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| What is urinary incontinence? |
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Reviewed by Dr Hilary McPherson, consultant obstetrician and gynaecologist and Dr Kate Patrick, specialist registrar
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| Although UI is common, many women don't report symptoms. |
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Urinary incontinence (UI) is a subject many of us find too embarrassing to talk about, leading many women to suffer in silence.
Even without the embarrassment factor, people tend to think it’s simply part of ageing and they have to put up with it.
This isn’t the case, because:
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around 80 per cent of urinary incontinence can be cured completely
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although it’s common after the menopause and your risk increases with age, it’s also common in pregnancy and after childbirth.
What is urinary incontinence?
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Did you know?
Men also suffer from incontinence, but in smaller numbers than women.
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Urinary incontinence is when you can’t control your bladder, so you pass urine when you don’t want to.
It happens when the pressure in your bladder is greater than the pressure in your urethra - the tube where urine comes out.
Urinary incontinence is a symptom rather than a disease. It can be caused by:
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birth defects
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pelvic surgery
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injury to the pelvic region or spinal cord
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neurological diseases
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multiple sclerosis
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polio
infection
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degenerative changes associated with ageing
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pregnancy or childbirth.
There are different types of urinary incontinence:
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stress urinary incontinence (SUI)
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urge urinary incontinence (UUI)
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mixed urinary incontinence (MUI)
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overflow urinary incontinence (OUI).
What is stress urinary incontinence?
Stress urinary incontinence happens when you sneeze, cough, laugh, lift or exercise. These activities place extra pressure on your bladder, causing accidental leaks.
Although bladder weakness is more common during pregnancy, after childbirth and after the age of 40, SUI can happen to women of any age. One in three women experience SUI at some point in their lives.
What is urge urinary incontinence?
Urge urinary incontinence happens when you feel an urgent need to empty your bladder, but can’t reach the toilet in time. You may be aware of the urge sensation but can't stop the leak before getting to the toilet. You may also:
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need to empty your bladder more frequently than normal, ie more than eight times a day
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pass less water than usual each time
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get up in the night several times to pass urine
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feel your bladder doesn’t empty completely
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leak when you hear running water.
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Term watch
Detrusor: the muscle in your bladder wall.
It relaxes to let urine into your bladder.
It contracts when you go to the toilet.
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Urge urinary incontinence is also known as 'overactive bladder' (OAB) and 'detrusor overactivity'. These terms relate to the main cause of UUI: uncontrollable contractions of the bladder muscle as the bladder fills.
UUI is the most common bladder problem in men and older people.
What is mixed urinary incontinence?
Mixed urinary incontinence is a combination of stress urinary incontinence and urge urinary incontinence.
If you do have both types, you’ll find that one type creates more of a problem for you than the other. This is the one that will be treated first.
What is overflow urinary incontinence?
Overflow urinary incontinence usually happens when there’s a blockage (such as a narrowing in the outlet tube), so your bladder doesn’t empty completely.
When your bladder refills, it puts pressure on the obstruction, which gives way slightly and you get a small leak of urine.
Overflow urinary incontinence is less common in women than SUI. It’s the most common type of urinary incontinence in men.
Who gets urinary incontinence?
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Did you know?
Urinary incontinence is about twice as common in women as it is in men.
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SUI affects over 2 million people in the UK and is extremely common.
It is estimated that approximately one third of women in the UK have stress incontinence according to the Bladder and Bowel Foundation.
Its figures show that urinary incontinence affects about one in eight middle-aged women.
A 1995 study by the Royal College of Physicians (RCP) breaks the figures down by age. According to its figures, UI affects:
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5-7 per cent of women aged 15-44
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8-15 per cent of women aged 45-64
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10-20 per cent of women aged 65 or over.
The RCP says more than 90 per cent of UI in women is due to stress or urge urinary incontinence.
A true picture?
However, the true figures are likely to be higher than these, because women don’t tend to report urinary incontinence - partly because they’re too embarrassed to talk about it, and partly because they don’t think anything can be done for it.
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In 1999 a British study questioned more than 1000 women aged 48. It found 50 per cent had reported symptoms of SUI in the previous year, and 22 per cent UUI.
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An American study looked at urinary incontinence in female soldiers with an average age of 28. It found nearly a third of them suffered UI during active duty or training that interfered with their job performance or was socially embarrassing.
What treatments are there for urinary incontinence?
There is a range of treatments available for urinary incontinence. The treatment your doctor recommends will be based on the type of UI you have and its severity. The main options are:
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References
Kuh et al: Kuh D, Cardozo L, Hardy R: (1999) Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort, Journal of Epidemiology Community Health. 53: 453-458.
Royal College of Physicians: (1995) Incontinence: causes, management and provision of services. A report by the Royal College of Physicians. 1-5.
Bulmer P Abrams. The overactive bladder. Rev Contemp Pharmacother 2000; 11: 1-11.
G Davis et al: Davis G, et al. Urinary incontinence among female soldiers. Mil Med 1999; 164(3):182-7.
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Based on a text by Dr Dan Rutherford, GP
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Last updated 11.11.2005
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