Urinary Incontinence – GyneClinics

Female Urinary Incontinence

ncontinence is an involuntary leaking of urine. It is a very common and upsetting problem, but many women will not consult their doctors about this problem, as it is quite embarrassing. This burden and embarrassment may however affect self-esteem and place stress on relationships. There are 3 main types of incontinence: stress, urge, and mixed incontinence. More than half of incontinence is due to weakness of the neck of the bladder. This type is called stress incontinence.

Urinary Stress Incontinence is the leaking of small amounts of urine during normal, daily physical activities, such as laughing, coughing or exercise.

It affects women in all age groups, but the most common predisposing factors are childbirth and pregnancy. Other risk factors include obesity, smoking, and hysterectomy.

Urodynamic tests, which look at the function of the bladder, are performed to clarify the diagnosis but these tests are not always necessary as many patients can be treated symptomatically.

It’s now easier to get specialist help and appropriate treatment, than before. Help is available through lifestyle changes, various medications, pelvic floor exercises and surgery. There are available devices (pelvic toners, cones, etc), which help to ensure that pelvic floor exercises are done correctly and effectively, but patients need to be very motivated. It can take up to six months of regular exercises to notice a realistic difference. New medications are available for both types of incontinences, but the treatment of urge incontinence is largely medical. Side effects can limit prolonged use.

Surgery for Stress Incontinence

There are many different operations for stress incontinence. Recent advances have lead to the development of Injectables, which are compounds that can be injected around the urethra to help it to close more effectively. The newest and most hopeful of these is called Bulkimaid. Bulkimaid, is a new minimally invasive treatment for Stress Urinary Incontinence. This involves injection of Hyaluronic acid around the urethra at the bladder neck, which allows it to close more effectively and therefore improve or cure incontinence. (Hyaluronic acid occurs naturally throughout human body). This procedure can be done in the clinic setting, under local anaesthesia. About 30-40% of patients are cured of their incontinence whilst overall 60-70% will see a significant improvement after treatment. This procedure is particularly beneficial to younger women who have worrying stress incontinence, which is not severe enough to justify major surgery. It allows for vaginal birth in future, which is not the case with other surgical treatments. The treatment can last up to 3 years and it can easily be repeated when necessary. Although the cure rates are not as high as the more invasive operation, as a walk-in procedure, that takes only a few minutes, this treatment, is acceptable to many women who leak urine on exertion, who want more than pelvic floor exercises, but who do not wish for more involving surgical procedure.

Sub-urethral Sling; e.g. Tension free Vaginal Tape (TVT): This is now the most widely performed operation for stress incontinence. The idea behind it is that stress incontinence results from weakness of the supporting tissues of the urethra, from the top to the middle portion. The aim of the tape is to reinforce the supports to the mid-urethra and thus restore continence. The procedure can be performed under local, regional or general anaesthesia. The tape or sling is placed at the mid-urethra. Your specialist can discuss more with you about the pros and cons of this procedure. However, the major advantage of the TVT over the long established Colposuspension, is that it has a very quick recovery time. Colposuspension involved an abdominal incision and elevating the neck of the bladder, to avoid loss of urine, during cough. The results are quite similar with both procedures, but complications are different.

Patients for TVT are treated as day cases or have an overnight stay in hospital, and most are fully back to normal within two weeks. After colposuspension, patients stay in hospital for about five days and it is can take up to six weeks before they can resume normal activities. There are different types and modifications of these TVT-type sling procedures.

Overactive Bladder

An overactive bladder (OAB) is when the bladder contracts suddenly without you having control, and when the bladder is not full or expected to contract. Overactive bladder syndrome is a common condition where no cause can be found for the repeated and uncontrolled bladder contractions. Overactive bladder syndrome is common. Symptoms include an urgent feeling to go to the toilet, going to the toilet frequently, and sometimes leaking urine before you can get to the toilet (urge incontinence). Treatment with bladder training often cures the problem. Sometimes medication may be advised in addition to bladder training to relax the bladder. Overactive bladder syndrome is sometimes called an irritable bladder or detrusor instability. (Detrusor is the medical name for the bladder muscle).

Symptoms include:

Urgency. This means that you get a sudden urgent desire to pass urine. You are not able to put off going to the toilet.
Frequency. This means going to the toilet often – more than seven times a day. In many cases it is a lot more than seven times a day.
Nocturia. This means waking to go to the toilet more than once at night.
Urge incontinence occurs in some cases. This is a leaking of urine before you can get to the toilet when you have a feeling of urgency.

