Let's Face It – Urinary incontinence in women

Urinary incontinence (UI) is the involuntary loss of large or small amounts of urine. With multiple types and causes, it’s something that 34% of women in the UK live with.¹ So, why isn’t it talked about enough?

As with most bodily functions, incontinence is unfortunately considered a societal taboo. The result? Silence and stigma. The more we’re able to face this taboo and talk openly about the causes and treatment available to those experiencing UI, the quicker they can receive the right support.

More common in women

While UI affects both men and women of all ages, it tends to be more common in women overall. In fact, incontinence affects roughly twice as many women as men² (and these figures could be even higher, given those who have UI might not talk to their doctor about it or not have the confidence to answer honestly in a survey).

Often linked to ageing and childbirth, incontinence can be perceived as something that’s a 'natural' or unavoidable aspect of life. This mindset can also deter women from seeking assistance.

While the risk of severe incontinence in men also increases with age, it’s still only about half of that in women.²

What causes urinary incontinence?

The cause of urinary incontinence can vary depending on the type of incontinence. It could include one or more of the following:

• Menopause: Hormonal changes during menopause can reduce oestrogen levels affecting the elasticity and strength of the pelvic tissues and bladder.
• Pregnancy and childbirth: Weakened pelvic floor muscles due to the physical changes during pregnancy and the process of childbirth.
• Obesity: Excess weight may put additional pressure on the bladder, increasing the likelihood of stress incontinence.
• Urinary tract infections: Temporary urinary incontinence due to inflammation and irritation of the bladder.
• Pelvic organ prolapse: When the bladder or uterus drops from its normal position, pressing on the bladder.
• Certain medications: Some medications can affect bladder control.
• Chronic coughing: Can lead to stress incontinence due to increased pressure on the bladder.
• Constipation: Can put pressure on the bladder and lead to issues with urinary control.
• Neurological disorders: For example, multiple sclerosis, Parkinson’s disease, or strokes can affect the nerves that control bladder function.

Risk factors

As well as common causes, some things can increase your risk of developing urinary incontinence without directly being the cause of the problem³ – known as risk factors.

Risk factors for urinary incontinence include:

• Ageing: Changes in the urinary tract and pelvic support structures can contribute to urinary incontinence. UI is more common in middle age and is very common in people over 80.
• Family history: There may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have the condition.³
• Having lower urinary tract symptoms (LUTS): A range of symptoms that affect the bladder and urethra (the tube that lets urine leave your bladder and your body).

Primary types of urinary incontinence

• Stress incontinence: When urine leaks out when your bladder is under pressure. Common causes might be coughing, sneezing, laughing, or physical exercise.
• Urge incontinence: A sudden, intense urge to pass urine followed by involuntary leakage. It is often associated with an overactive bladder.
• Urinary overflow: Accidentally passing urine because the bladder is too full. This occurs when the bladder isn't emptying completely, which causes urine to build up and then leak out.
• Functional incontinence: Due to physical or cognitive impairments that prevent a person from reaching the bathroom in time.

What lifestyle changes can I make to help with my incontinence?

• Pelvic floor exercises: Regularly performing Kegel exercises can strengthen your pelvic floor muscles, which support your bladder and help improve control.
• Bladder training: Gradually increasing the time between bathroom visits can help train the bladder to hold urine longer and reduce urgency.
• Dietary modifications: Limiting your intake of bladder irritants such as caffeine, alcohol, spicy foods, and artificial sweeteners can reduce symptoms. Staying hydrated is important, but it's also beneficial to monitor fluid intake to avoid overloading your bladder. Most people should aim to drink enough during the day, so their urine is a clear pale yellow colour.⁴
• Weight management: Maintaining a healthy weight can reduce pressure on your bladder and pelvic floor muscles, potentially alleviating symptoms.
• Regular physical activity: Engaging in regular exercise can improve overall muscle tone and support healthy weight management, contributing to better bladder control.
• Stop smoking: Quitting smoking can reduce coughing, which puts additional pressure on your bladder and can make incontinence worse.
• Scheduled bathroom visits: Establishing a regular bathroom schedule can help manage the frequency and urgency of urination.
• Avoiding constipation: Eating a fibre-rich diet and staying hydrated can help prevent constipation, which can put extra pressure on your bladder.

While these lifestyle changes can help alleviate symptoms, they may not completely eliminate incontinence. Consult your GP or specialist healthcare professional for personalised advice and treatment options that are best suited to you.

Medical support

There are several medical support options available if you’re experiencing incontinence, which are tailored to the type and severity of your condition. Common approaches include:

• Medications: Various medications can help manage incontinence by relaxing bladder muscles or increasing bladder capacity. Anticholinergics and beta-3 adrenergic agonists are commonly prescribed for overactive bladder symptoms.
• Physical therapy: Specialised physical therapists can guide patients through pelvic floor exercises and provide biofeedback to improve muscle strength and bladder control.
• Medical devices: Devices such as urethral inserts and pessaries can be used to support the bladder and reduce leakage, particularly in cases of stress incontinence.
• Injections: Botulinum toxin (Botox) injections into the bladder muscle can help reduce urinary urgency and frequency in cases of an overactive bladder.
• Nerve stimulation: Techniques like sacral nerve stimulation or percutaneous tibial nerve stimulation can help regulate bladder function by stimulating specific nerves.
• Surgical options: For severe cases, surgical interventions such as sling procedures, bladder neck suspension, or artificial urinary sphincters may be considered to provide more permanent solutions.
• Behavioural treatments: Techniques like bladder training and scheduled voiding can be supported by your healthcare professional to help you develop better bladder control.

Products to help with urinary incontinence

If you’re waiting for a diagnosis or for a treatment to work, there are a wide range of products and devices available for UI, including:

• Incontinence pads and pants
• Bed and chair protection
• Skincare and hygiene products
• Specially adapted clothing and swimwear

Full details can be found on the NHS website.

You may be able to get incontinence products on the NHS depending on your local integrated care board (ICB). Ask your GP for details of your local continence service. To qualify for NHS products, you may need to be assessed by a healthcare professional.

When to seek medical advice

Please don’t suffer in silence. Urinary incontinence is a common condition, one which can be effectively managed. See your GP if you’re experiencing any type of UI. They’ll be able to determine the most appropriate treatment based on your specific condition and needs.

Useful websites

• Bladder & Bowel UK – A charity that works to raise awareness and find solutions for bladder and bowel problems. It also offers independent advice on products that can help manage bladder and bowel problems. If you prefer to speak over the phone, its helpline is: 0161 214 4591.
• The Continence Product Advisor gives independent and evidence-based advice on how to choose and use suitable incontinence products.
• The NHS website also provides a lot of helpful information.
• Bladder Health UK offers support, help and information to assist those with bladder conditions to live positively. Confidential advice line on 0121 702 0820 with an expert patient (who has firsthand experience of suffering with Interstitial Cystitis for 20 years), a retired uro-gynaecology nurse and a specialist continence nurse.
• Bladder & Bowel Community help support the millions of people in the UK who are living with conditions that affect their bladder or bowel. Whether you have a condition yourself or are a relative, friend or carer of someone who does, you can find support, information, guidance and help.

References

1. Urinary incontinence in women – NICE
2. What percentage of the population are affected by incontinence? – Incontinence UK
3. Urinary incontinence causes – NHS
4. Water, drinks and hydration – NHS

More information on important women’s health topics can be found here.