Urinary incontinence, or involuntary leakage of urine, is extremely common and can affect women at any age. Despite this, many women are embarrassed to talk about bladder leakage or assume that it is simply a normal part of pregnancy and having children, going through the menopause or getting older.
Miss Rhiannon Bray, Consultant Urogynaecologist at New Victoria Hospital, explains urinary incontinence and offers reassurance and guidance on the available treatments.
Is urinary incontinence normal?
Research has found that while urinary incontinence (UI) is common among women, many do not seek professional help. A UK community survey involving 1,415 women, conducted in 2015, found that around 40% of respondents reported UI, but only 17% had sought professional help. More recent research suggests that this reluctance to seek help persists. A 2023 UK study found that women often viewed urinary incontinence as a normal part of ageing, while embarrassment, limited information and the belief that healthcare professionals could not help were among the barriers to seeking support.
“As a Urogynaecologist, one of the most important messages I give women is that although urinary incontinence is common across age groups, it is not something you simply have to put up with. While prevalence increases with age, particularly around menopause, it is not a normal part of ageing, and there are many effective treatments available,” reassures Miss Bray, BSc, MBBS, MD, MRCOG.
Types of urinary incontinence
The first step is understanding what type of UI you have, as different types of bladder leakage have different causes and treatments.
The three main UI types are:
- Stress Urinary Incontinence (SUI)
- Urgency Urinary Incontinence (UUI)
- Mixed Urinary Incontinence (MUI)
What is stress urinary incontinence (SUI)?
If you leak urine when you cough, sneeze, laugh, exercise, run or jump, you may have stress urinary incontinence, the most common form of incontinence affecting approximately 20–30% of young adult women, rising to around 30–50% in women aged 45–59.
This happens when increased abdominal pressure pushes on the bladder, and the urethra cannot stay completely closed, resulting in leakage.
Pregnancy and childbirth are important risk factors, particularly following vaginal delivery, but other factors including increasing age, being overweight, and pelvic floor disorders, such as pelvic organ prolapse, can also contribute.
Symptoms vary considerably. For some women this may be an occasional small leak with a cough or sneeze, while for others it can prevent them from exercising or significantly interfere with everyday life.
What is urgency urinary incontinence (UUI)?
Urgency urinary incontinence is different. This is when you experience a sudden and compelling need to pass urine and may leak before you can reach the toilet.
This is often, but not always, associated with a condition called overactive bladder, where you may also need to pass urine frequently during the day and sometimes wake several times during the night.
What is mixed urinary incontinence (MUI)?
Some women experience both stress and urgency urinary incontinence. This is known as mixed urinary incontinence.
It is important to establish which type of leakage you are experiencing, and which symptom is causing you the most difficulty, because the treatments are different.
If bladder leakage is affecting your quality of life, you should seek medical advice. You don't need to wait until your symptoms become severe. You can book an appointment with a Urogynaecology specialist who can assess your symptoms and, if necessary, advise on the most appropriate diagnostic examinations and treatments.
What to expect during a consultation with a Urogynaecologist
An assessment will usually involve discussing when the leakage happens, how frequently you pass urine, and whether you have other symptoms such as urgency, recurrent urinary tract infections (UTIs), difficulty emptying your bladder, or any other symptoms and conditions such as a pelvic organ prolapse.
A bladder diary can be particularly useful. This involves recording what and how much you drink, how frequently you pass urine, the amount of urine you pass and when leakage occurs.
Not everyone with UI requires further investigations. However, depending on your symptoms, tests such as urodynamics, which assesses how your bladder stores and empties urine, may sometimes be recommended.
What are the most common UI treatments?
Surgical treatment is not always necessary and can vary depending on the type and severity of the incontinence.
Some of the most common UI treatments include:
- Lifestyle and behavioural changes
- Pelvic floor exercises
- Bladder training
- Prescription medication
- Vaginal oestrogen
- Urethral bulking
- Sling surgery
How is stress urinary incontinence treated?
Treatment for stress urinary incontinence usually starts with non-surgical approaches. Pelvic floor muscle training is one of the first treatments recommended, as the pelvic floor muscles support the bladder, uterus and bowel and play an important role in bladder control. Strengthening these muscles can help improve symptoms, particularly when they are carried out regularly and correctly, so working with a specialist pelvic health physiotherapist can be particularly helpful.
Lifestyle changes, including maintaining a healthy weight and treating constipation, can also be helpful.
If conservative treatments aren't sufficient, there are other options to consider.
Urethral bulking involves injecting a bulking agent into the wall of the urethra to help it close more effectively and reduce leakage.
Surgical procedures can also provide additional support to the urethra and may be considered when other treatments have not been effective or are not suitable.
The most appropriate treatment will depend on the type and severity of your symptoms, your medical history and your personal preferences. A specialist assessment can help you understand your options and decide which approach is right for you.
How is an overactive bladder treated?
Overactive bladder and urgency urinary incontinence require a different approach.
Treatment will often begin with reviewing your fluid intake, bladder habits, and symptoms. Bladder training aims to gradually increase the time between visits to the toilet and can help you regain control over urgency. Reducing excessive caffeine and other bladder irritants may also help.
There are also medications available which can reduce urgency and urinary frequency.
If these treatments don't provide sufficient improvement, there are further specialist options, including botulinum toxin (Botox) injections into the bladder and treatments which act on the nerves involved in bladder control.
Hormonal changes can also affect the bladder and urinary tract. Around and after the menopause, falling oestrogen levels can contribute to urinary and vaginal symptoms, including urinary urgency, frequency and recurrent UTIs. Vaginal oestrogen can be helpful for appropriate women, particularly when bladder symptoms occur alongside vaginal dryness, irritation or recurrent urinary tract infections.
Bladder leakage is common – but you don't have to live with it
Women can become remarkably good at adapting their lives around their bladder. You may stop running or exercising, avoid certain activities, wear pads every day, plan journeys around toilets or worry about going somewhere where you don't know where the nearest toilet will be.
These changes can happen gradually, and it is easy to underestimate how much urinary incontinence is affecting your quality of life.
There is no single treatment that is right for every woman, so the important thing is to identify the type and cause of your bladder leakage, so that treatment can be tailored to you. Seeking specialist advice is the first step towards taking back control of your bladder.
Frequently asked questions about urinary incontinence
Q: Is urinary incontinence a normal part of ageing?
A: No. Although urinary incontinence becomes more common with age, it isn't an inevitable part of getting older and can often be treated or improved.
Q: Can urinary incontinence be treated without surgery?
A: Yes. Depending on the type and cause, treatment may include pelvic floor muscle training, bladder training, lifestyle changes and medication. Some women may benefit from procedures or surgery.
Q: Can pelvic floor exercises help urinary incontinence?
A: Pelvic floor muscle training is a first-line treatment for stress and mixed urinary incontinence and is most effective when performed correctly and consistently.
Q: When should I see a doctor about bladder leakage?
A: You should seek medical advice if urinary leakage is affecting your daily activities, exercise, sleep, confidence or quality of life, or if you have other urinary symptoms.
Q: What type of doctor treats urinary incontinence in women?
A: A urogynaecologist specialises in conditions affecting the female pelvic floor, including urinary incontinence, overactive bladder and pelvic organ prolapse.
Urinary incontinence is common, but you don't have to simply accept it. If bladder leakage is affecting your quality of life, our Urogynaecology Consultants can assess your symptoms, identify the likely cause and discuss treatment options with you.
To arrange an appointment, please call 020 8949 9020 or complete our online enquiry form.