Causes of Overactive Bladder

The cause is not fully understood. The bladder muscle seems to become overactive and contract (squeeze) when you don’t want it to. Normally, the bladder muscle (detrusor) is relaxed as the bladder gradually fills up. As the bladder is gradually stretched, we get a feeling of wanting to pass urine when the bladder is about half full. Most people can hold on quite easily for some time after this initial feeling until a convenient time to go to the toilet. However, in people with an overactive bladder, the bladder muscle seems to give wrong messages to the brain. The bladder may feel fuller than it actually is. The bladder contracts too early when it is not very full, and not when you want it to. This can make you suddenly need the toilet. In effect, you have much less control over when your bladder contracts to pass urine. In most cases, the reason why an overactive bladder develops is not known. Symptoms may get worse at times of stress. Symptoms may also be made worse by caffeine in tea, coffee, cola, etc, and by alcohol. In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease such as following a stroke, with Parkinson’s disease, with multiple sclerosis or after spinal cord injury. Also, similar symptoms may occur if you have a urine infection or a stone in your bladder. These conditions are not classed as overactive bladder syndrome as they have a known cause.

Treatments for overactive bladder syndrome

Some general lifestyle measures may help.
Bladder training is a main treatment. This can work well in up to half of cases.
Medication may be advised instead of, or in addition to, bladder training.
Pelvic floor exercises may also be advised in some cases.

General Lifestyle Measures

Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
Caffeine. This is in tea, coffee, cola, and is part of some painkiller tablets. Caffeine has a diuretic effect (will make urine form more often). Caffeine may also directly stimulate the bladder to make urgency symptoms worse. It may be worth trying without caffeine for a week or so to see if symptoms improve. If symptoms do improve, you may not want to give up caffeine completely. However, you may wish to limit the times that you have a caffeine-containing drink. Also, you will know to be near to a toilet whenever you have caffeine.
Alcohol. In some people, alcohol may make symptoms worse. The same advice applies as with caffeine drinks.
Drink normal quantities of fluids. It may seem sensible to cut back on the amount that you drink so the bladder does not fill so quickly. However, this can make symptoms worse as the urine becomes more concentrated, which may irritate the bladder muscle. Aim to drink normal quantities of fluids each day. This is usually about two litres of fluid per day – about 6-8 cups of fluid, and more in hot climates and hot weather.
Go to the toilet only when you need to. Some people get into the habit of going to the toilet more often than they need. They may go when their bladder only has a small amount of urine so as “not to be caught short”. This again may sound sensible, as some people think that symptoms of an overactive bladder will not develop if the bladder does not fill very much and is emptied regularly. However, again, this can make symptoms worse in the long run. If you go to the toilet too often the bladder becomes used to holding less urine. The bladder may then become even more sensitive and overactive at times when it is stretched a little. So, you may find that when you need to hold on a bit longer (for example, if you go out), symptoms are worse than ever.

Bladder training (sometimes called Bladder Drill)

The aim of Bladder Drill is to slowly stretch the bladder so that it can hold larger and larger volumes of urine. In time, the bladder muscle should become less overactive and you should become more in control of your bladder. This means that more time can elapse between feeling the desire to pass urine, and having to get to a toilet. Leaks of urine are then less likely. A doctor, nurse, or continence advisor will explain how to do bladder training. The advice may be something like the following:

You will need to keep a diary. On the diary make a note of the times you pass urine, and the amount (volume) that you pass each time. Also make a note of any times that you leak urine (are incontinent). Your doctor or nurse may have some pre-printed diary charts for this purpose to give you. Keep an old measuring jug by the toilet so that you can measure the amount of urine you pass each time you go to the toilet. When you first start the diary, go to the toilet as usual for 2-3 days at first. This is to get a baseline idea of how often you go to the toilet and how much urine you normally pass each time. If you have an overactive bladder you may be going to the toilet every hour or so, and only passing less than 100-200ml each time. This will be recorded in the diary.

After the 2-3 days of finding your baseline, the aim is then to hold on for as long as possible before you go to the toilet. This will seem difficult at first. For example, it you normally go to the toilet every hour, it may seem quite a struggle to last one hour and five minutes between toilet trips. When trying to hold-on, try distracting yourself. For example: a) Sitting straight on a hard seat may help. b) Try counting backwards from 100. c) Try doing some pelvic floor exercises (see below).

