Urinary incontinence

Written by: 
Dr Kieran Walsh

Urinary incontinenceThe involuntary passage of urine or faeces. is the involuntary passage of urine from the bladderThe organ that stores urine. - in layperson's terms, it means wetting yourself. It is embarrassing and uncomfortable and sometimes painful.

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Continence advisers regularly speak about patients (both men and women) who suffered with incontinenceThe involuntary passage of urine or faeces. for as long as five to ten years before seeking help; then, when they did see an adviser, it turned out that they had a perfectly treatable condition

Although it would seem logical that anyone suffering from urinary incontinenceThe involuntary passage of urine or faeces. should go to a doctor for help, the fact is that most sufferers do not. Studies have shown that fewer than one in five older people who have incontinenceThe involuntary passage of urine or faeces. seek help for it. So why don't they?

The truth is that many people find it embarrassing and perhaps shameful, or they may even regard it as an intrinsic part of growing old - that is, something you just have to put up with.

Some people manage their incontinenceThe involuntary passage of urine or faeces. themselves, even though this may mean they can't socialise as much as they want to or even feel they can't go out at all. Some report that wherever they go, they are looking out of the corner of their eye for a sign for the bathroom.

Many patients are worried that if they do seek help, they will encounter health professionals who are embarrassed themselves or dismissive, or who don't know what to advise.

If you or someone close to you has incontinenceThe involuntary passage of urine or faeces., what should you do? The following sections will help you to make the right decisions:

Getting to grips with urinary incontinence

The first thing that's important to do is to get over the embarrassment and the sense that you shouldn't or can't do anything about the problem.

If you have incontinenceThe involuntary passage of urine or faeces., it's vital not to hide it away from family and health professionals - it is well worth discussing the problem with your doctor, as there is much that can be done to alleviate the problem.

If your own doctor doesn't know much about urinary incontinenceThe involuntary passage of urine or faeces., another option is to ask to be referred to a specialist. In most countries, there is no shortage of doctors who specialise in the condition. Perhaps more importantly, many clinics and hospitals have an incontinenceThe involuntary passage of urine or faeces. nurse who can offer treatments and practical advice.

The first time you mention your urinary incontinenceThe involuntary passage of urine or faeces. will be the most difficult - after that, it will be like talking about anything else. Getting it off your chest initially will be of benefit in itself; in addition, there are many therapies, tablets and even operations that may help.

There is help available

The treatment you get will depend on:

  • Whether you are a man or a woman
  • The type of incontinenceThe involuntary passage of urine or faeces. that you have.

However, some things can help everyone:

  • In the first instance, many people find drinking cranberry juice helpful. There is not a great amount of evidence that it works, but it is not a drug and is therefore unlikely to do much harm
  • Avoiding drinking too much coffee or alcohol may also help.

The next step is to try the specific treatments available for specific types of incontinenceThe involuntary passage of urine or faeces..

Treatments for women

If you are a woman and have urge incontinenceThe involuntary passage of urine or faeces. (that is, you have a barely controllable urge to urinate immediately and sometimes have accidents), then bladderThe organ that stores urine. retraining can help. This involves training your bladderThe organ that stores urine. to hold the urine in. You start by holding in the urine for a few minutes and gradually increase the time until you have better control over the urge to urinate.

If bladderThe organ that stores urine. retraining doesn't help you, there are certain medications that may - these are called anticholinergic drugs. They act by calming down the bladderThe organ that stores urine., but they can cause side effects such as a dry mouth.

Women with stressRelating to injury or concern. incontinenceThe involuntary passage of urine or faeces. (that is, urine leaks out when you cough, sneeze or laugh) can also start with non-drug treatments called pelvicRelating to the pelvis. floor exercises.

These exercises involve imagining that you are urinating and trying to stop. You then squeeze your pelvicRelating to the pelvis. floor muscles. Like any muscles, these will get stronger the more you exercise them, and you should soon be able to stop yourself passing urine when you cough.

Pelvic floor exercises are not a miracle cure - it will take time and effort to become good at them and to start seeing results.

Find out more about how to do these in the quick guide, Pelvic floor exercises.

If pelvicRelating to the pelvis. floor exercises don't work for you, there are other options - such as electrical stimulation of the bladderThe organ that stores urine. muscles or even surgery as a last resort. Duloxetine, a drug usually used to treat depression, can also help.

Treatments for men

The causes of incontinenceThe involuntary passage of urine or faeces. in men are different. Prostate problems or problems with the nerves that supply the bladderThe organ that stores urine. are most common.

The prostate gland is located just below the bladderThe organ that stores urine. and wraps around the urethra The tube that carries urine from the bladder, and in men also carries semen during ejaculation.- the tube from which you pass urine. As men get older, the prostate tends to enlarge and affect the flow of urine. This can lead to a weak stream, leaking of urine or frequent urination, which can sometimes in turn lead to a form of urinary incontinenceThe involuntary passage of urine or faeces. known as urge incontinenceThe involuntary passage of urine or faeces..

Treatment may be with drugs or an operation. Alpha-blocker drugs can help improve the urine flow, but they may cause dizziness and problems with sexual function. A drug called finasteride can also help, but it takes longer to start working and may also cause sexual function problems.

Transurethral resection of the prostate is a tried and tested operation for an enlarged prostate glandAn organ with the ability to make and secrete certain fluids., but it can cause bleeding in the short term and problems with getting and maintaining an erectionThe enlarged, rigid state of the penis during sexual arousal. (erectile dysfunction) in the long term. Some men may suffer from urinary incontinenceThe involuntary passage of urine or faeces. after the procedure.

There are also some newer surgical procedures that could help - it may be worthwhile asking your urologist what types of operation are on offer.

Treatments related to other underlying problems

Problems with the nerves that supply the bladderThe organ that stores urine. can also cause incontinenceThe involuntary passage of urine or faeces.. Men or women affected by stroke, multiple sclerosis or spinal cord injury can thus develop incontinenceThe involuntary passage of urine or faeces.. Treatment usually involves tackling the underlying problem if possible - for example, by addressing the multiple sclerosis.

Sometimes health professionals will advise symptomatic care - that is, treatment to relieve the symptoms of incontinenceThe involuntary passage of urine or faeces. or the discomfort associated with it. This may involve you using incontinenceThe involuntary passage of urine or faeces. pads or intermittent self-catheterisation (where you pass a tube into the bladderThe organ that stores urine. to empty it at regular intervals).

The Bladder and Bowel Foundation also gives out 'I can't wait' cards for people to show when they need to find a bathroom urgently or jump a queue. These are available on this page (opens in a new window) at their website, bladderandbowelfoundation.org

In summary

Urinary incontinenceThe involuntary passage of urine or faeces. is not the end of the world, but it may cause many problems if you don't seek help.

Continence advisers regularly speak about patients (both men and women) who suffered with incontinenceThe involuntary passage of urine or faeces. for as long as five to ten years before seeking help; then, when they did see an adviser, it turned out that they had a perfectly treatable condition.

So rather than being embarrassed or hoping that the problem will go away on its own, remember that it's always worth discussing it with your doctor.