Urinary incontinence in adults
- Dr Demetri Panayi, Consultant Obstetrician and Gynaecologist
Urinary incontinence is when you pass urine (pee) without meaning to. This common problem can be embarrassing and may affect every area of your life. If you find yourself putting up with it, you’re not alone. But there’s a lot of help available and it can often be treated.
Types of urinary incontinence
There are several types of urinary incontinence.
- Urge incontinence. This is when you feel a sudden need to pee without warning. You have to go then and there. You can’t put it off or delay for the toilet.
- Stress incontinence. This is when urine leaks when you sneeze, cough or exert yourself.
- Overflow incontinence. This is when you can’t fully empty your bladder so urine keeps dribbling out.
- Functional incontinence. This is when you can’t reach a toilet in time or can’t use a toilet properly due to mobility problems.
- Total incontinence. This is when your bladder can’t store urine at all.
- Mixed incontinence. This means you have both stress incontinence and urge incontinence.
An overactive bladder is when you get a strong urge to pee often, including at night. It may lead to urge incontinence.
Urinary incontinence can affect people of any age. It’s most common in older people but shouldn’t be seen as a normal sign of getting older. Women are more likely than men to have urinary incontinence.
Urinary incontinence can sometimes be caused by an underlying health condition. So it’s important to visit your GP if you’re experiencing urinary leakage symptoms. For more information on urinary incontinence causes, visit our Causes of urinary incontinence section.
Symptoms of urinary incontinence
Leaking urine is the main urinary incontinence symptom. But this can vary quite a bit, from leaking a few drops to partly or totally emptying your bladder.
Symptoms of urge incontinence
Urge incontinence may cause:
- a sudden urge to pee which you can’t put off
- not being able to make it to the toilet in time
- needing to go to the toilet at night
- sometimes leaking urine at night
Symptoms of stress incontinence
Stress incontinence may cause leaking of urine when you’re doing activities, such as:
- coughing
- sneezing
- lifting something heavy
- exercising
- standing up from sitting down
- exerting yourself
If you have mixed incontinence, you may have all of these symptoms.
Symptoms of bladder leakage
You may have other bladder leakage symptoms, such as:
- needing to pee often
- dribbling urine after you’ve been to the toilet
- constantly dribbling urine day and night
- it hurts or stings when you pee
- difficulty passing urine when you want to
- feel like you haven’t emptied your bladder fully when you pee
Symptoms of overactive bladder
If you have an overactive bladder, you may:
- have to rush to the toilet to pee
- need to pee often during the day
- wake up in the night to pee
- leak urine before you get to the toilet
- have pain in your tummy or bladder
Having urinary incontinence can affect your mood and may lead to depression and anxiety.
Causes of urinary incontinence
The cause of urinary incontinence depends on which type of incontinence you have.
Urge incontinence happens when the muscle of your bladder wall contracts when you don’t want it to. You feel the need to pee urgently. This can develop as you get older or may be caused by neurological conditions, such as a stroke. Stress incontinence is due to weak pelvic floor muscles. This has several possible causes, including the following.
- Being pregnant and having a vaginal birth. This stretches and weakens your pelvic floor muscles. You’re more likely to have stress incontinence if you’ve had more than one pregnancy.
- Having an episiotomy during childbirth. This is a cut to the area between your vagina and anus.
- Being overweight.
- Being constipated.
- Having an enlarged prostate gland.
- Having radiotherapy or surgery to treat prostate cancer.
- Getting older – the older you are, the more likely you are to have any type of incontinence.
- Other members of your close family having stress incontinence.
- Having a prolapse – this is when one or more of the organs in your pelvis slip down from their normal position.
An overactive bladder doesn’t always have a specific cause. It gets more common as people get older. It may be due to a nerve problem, such as multiple sclerosis or stroke. It can be due to a prostate problem.
Several things can make you more likely to have urinary incontinence. These include:
- a urine infection
- drinking too much caffeine
- Parkinson’s disease
- a long-term cough
- high-impact activities such as long-distance running
- some medicines
- constipation
Diagnosis of urinary incontinence
If you’re leaking urine and it’s upsetting you or affecting your day-to-day life, you should see your GP. You can also see a specialist pelvic health physiotherapist, or your GP may refer you to one.