With time, it should become easier as the bladder becomes used to holding larger amounts of urine. The idea is gradually to extend the time between toilet trips and to train your bladder to stretch more easily. It may take several weeks, but the aim is to pass urine only 5-6 times in 24 hours (about every 3-4 hours). Also, each time you pass urine you should pass much more than your baseline diary readings. (On average, people without an overactive bladder normally pass 250-350 ml each time they go to the toilet.) After several months you may find that you just get the normal feelings of needing the toilet, which you can easily put off for a reasonable time until it is convenient to go. Bladder training can be difficult, but becomes easier with time and perseverance. It works best if combined with advice and support from a continence advisor, nurse, or doctor. Make sure you drink a normal amount of fluids when you do bladder training (see above).

Medication

If there is not enough improvement with bladder training alone, medicines in the class of drugs called antimuscarinics (also called anticholinergics) may also help. They include: oxybutynin, tolterodine, trospium chloride, darifenacin, propiverine, and solifenacin. These also come in different brand names. For example Fesoterodine (Toviaz) – Fesoterodine is the most recent anticholinergic agent to be approved. It is available in 2 doses, and the 8-mg dose has been shown to be superior to tolterodine (Detrusiol LA) 4mg in the reduction of symptoms. It shares a similar muscarinic receptor affinity as tolterodine. They work by blocking certain nerve impulses to the bladder, which relaxes the bladder muscle and so increases the bladder capacity.

Medication improves symptoms in some cases, but not all. The amount of improvement varies from person to person. You may have fewer toilet trips, fewer urine leaks, and less urgency. However, it is uncommon for symptoms to go completely with medication alone. A common plan is to try a course of medication for a month or so. If it is helpful, you may be advised to continue for up to six months or so and then stop the medication to see how symptoms are without the medication. Symptoms may return after you finish a course of medication. However, if you combine a course of medication with bladder training, the long-term outlook may be better and symptoms may be less likely to return when you stop the medication. So, it is best if the medication is used in combination with the bladder training.

Side-effects are quite common with these medicines, but are often minor and tolerable. Read the information sheet which comes with your medicine for a full list of possible side-effects. The most common is a dry mouth, and simply having frequent sips of water may counter this. Other common side-effects include dry eyes, constipation and blurred vision. However, the medicines have differences, and you may find that if one medicine causes troublesome side-effects, a switch to a different one may suit you better.

Pelvic floor exercises

Many people have a mixture of overactive bladder syndrome and stress incontinence. Pelvic floor exercises are the main treatment for stress incontinence. Briefly, this treatment involves exercises to strengthen the muscles that wrap underneath the bladder, uterus (womb) and rectum. It is not clear if pelvic floor exercises help if you just have overactive bladder syndrome without stress incontinence. However, pelvic floor exercises may help if you are doing bladder training (see above).

Surgery for OAB

If the above treatments are not successful, surgery is sometimes suggested to treat overactive bladder syndrome. Procedures that may be used include:

Sacral nerve stimulation. An overactive bladder can be treated by sacral nerve stimulation. A small pulse generator device is implanted under the skin of the buttock to send a burst of electrical signals to the nerves that control the bladder.
Augmentation cystoplasty. In this operation, a small piece of tissue from the intestine is added to the wall of the bladder to increase the size of the bladder. However, not all people can pass urine normally after this operation. You may need to learn self-catheterising (put a small tube) o empty your bladder.
Urinary diversion. In this operation, the ureters (the tubes from the kidneys to the bladder) are routed directly to the outside of your body. There are various ways that this may be done. Urine does not flow into the bladder. This procedure is only done if all other options have failed to treat your overactive bladder syndrome.

Treatment of OAB with Botox (Botulinum toxin A)

This is an alternative treatment to surgery if other treatments including bladder training and medication have not helped your symptoms. The treatment involves injecting botulinum toxin A into the sides of your bladder. This treatment has an effect of damping down the abnormal contractions of the bladder. However, it may also damp down the normal contractions so that your bladder is not able to empty fully. If you have this procedure you usually need to insert a catheter (a small tube) into your bladder in order to empty it. Note: botulinum toxin A has not been licensed for the treatment of overactive bladder syndrome in the UK..

