Urinary incontinence in women – how to get it sorted

Whatever your symptoms, you may find this distressing or embarrassing, and it can have a big impact on your quality of life. Many women find it affects their work, social and love life, because of worries about leaks, smells or needing to be near a toilet. And if it goes untreated, it can knock your mood, confidence or self-esteem.

But the good news is that there are lots of steps you can take to help with female incontinence. It may take time to figure out what works for you, but there’s no need to put up with it. Here’s what you need to know about the different types of urinary incontinence, how they’re diagnosed, and how to deal with them.

Who is likely to get urinary incontinence?

Urine leakage in women is very common. Exactly how many people it affects isn’t known, as women often don’t report it or seek help. But 1 study suggested it may affect 40% of women over the age of 21. So if you’re noticing it, you’re not alone.

It’s also estimated to happen to twice as many women as men. This is thought to be due to things such as pregnancy, childbirth and the

affecting your bladder and the muscles that support it, as well as differences in the female body.

It can happen at any age, but it becomes more likely as you get older, particularly in middle age, and again when you’re over 70. You may only get small leaks from time to time, or they may be larger or happen very often. How and when you’re affected depends on the type of urinary incontinence you have.

Find useful information on areas of female incontinence with our

.

Types of urinary incontinence

Different kinds of urinary incontinence have different causes, symptoms and treatment options. Stress incontinence and urge incontinence are the most common types in women.

Stress incontinence

Stress incontinence is thought to affect about 1 in 3 women at some stage of their life. It’s when you leak pee when your bladder and the tube that carries pee out of your body (urethra) are put under extra pressure – for example, when you exercise, laugh, cough or lift something heavy.

The leaks can vary from very small to larger amounts – especially if your bladder is full at the time.

It happens because your urethra can’t stay closed under pressure. This can be due to weak or damaged muscles around your bladder, bottom and vagina (pelvic floor muscles), or damage to the ring of muscle that holds your urethra shut (urethral sphincter).

These muscles can be weakened or damaged by various things, including:

• pressure on your tummy from pregnancy or being very overweight (
  obese
  )
• childbirth – especially if you have a vaginal delivery (read about urinary incontinence in pregnancy and childbirth)
• surgery that can can affect your bladder or the surrounding area, such as having your womb removed (
  hysterectomy
  )
• hormonal changes during the menopause (read about urinary incontinence in menopause)
• some medicines – such as water tablets (diuretics), because they’re designed to get rid of excess fluid in your body
• smoking – because it can cause a long-term (chronic) cough, which puts pressure on your muscles
• constipation
  – because a full bowel puts pressure on your bladder, and straining can weaken your pelvic floor muscles
• neurological conditions – such as
  multiple sclerosis (MS)
  or
  Parkinson’s disease
• connective tissue disorders – such as
  Ehlers-Danlos syndrome

FInd out more about stress incontinence.

Urge incontinence

With urge incontinence, you get a sudden and very urgent need to pee, meaning you sometimes pee before you can get to a toilet.

It’s a symptom of an overactive bladder, which is when the muscles in the walls of your bladder – called the detrusor muscles – squeeze (contract) too often.

The sudden urge to pee can be triggered by things you might do in a typical day, such as washing your hands, or unlocking your front door when you arrive home. It can also happen if the nerves that help stimulate your bladder are damaged, which can be caused by conditions such as

or Parkinson's disease.

It’s isn’t always clear what causes your detrusor muscles to be overactive, but it may be caused by:

• drinking too much alcohol or caffeine – these can irritate your bladder
• not drinking enough fluids – this can lead to very strong pee, which can also irritate your bladder
• urinary tract infections (UTIs)
• constipation – it’s thought this is because it can put pressure on your bladder
• neurological conditions
• some medicines

FInd out more about urge incontinence.

Mixed incontinence

Research suggests that more than 30% of women with urinary incontinence have both stress and urge incontinence, which is known as mixed incontinence. This means you can have a combination of symptoms and many potential triggers throughout the day and night, which can have a big effect on your wellbeing and quality of life.

Mixed incontinence is usually caused by some combination of the things that cause stress and urge incontinence.

Other types of urinary incontinence

• overflow incontinence – this is when your bladder never empties completely, and the pressure that builds up from having an over-full bladder can cause you to often leak pee. It’s usually because of a blockage in your urethra, such as bladder stones. It can also be caused by your bladder muscles not contracting properly, which can happen after surgery or a spinal cord injury
• functional incontinence – this is when you can’t get to the toilet in time to pee, due to problems with walking or conditions such as
  arthritis
  or
  dementia
• total incontinence – this is when your bladder can’t store pee. You may pass urine all the time or have a lot of leaks. It’s usually caused by serious problems, such as a bladder issue you’re born with or a spinal cord injury

When to see a doctor

You can use our

to get more information about your symptoms. But you should see a doctor about urinary incontinence if it’s affecting your quality of life or mental health, it doesn’t improve with self-care measures (see below), or it’s getting worse.

It’s a common problem that doctors deal with all the time, so there’s no need to feel embarrassed – they’ll want to help you treat and manage your condition in a way that works for you.

You should see a doctor as soon as possible if:

• urinary incontinence starts very suddenly
• you have symptoms of an infection – such as burning when you pee – that don’t go away after a couple of days
• you have trouble peeing
• you notice
  blood in your pee
• you have pain in your bladder or urethra
• you’re constantly leaking pee
• you’ve also lost control of your bowels (
  bowel incontinence
  )

Fortunately, urinary incontinence is rarely a sign of a more serious problem. But you should get emergency medical help if:

• you have sudden urinary incontinence combined with lower back pain
• you can’t pee at all

How is urinary incontinence diagnosed?