Your GP will ask about your symptoms and medical history. This helps them find out which type of incontinence you have and rule out any underlying causes. Your GP will also ask about any medicines you may be taking.
Your GP may examine you too. They’ll feel your tummy and probably do an internal examination.
- If you have a vagina, your GP may need to check it. This means putting a finger into your vagina and asking you to squeeze your pelvic floor muscles, to see how well the muscles are working.
- If you have male sex organs, your GP may ask to check your prostate by doing an internal examination of your rectum (back passage). They may also ask to examine your penis.
Your GP may ask you to keep a ‘bladder diary’ for a few days. It’s best to fill in your diary on both work and non-working days to give a complete picture. Write down:
- when you pee
- how much urine you pass
- if and when you leak any urine
- how much fluid you’re drinking each day
Your GP will also ask how your symptoms are affecting your daily life.
Tests
Your GP will probably ask you for a urine sample. They’ll use this to check for problems such as blood in your urine. Depending on your symptoms, your GP may ask you for a urine sample to send to the lab to check for an infection.
They may also refer you to a specialist for further tests. These may include the following.
- An ultrasound scan of your bladder after you’ve peed. This can help to show whether or not your bladder is emptying properly.
- Urodynamic tests. These can show when you’re leaking urine and help your doctor decide what type of incontinence you have.
- A blood test called a prostate specific antigen (PSA) test. This test looks for any problems with your prostate that could be causing your symptoms.
You may be referred for a pelvic floor muscle assessment.
Self-help for urinary incontinence
There are several things you can do to help manage your symptoms. Your doctor or physiotherapist may suggest some of the following.
- Drinking less caffeine, alcohol and fizzy drinks.
- Losing weight if you’re overweight.
- Changing the amount of fluid you drink each day – ideally drinking 1.5 to 2 litres a day.
- Treating any constipation.
- Giving up smoking if you’re a smoker.
- Doing pelvic floor exercises – these may help if you have stress incontinence.
- Bladder training – this may help if you have urge incontinence.
Your doctor or physiotherapist may recommend the Squeezy app for your smartphone. You can use this app to follow a pelvic floor exercise plan recommended by NHS physiotherapists. You can use it on your own or work with a specialist physiotherapist – they can change the exercise plan to suit your needs.
To find out more about pelvic floor exercises and bladder training, see our section on Treatment of urinary incontinence.
You may also find it helpful to use incontinence products while you are waiting for or during treatment. For example:
- wearing pads in your underwear to soak up any leaks – change these regularly to avoid skin irritation
- using a handheld urinal
- using devices that help to prevent leaks, such as special incontinence pessaries and tampons. These can’t be used all the time, but may help at specific times, such as when you exercise.
Treatment of urinary incontinence
Your doctor will usually recommend you start with the simplest treatments. This means trying lifestyle changes and other treatments before thinking about surgery. For information on things you can do to help yourself, see Self-help for urinary incontinence section.
The right treatment for you depends on the type of incontinence you have. Each treatment comes with risks and benefits. Talk to your doctor about your treatment options. Make sure you have all the information you need to decide what’s best for you.
Treatment for stress incontinence
There are several different types of treatment for stress incontinence.
Pelvic floor muscle training (Kegel exercises)
Your doctor is likely to suggest pelvic floor exercises first. Your pelvic floor muscles help to control your bladder and bowel. Strengthening and toning these muscles using exercises can sometimes help stress incontinence. A specialist pelvic health physiotherapist can show you how to do these exercises. You’ll need to do them three times a day for at least three months to see if they help.
Biofeedback and electrical stimulation
If you have problems tightening your pelvic floor muscles, using biofeedback or electrical stimulation with pelvic floor exercises may make this easier.
- Biofeedback is when sensors placed internally or on your skin send signals to a monitor when you squeeze your pelvic floor muscles. This can help to show you how well you’re doing the exercises.
- Electrical stimulation can also be used to help stimulate your pelvic floor muscles using an electrical current. It involves having a small electrical probe placed on your skin or inside the vagina.
Medicines
Your doctor may offer you medicine for stress urinary incontinence if your first treatments don’t work and you prefer not to have surgery. They’ll talk to you about the possible side-effects and review you after four weeks to see if the medicine is working.
If you’re going through, or have gone through, the menopause, your GP may prescribe hormone replacement therapy (HRT). This may be a topical oestrogen (cream or gel) or tablets.