Treatment Of Urge Incontinence

Non surgical treatments are available for those who suffer from urge incontinence. One of the first approaches may be to ‘retrain’ the bladder to learn to hold on to urine for a little longer every few days. Anyone who is affected should try to keep an accurate bladder diary showing how often urine is passed during the day and night.
If there is not enough improvement with bladder training alone, medicines in the class of drugs called antimuscarinics (also called anticholinergics) may also help. They include: oxybutynin, tolterodine, trospium chloride, propiverine, darifenacin, and solifenacin. These also come in different brand names. They work by blocking certain nerve impulses to the bladder, which relaxes the bladd er muscle and so increases the bladder capacity.
Medication improves symptoms in some cases, but not all. The amount of improvement varies from person to person. You may have fewer toilet trips, fewer urine leaks, and less urgency. However, it is uncommon for symptoms to go completely with medication alone. A common plan is to try a course of medication for a month or so. If it is helpful, you may be advised to continue for up to six months or so and then stop the medication to see how symptoms are without the medication. Symptoms may return after you finish a course of medication. However, if you combine a course of medication with bladder training, the long-term outlook may be better and symptoms may be less likely to return when you stop the medication. So, it is best if the medication is used in combination with the bladder training.

Electrical nerve stimulation- may help block the urge to pass urine so often.
Botulinum toxin injections into the bladder muscle- it has been found that these injections can suppress the urge to urinate.
Hormone Replacement Therapy- (HRT) may also help with an overactive bladder. It replaces lost oestrogen, which is important for good bladder function

Treatment Of Stress Incontinence

Firs t-line treatment involves strengthening the pelvic floor muscles with pelvic floor exercises. About 6 in 10 cases of stress incontinence can be cured or much improved with this treatment. If you are overweight and

incontinent then you should first try to lose weight in conjunction with any other treatments. Surgery may be offered if the problem continues and is a significant problem. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery.

Strengthening the pelvic floor muscles – pelvic floor exercises

It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on how to do pelvic floor exercises correctly. Below are instructions you can follow yourself at home.

Learning to exercise the correct muscles:

Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your anus (back passage). You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don’t move your buttocks or legs.
Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise (ones nearer the front). These are the ones to strengthen. If you are not sure that you are exercising the correct muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercises.

Doing Kegel’s exercises:

You need to do the exercises every day.
Sit, stand or lie with your knees slightly apart. Slowly tighten your pelvic floor muscles under the bladder as hard as you can. Hold to the count of five, then relax. Repeat at least five times. These are called slow pull-ups.
Then do the same exercise quickly for a second or two. Repeat at least five times. These are called fast pull-ups.
Keep repeating the five slow pull-ups and the five fast pull-ups for five minutes.
Aim to do the above exercises for about five minutes at least three times a day, and preferably 6 -10 times a day.
Ideally, do each five-minute bout of exercise in a different position each time. That is, sometimes when sitting, sometimes when standing, and sometimes when lying down.
As the muscles become stronger, increase the length of time you hold each slow pull -up. You are doing well if you can hold each slow pull-up for a count of 10 (about 10 seconds).
In addition to the specific times you set aside to do pelvic floor exercises, try to get into the habit of doing them whilst going about everyday life. Pelvic floor exercises could be done when answering the phone, washing up, travelling, etc.
After several weeks the muscles will start to feel stronger. You may find you can squeeze the pelvic floor muscles for much longer without the muscles feeling tired.

It takes time, effort and practice to become good at these exercises. It is a dvised that you do these exercises for at least three months to start with. You should start to see the benefit after a few weeks. However, it often takes 8-20 weeks for most improvement to occur. After this time you may be cured from stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice. If possible, continue pelvic floor exercises as a part of everyday life forever, to stop the problem recurring. Once incontinence has gone, you may only need to do 1-2 five-minute repetitions each day to keep the pelvic floor muscles strong and toned up, and the incontinence away.

Other ways of exercising pelvic floor muscles

Sometimes a continence advisor or physiotherapist will advise extra methods if you are having problems performing the pelvic floor exercises. These are in addition to those described above. Examples include:

Electrical stimulation. Sometimes a special electrical device is used to stimulate the pelvic floor muscle s with the aim of making them contract and become stronger.
This is a technique to help you to make sure that you are exercising the correct muscles. For this, a physiotherapist or continence advisor inserts a small device into your vagina whe n you are doing pelvic floor exercises. When you squeeze the right muscles, the device makes a noise (or some other signal such as a display on a computer screen) to let you know that you are squeezing the correct muscles.
Vaginal cones . These are small plastic cones that you put inside your vagina for about 15 minutes, twice a day. The cones come in a set of different weights. At first, the lightest cone is used. You need to use your pelvic floor muscles to hold the cone in place. So, it is a way to help you to exercise your pelvic floor muscles. Once you can hold on to the lightest one comfortably, you move up to the next weight, and so on.
Other devices . There are various other devices that are sold to help with pelvic floor exercises. Basically, they all rely on placing the device inside the vagina with the aim of helping the pelvic muscles to exercise and squeeze. There is little research evidence to show how well these devices work. It is best to get the advice from a continence advisor or physiotherapi st before using any. One general point is that if you use one, it should be in addition to, not instead of, the standard pelvic floor exercises described above.

