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Urinary incontinence in women

Expert reviewer, Emma Mitchell, Physiotherapist at Bupa UK and Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics
Next review due October 2024

Urinary incontinence is when you pass urine (pee) without meaning to. It’s common in women, particularly as you get older. If you have urinary incontinence, it can be embarrassing and may affect every area of your life. If you find yourself just putting up with it, you’re not alone. But there’s actually a lot of help available and incontinence can often be treated.

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Types of urinary incontinence

There are two main types of urinary incontinence in women.

  • Urge incontinence. This is when you feel a sudden need to pee without warning which is difficult to put off. You have to go to the toilet then and there.
  • Stress incontinence. This is when urine leaks when you sneeze, cough or exert yourself.

You can also have 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 sometimes, but not always, leads to urge incontinence.

Symptoms of urinary incontinence

The main symptom of urinary incontinence is leaking urine. But this can vary quite a bit, from leaking a few drops to partly or totally emptying your bladder.

If you have urge incontinence, you’ll feel a sudden urge to pee which you can’t put off. You may not be able to make it to the toilet in time. You may also need to go to the toilet at night and sometimes leak at night too.

If you have stress incontinence the main symptom is leaking urine when you do things like cough, sneeze, lift something heavy or exercise.

If you have mixed incontinence, you may have all of these symptoms.

You may have other symptoms such as:

  • needing to pee often
  • dribbling urine after you’ve been to the toilet
  • it hurts or stings when you pee
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Causes of urinary incontinence

The cause of urinary incontinence depends on the 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 be caused by neurological conditions such as a stroke. Often, no cause is found.

Some things which make having stress incontinence more likely include the following.

  • Being pregnant and having a vaginal birth. This stretches and weakens your pelvic floor muscles, which can lead to incontinence. Stress incontinence is more likely if you needed an episiotomy during childbirth. This is a cut to the area between your vagina and anus. Stress incontinence is also more likely if you have more than one pregnancy.
  • Being overweight.
  • Being constipated.
  • 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 the normal position.

Other causes of incontinence include:

  • a urine infection
  • drinking too much caffeine
  • Parkinson’s disease
  • a long-term cough
  • strenuous activity such as weight-lifting
  • some medicines

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 to find out which type of incontinence you have and to rule out any underlying causes. Your GP will also ask about any medicines you may be taking.

Your GP should examine you too. They’ll feel your tummy and probably do an internal examination. This means putting a finger into your vagina and asking you to squeeze your pelvic floor muscles. This can help to show how well the muscles are working.

Your GP may ask you to keep a ‘bladder diary’ for a few days. This means writing down when you pee, how much urine you pass and if you have any incontinence. It’s best to fill in your diary on both work and non-working days to give a complete picture.

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 to decide what type of incontinence you have.

Self-help

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.
  • Losing weight if you’re overweight.
  • Changing the amount of fluid you drink each 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.

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
  • using a handheld urinal
  • using devices that you insert into your urethra or vagina to prevent leaks. These can’t be used all the time, but may help in some situations (for example, during exercise).

Treatment of urinary incontinence

Treatment for incontinence usually starts 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 our section on self-help.

Treatment depends on the type of incontinence you have.

Treatment for stress incontinence

There are three main treatments for stress incontinence.

  • Pelvic floor muscle training (Kegel exercises). Your pelvic floor muscles help to control your bladder and bowel. Strengthening and toning these 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 three months to see if they help. If you have problems tightening your pelvic floor muscles, using biofeedback or electrical stimulation may help. Biofeedback is when sensors placed on your skin or in your vagina 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 uses an electrical current to stimulate your pelvic floor muscles. It involves having a small electrical probe placed in your 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.
  • Surgery. Your doctor may suggest surgery for stress incontinence if other treatments haven’t helped. The different types of surgery are described below.

Surgery for stress incontinence

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.

  • Colposuspension. Your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone.
  • Sling surgery. In this procedure, your surgeon will place a piece of your own tissue under your urethra. This acts as a sling to support it.
  • Injections of bulking agents into the wall of the urethra. This narrows your urethra, helping it to stay closed and so hold urine in your bladder. The effects of this procedure may wear off over time. So, you may need to have further injections.
  • Artificial sphincters. If you’ve already had surgery for stress incontinence and this hasn’t worked, you may be offered an artificial urinary sphincter.

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.

Treatment for urge incontinence

There are several different types of treatment for urge incontinence.

  • Bladder training. This 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). These help to stop the muscle in your bladder from tightening when it shouldn’t. They can take about a month to work and can cause a dry mouth and constipation. But these can be signs that the medicine is working.

If these treatments don’t work, there are other options.

  • Botulinum toxin A. 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.

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.

Prevention of urinary incontinence

Being overweight, being constipated, lifting heavy weights and drinking a lot of caffeine all make incontinence more likely. So, if you’re worried about incontinence, try to maintain a healthy weight, eat and drink healthily and modify the strenuous exercise you do.

You may be able to prevent incontinence during pregnancy and in the first few months afterwards by doing pelvic floor exercises while you’re pregnant. Ask your midwife for more information.

Frequently asked questions about urinary incontinence in women

  • The cause of urinary incontinence depends on the type you have. All types of incontinence get more likely as you get older. Things that increase your risk of stress incontinence include being pregnant, giving birth vaginally, being overweight and being constipated. For more information, see our section on causes of incontinence.

  • Don’t be embarrassed to talk to your GP if you have incontinence. They’ll encourage you to follow self-help measures. These include losing excess weight, drinking less caffeine and doing pelvic floor exercises. Depending on what type of incontinence you have, medicines or surgery may be an option for you. For more information, see our section on treatment of incontinence.

  • The two main types of urinary incontinence are called urge incontinence and stress incontinence. With urge incontinence, you feel a sudden urge to pee which is difficult to put off. You need to rush to the toilet. Stress incontinence is when urine leaks out if you sneeze, cough or do strenuous exercise (especially lifting weights). You may have both types – this is called mixed incontinence.

  • Having urinary incontinence may affect your life in many areas. It can cause problems with work and leisure activities and lead to problems in your relationships and sex life. You may feel less like going out and become socially isolated, anxious and even depressed. Many women don’t seek medical help, perhaps because they feel embarrassed. But there’s a lot of help available, and things that you can do yourself to help improve your symptoms. For more information, see our sections on self-help and treatment.



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Related information

  • Discover other helpful health information websites.

    • Urinary incontinence and pelvic organ prolapse in women: management. National Institute for Health and Care Excellence (NICE), 2019. nice.org.uk
    • Incontinence – urinary, in women. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2019
    • Urinary incontinence in women. BMJ Best practice. bestpractice.bmj.com, last reviewed September 2021
    • Urinary incontinence relevant anatomy. Medscape. emedicine.medscape.com, updated October 2019
    • Urinary incontinence. Medscape. emedicine.medscape.com, updated July 2021
    • Urinary incontinence. Patient. patient.info, last edited May 2019
    • Urinary incontinence in adults. MSD Manuals. msdmanuals.com, last full review/revision April 2020
    • Woodley SJ, Boyle R, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2020, Issue 5. doi: 10.1002/14651858.CD007471.pub4
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, October 2021
    Expert reviewer, Emma Mitchell, Physiotherapist at Bupa UK and Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics
    Next review due October 2024

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