Surgery
If the less invasive treatments don’t help you, your GP will refer you to a specialist to discuss surgery. The main types of surgery for stress incontinence include the following.
- Sling surgery. Your surgeon will place a piece of your own tissue under your urethra. This acts as a sling to support it.
- Artificial sphincters. If you’ve already had surgery for stress incontinence and this hasn’t worked, you may be offered an artificial urinary sphincter.
If you have female sex organs, you may also be offered:
- Colposuspension. Your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone.
- Injections of bulking agents into the wall of the urethra. This narrows your urethra, helping it to stay closed so your bladder can hold urine. The effects of this procedure may wear off over time. So, you may need to have more injections.
Each procedure comes with risks and benefits. It’s important to discuss these with your doctor before you agree to go ahead with the procedure.
Treatments for urge incontinence
There are several different types of treatment for urge incontinence and an overactive bladder.
Bladder training
Bladder training is usually the first treatment. You’ll be asked to do it for six weeks to see if it works. The training includes lengthening the time between planned visits to the toilet. Distraction and relaxation techniques help you control the urge to pee.
Medicines
Your doctor may offer medicines called anticholinergics (also known as antimuscarinics) if bladder retraining doesn’t help. These medicines help to stop the muscle in your bladder from tightening when it shouldn’t. They can take about a month to work. They can cause a dry mouth and constipation.
Other treatments
If bladder training or medicines don’t work, your doctor may suggest the following.
- Botulinum A toxin. This is injected into the wall of your bladder. It helps to stop the muscle in your bladder being overactive.
- Nerve stimulation. This involves sending electrical signals to the nerves that control your bladder.
- Surgery. There are two main types of surgery for urge incontinence. One involves making your bladder bigger (augmentation). The other redirects urine away from your bladder into a bag (urinary diversion). Both are major operations and only used if other treatments haven’t worked.
Treatments for overflow incontinence
If you have overflow incontinence, the underlying cause will need to be treated. If your prostate gland is bigger than it should be and blocking your bladder, you may need to have prostate surgery. If surgery isn’t suitable, you may need to use a catheter to help you pee.
Prevention of urinary incontinence
If you’re worried about urinary incontinence, you may be able to reduce your risk if you:
- lose weight if you’re overweight
- eat fibre-rich foods and drink plenty of fluids to prevent constipation
- treat any constipation
- limit lifting heavy weights
- stop smoking
- get plenty of exercise, but don’t overdo high-impact exercise
- reduce how much caffeine you have each day
If you’re pregnant, you may be able to prevent incontinence during pregnancy and in the first few months afterwards by doing pelvic floor exercises. Ask your midwife for more information.
Bladder health
Inside Health: Bladder Health | Highlights | Watch in 6:27 minutes
Watch highlights from our Inside Bladder Health where Dr Zoe Williams and Bupa’s Dr Elizabeth Rogers speak honestly about urinary incontinence, overactive bladders, pelvic floor issues and more. They’ll be talking about how to live better with bladder conditions, and why you should never be embarrassed to ask for help.
Speaker 1: Dr Zoe Williams
Welcome to Inside Health where we help you get under the skin of some of the big health concerns that affect us all.
Today we're shining a light on bladder health.
So we're gonna be talking about some of the common bladder conditions, giving you some top tips on how to manage your pelvic floor and answering some of your questions.
Speaker 2: Dr Elizabeth Rogers
Urinary incontinence is essentially the involuntary leakage of urine.
So by that I mean you basically go for a wee when you don't want to or you don't intend to.
Dr Zoe Williams:
So what are some of the typical causes then of urinary incontinence?
Dr Elizabeth Rogers:
So the causes depend on which type of incontinence you've got.
And often we don't find one single cause, so it tends to be kind of multifactorial.
If we think about stress incontinence, so this is the kind where you leak a bit of urine when you either cough or sneeze or exert yourself, we need to have a bit of a think about the structures involved when you need to urinate.
So we've probably all heard of our pelvic floor. So a group of structures and muscles that basically help control the flow of urine out of the bladder.
Anything that either weakens or damages these muscles can lead to incontinence.
So, you might think about things like pregnancy, having a vaginal birth, having a forceps delivery for example, can damage the pelvic floor, having constipation, so you're constipation where you're having to strain a lot, or having a chronic cough where you are coughing all the time. So those can all be causes.
