blood in the urine
  2. Urine microscopy and culture: this is to check if you presently have an infection in your urinary tract
  3. A blood test to check your blood glucose level (to exclude diabetes) and your kidney function.
  4. Sometimes a bladder diary is helpful: this involves keeping a diary over a few days of every time you need to urinate and how often and how much you drink. It is important that you do not restrict your fluid intake to avoid having to pass urine as that may cause you to be dehydrated.

Specialised tests may include any or all of the following:

  • Pelvic ultrasound to view your urinary tract and pelvic organs (uterus and ovaries)
  • Urodynamic testing. The pressure in your bladder is measured when it is at rest and when it is filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. During this time a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health.
  • Cystoscopy. This is performed under anaesthetic. A thin tube with a lens is inserted into the bladder through the urethra so the bladder lining can be carefully inspected.

What can you do about stress or urge incontinence symptoms?

There are a range of treatment options which may be appropriate and should be discussed with your doctor, including:

  • pelvic floor exercises
  • bladder retraining
  • weight loss
  • avoiding irritants such caffeine containing drinks which increase the urge to pass urine (such as tea and coffee)
  • preventing urinary tract infections
  • drink plenty of fluid
  • ask your doctor about cranberry juice or cranberry tablets
  • ask your doctor about low dose vaginal oestrogen cream / pessaries if you are postmenopausal

In some women the combination of pelvic floor exercises / bladder retraining and weight loss will be enough to significantly reduce UI. Supervision by continence physiotherapists or nurses (who specialise in pelvic floor muscle training) is often useful. The pelvic floor is a name for the muscles that hold your bladder, uterus and vagina and bowel in the correct positions. There are three openings through the pelvic floor - for the urethra (connected to the bladder and through which you pass urine), the vagina and the lower bowel (rectum). When these muscles are working properly they help the openings of the bowel and bladder stay firmly closed when intended. When these muscles are weak women leak urine and sometimes faecal matter without control.

For severe or complicated UI there are further treatment options such as:

  • drug treatments – with a variety of therapies for the different forms of UI
  • nonsurgical interventions including vaginal devices, urethral inserts and electrical stimulation
  • surgery – there is a range of specialised procedures that can be performed with good outcomes

Disclaimer: This information aims to inform patients and health professionals about Urinary Incontinence. This website's content is designed to complement, not replace, the relationship between a patient and his/her own doctor.