Your doctor will start by asking questions. You might find it useful to keep a ‘bladder diary’ for at least a few days, so you can give them detailed information. You can keep a note of:

• how often you get leaks
• whether the leaks are small or large
• how often you need to pee
• whether you get an urgent need to pee
• whether you have trouble peeing
• how much fluid you drink, including caffeinated drinks and alcohol

Your doctor may also examine your pelvis and vagina to see what could be causing your incontinence, and take a

to check for bacteria, blood or protein.

Often, your doctor will be able to diagnose what type of urinary incontinence you have based on your symptoms, and will suggest you start treatment at this stage.

If they’re not sure what’s causing your incontinence, or treatment doesn’t help, you might need other tests at a hospital, or be referred to a specialist called a urologist.

Further tests may include:

• urine samples to check for infections
• blood tests
  to check for other causes
• a residual urine test, which uses an
  ultrasound scan
  to see how much urine is left in your bladder after you pee
• a
  cystoscopy
  , which uses a thin tube with a camera on it to look at your bladder and urethra
• ‘urodynamic’ tests to check how your bladder and urethra are working, which involve measuring the pressure in your bladder or tummy, and testing your urine flow and amount

What’s the treatment?

Self-care measures

Whatever kind of incontinence you have, your doctor will usually suggest some lifestyle changes as the first step in managing and treating it. These include:

• eating a healthy, balanced diet
  – this should include at least 5 portions of fruit and vegetables a day and foods that are high in fibre to avoid constipation. Some people find certain foods irritate their bladder, including spicy food, acidic foods such as citrus fruit, chocolate and fizzy drinks, so you may want to try avoiding these to see if this helps
• losing weight if you’re overweight
  – this will reduce the pressure on your pelvic floor muscles and the nerves that control your bladder. Try these tips for losing weight
• drinking enough fluid to help you pee regularly and avoid
  dehydration
  – although drinking too much can also make incontinence worse. It’s generally recommended that we drink 1.5 litres of fluid a day – you could try setting yourself a daily target using the goal setters in the Healthily app
• cutting down on alcohol
  and drinks containing caffeine, such as tea, coffee, cola and energy drinks, as both alcohol and caffeine can make bladder problems worse. You can make a commitment to cut down using the goal setters in the Healthily app
• exercising regularly – this can help you manage your weight and strengthen your muscles, including your pelvic floor muscles. Try these
  tips for getting active
• quitting smoking
  if you smoke – this can ease the strain on your pelvic floor from coughing, and reduce bladder irritation
• using incontinence products
  , such as absorbent pads or devices to prevent leaks. While they don’t treat incontinence, they can help you feel more confident and protect your skin from getting sore while you wait for other treatments to work

Pelvic floor or bladder exercises

Depending on the type of incontinence you have, your doctor will usually suggest at least 1 of these exercises to help. They can take a bit of time and effort to get right and start working, but they can be very effective:

• pelvic floor exercises – these strengthen your pelvic floor muscles, which support your bladder and urethra, so they can help with any kind of urinary incontinence. You can try them yourself, or your doctor may refer you to a specialist physiotherapist for training. Find out
  how to do pelvic floor exercises
• bladder training – this is usually the first step in treating urge incontinence. It involves learning how to increase the length of time between getting the urge to pee and going to the toilet, and should be done under the guidance of a specialist

Other non-surgical treatments

Depending on your symptoms, you may also be offered other

. These can include electrical stimulation to work your pelvic floor muscles, and pessaries you insert into your vagina. In some cases, if other treatment doesn’t help, you may be prescribed medication.

Read more about

.

Surgery and procedures

If other treatments aren’t effective or are unsuitable for you, there are several types of surgery and other procedures your doctor may recommend.

For stress incontinence, this can include surgery to raise the neck of your bladder or support it with a sling to stop leaks.

If you have urge incontinence, you may be offered a procedure to stimulate the nerves connected to your bladder.

For overflow incontinence, treatment may involve using a device called a

to help drain your bladder.

Read more about surgical treatments and procedures for urinary incontinence.

Preventing urinary incontinence

It’s not always possible to prevent urinary incontinence, but these simple steps can help:

• eat a healthy, balanced diet – there’s no solid evidence that specific vitamins or minerals help with urinary incontinence, but getting a range of nutrients will support your overall health and can prevent constipation
• keep to a healthy weight – to avoid pressure on your pelvic floor
• avoid smoking – or quit if you already smoke
• drink enough fluids – your pee should be the colour of pale straw
• limit your intake of caffeinated drinks and alcohol
• go to the toilet when you need to, and fully empty your bladder – it’s fine to hold in pee occasionally if you have to, but doing it all the time can lead to problems
• practise pelvic floor exercises – these are good for the health of your bladder and bowel, whether or not you have incontinence, so don’t wait until you have a problem to start doing them

Your health questions answered

Is urinary incontinence ever a sign of cancer?

“Very rarely, urinary incontinence can be a symptom of some forms of cancer, including cancer of the bladder, bowel or womb. However, you’re more likely to get other symptoms with these types of cancer. It’s important to remember that urinary incontinence is very common, and other causes are much more likely. Although cancer isn’t a common cause, it’s a good idea to see a doctor about leaks, so they can rule out anything serious.”