Dr Zoe Williams:
Commonly we think of it at affecting women more.
But tell us some of the reasons why it might impact on men.
Dr Elizabeth Rogers:
Yeah, so men do also have a pelvic floor as well, so ensuring that they've got a strong pelvic floor, avoiding things like a chronic cough and constipation are really important.
Our anatomical makeup is of course slightly different.
So in men you've got the prostate gland and that sits just below the bladder. And urine comes out of the bladder through a tube called the urethra and that passes through the middle of the prostate gland.
And if there are changes in the prostate gland, such as it getting larger, that can press on that tube, it can affect the way that urine flows out of your bladder.
So, it can cause problems such as weak stream and it makes it harder for men to go to the toilet.
But for many men they also get problems kind of with urge incontinence and urgency and feeling like they need to go to the loo then and there. Or that they need to go to the toilet really frequently.
Dr Zoe Williams:
When it comes to bladder health one of the most important things for us to talk about is how to train your pelvic floor.
I think looking after your pelvic floor is one of the best ways that we can prevent issues like incontinence in the future, but it also forms a really important part of the treatment plan if people are having issues like incontinence.
Firstly, I think it's important to identify what the pelvic floor is.
It's a structure that's deep in the pelvis that's made up of muscles and connective tissue and you can kind of think of it as a trampoline that attaches at the front on the pubic bone, at the back, on the tailbone and either side on the seat bones.
And you want that trampoline to be firm and strong, but have a little bit of give, like a good trampoline. On top of that trampoline sits your bladder, your womb, if you're a woman, and your bowels. And there are some holes in it and these holes allow you to pee and poo.
When you jump up and down, for example, or cough or sneeze, those muscles give a little bit of tension to maintain control of the bowels and the bladder.
So what I'm gonna do next is I'm gonna describe exactly how to do a pelvic floor exercise. It's a bit complicated, so I'm gonna do it in a stepwise approach and I'm gonna do it with you. So I want you to follow along with what I do.
Pelvic floor exercise
Okay, first of all, just go with me on this.
Imagine you need to fart, but you're in a busy lift and you need to hold onto it, so just imagine that.
And what I want you to do now is hold onto the fart.
So the muscles you're using are part of the pelvic floor, relax them, now what I want you to do is do that again.
Imagine you're gonna fart, hold onto it and pull those muscles up inside and hold onto them.
Well done, that's the first bit.
The next bit is imagine you're having a pee and somebody's walking in the room and you don't want them to know you're there, so you need to stop midway through.
So imagine you're having a pee, hold onto it, stop it and relax.
We'll do that one again.
So imagine you're having a pee, stop it.
Pull those muscles up inside, squeeze and relax.
So now you've got all the different components.
We're gonna put it all together to do one exercise.
So first of all, imagine you need to fart, hold onto it, draw it up inside, imagine you need to pee, hold onto it, draw it up inside, you should relax your buttock, relax your legs.
It should be just the muscles inside.
Squeeze for as long as you can and then relax.
You'll only be able to hold onto it for one to two seconds at the start, but that will get longer as you progress.
So you just did one exercise, well done.
You do eight of those three times a day and that is the ideal workout for your pelvic floor.
Dr Zoe Williams to Dr Elizabeth Rogers:
I think at this stage probably what people really wanna know is what can they actually do?
And there is lots of things that they can do.
So what are your top tips and advice for how people can manage these symptoms if they are having them?
Dr Elizabeth Rogers:
As you demonstrated earlier, Zoe, pelvic floor exercise is really important.
Reducing caffeine intake is a really good place to start.
So caffeine irritates the bladder and not only that, it's what we call a diuretic and by that what I mean is it encourages your body to produce more urine.
So it's got a real double whammy effect there.
Coffee tends to be the biggest culprit.
However, there are other caffeine containing drinks such as fizzy drinks, tea and hot chocolate and even chocolate itself.
And in fact, some cold and flu relief medications have caffeine as well, so it's worth being aware of that.
If you're overweight, trying to lose some weight can help. It reduces the pressure on your pelvic floor.
And making healthy lifestyle choices such as reducing your alcohol intake.
And if you're a smoker, now is a really good time to think about quitting smoking.
In some cases if that's not working, your GP might consider referring you on rather for some further input with a physiotherapist or a continence advisor and what they do is something called bladder retraining.
And it's basically a way of helping you regain control over your bladder.
The cause of urinary incontinence depends on the type you have. An overactive bladder doesn’t always have a specific cause. Stress incontinence is caused by weak pelvic floor muscles. This can be due to lots of things, including pregnancy, the menopause, or constipation. For more information, see our causes of urinary incontinence section.
Don’t be embarrassed to talk to your GP if you have incontinence. They’ll encourage you to follow self-help measures, such as losing excess weight, drinking less caffeine and doing pelvic floor exercises. They may also recommend medicines or surgery. For more information, see our self-help for urinary incontinence and treatment of urinary incontinence sections.
There are several different types of urinary incontinence. The two main types are called urge incontinence and stress incontinence. If you have both types, this is called mixed incontinence. For more information, see our types of urinary incontinence section.
Having urinary incontinence may affect your life in lots of ways, including your work and leisure activities. It can get worse over time if it’s not treated. It can lead to problems in your relationships and sex life. So it’s important to speak to your GP about your symptoms.
Did our Urinary incontinence in adults information help you?
We’d love to hear what you think.∧ Our short survey takes just a few minutes to complete and helps us to keep improving our health information.
∧ The health information on this page is intended for informational purposes only. We do not endorse any commercial products, or include Bupa's fees for treatments and/or services. For more information about prices visit: www.bupa.co.uk/health/payg
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.
The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.
- Urinary incontinence. Patient. patient.info, last updated January 2024
- Renal medicine and urology. Oxford Handbook of General Practice (online). 5th ed. Oxford Academic. academic.oup.com, published online June 2020
- Urinary incontinence in adults. The MSD Manuals. msdmanuals.com, reviewed/revised September 2023
- Urology. Oxford Handbook of Clinical Surgery (online). 5th ed. Oxford Academic. academic.oup.com, published online November 2021
- Urinary incontinence in women. BMJ Best practice. bestpractice.bmj.com, last reviewed February 2024
- Management of normal delivery. The MSD Manuals. msdmanuals.com, reviewed/revised May 2021
- Lower urinary tract symptoms in men. Patient. patient.info, last updated November 2021
- Prostate cancer. The MSD Manuals. msdmanuals.com, reviewed/revised October 2023
- Pelvic floor dysfunction: prevention and non-surgical management. NICE guideline NG210. National Institute for Health and Care Excellence (NICE). nice.org.uk, published December 2021
- Park J, Lee H, Kim Y, et al . Effectiveness of fluid and caffeine modifications on symptoms in adults with overactive bladder: A systematic review. Int Neurourol J 2023; 27(1):23–35. doi: 10.5213/inj.2346014.007. Epub 2023 Mar 31. PMID: 37015722; PMCID: PMC10073005
- Duloxetine. NICE British National Formulary. bnf.nice.org.uk, updated February 2024
- Urinary incontinence and pelvic organ prolapse in women. NICE British National Formulary. bnf.nice.org.uk, updated February 2024
- Oxybutynin hydrochloride. NICE British National Formulary. bnf.nice.org.uk, updated February 2024
- Colposuspension for stress urinary incontinence (SUI). British Association of Urological Surgeons. baus.org.uk, published August 2020
- Urethral bulking injections for stress urinary incontinence (SUI). British Association of Urological Surgeons. baus.org.uk, published June 2023
- Incontinence of urine. British Association of Urological Surgeons. baus.org.uk, accessed March 2024
- Overactive bladder. Patient. patient.info, last updated November 2021
- Campbell KG, Batt ME, Drummond A. A feasibility study of the physiotherapy management of urinary incontinence in athletic women: trial protocol for the POsITIve study. Pilot Feasibility Stud 2020; 6:103. doi: 10.1186/s40814-020-00638-6. PMID: 32695435; PMCID: PMC7366300
- Squeezy. About Squeezy for women. squeezyapp.com/women/about-squeezy-for-women/, accessed June 2024
- Urinary incontinence in women. Prognosis. BMJ Best Practice. bestpractice.bmj.com, bestpractice.bmj.com/topics/en-gb/169/prognosis, last reviewed February 2024
- Victoria Goldman, Freelance Health Editor