Surgery for Stress Incontinence

Various surgical operations are used to treat stress incontinence. They tend only to be used when the pelvic floor muscle exercises have not helped. The operations aim to tighten or support the muscles and structures below the bladder. The tension-free vaginal tape (TVT) procedure is the name of an operation often us ed to treat stress incontinence. It involves a sling of synthetic (man -made) tape being used to support the urethra and bladder neck. Colposuspension is the name of another operation to support the urethra and treat stress incontinence.

If you have a vaginal prolapse, especially one called a cystocele, surgical repair of this weakness (called an anterior repair) is often performed and the associated urinary incontinence can be treated. Other procedures involve injections of bulking agents around the bladder entrance, to keep it closed. These injections may be either natural materials (such as fat) or synthetic ones (such as silicone). In general, surgery for stress incontinence is often successful.

Medication for Stress Incontinence

Duloxetine (brand names Cymbalta®, Yentreve®) is a medicine that is usually used to treat depression. However, it was found to help with stress incontinence separate to its effect on depression. It is thought to work by interfering with certain chemicals that are used in transm itting nerve impulses to muscles. This helps the muscles around the urethra to contract more strongly. One study showed that in about 6 in 10 women who took duloxetine, the number of urine leakages were halved compared to the time before they took the medi cation. Therefore, on its own, duloxetine is not likely to cure the incontinence but may help to make it less of a problem. However, duloxetine in addition to pelvic floor exercises may give a better chance of curing the incontinence than either treatment alone. Duloxetine may be advised if pelvic floor exercises alone are not helping to treat your stress incontinence. It is usually advised in women who do not want to undergo surgery, or in women who have health problems that may mean that surgery is unsuitable.

Urinary Incontinence in Women

Urinary incontinence is involuntary loss of urine, what is not socially or hygienically acceptable. Millions of women experience involuntary loss of urine, meaning they pass or leak urine when they do not intend to. Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. Urinary Incontinence can be slightly bothersome or totally debilitating. For s ome women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause great emotional distress.

Urinary Incontinence is quite common and can occur at any age, but it is more likely to develop as you get older. It is estimated that about three million people in the UK are regularly incontinent. Overall this is about 4 in 100 adults. However, as many as 1 in 5 women over the age of 40 have some degree of urinary incontinence. It is likely that the true number of people affected is much higher. Many people do not tell their doctor about their incontinence, due to embarrassment. Some people wrongly think that incontinence is a normal part of ageing or that it cannot be treated. This is unfortunate as many cases can be successfully treated or significantly improved .

Understanding Your WaterWorks

The kidneys make urine continuously. A trickle of urine is constantly passing to the bladder down the ureters (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat. The bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles below the bladder that surround and support the urethra (the pelvic floor muscles). When a certain volume of urine is in the bladder, you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle contracts (squeezes), and the urethra and pelvic floor muscles relax to allow the urine to flow out. Complex nerve messages are sent between the brain, the bladder, and the pelvic floor muscles. These tell you how full your bladder is, and tell the correct muscles to contract or relax at the right time.

Types of Urinary Incontinence

There are several different types of urinary incontinence:

Stress incontinence is the most common type. It occurs when the pres sure in the bladder becomes too great for the bladder outlet to withstand. This is usually caused by weak pelvic floor muscles. Urine tends to leak most when you cough, laugh, sneeze or when you exercise (such as when you jump or run). In these situations there is a sudden extra pressure (stress) inside the abdomen and on the bladder. Small amounts of urine often leak. Sometimes much larger volumes of urine are accidentally passed. Pelvic floor muscles are often weakened by childbirth. Stress incontinence is common in women who have had several children, in obese people and with increasing age.

Urge incontinence (unstable or overactive bladder) is the second most common cause. This is when you get an urgent desire to pass urine. Sometimes urine leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. In most cases, the cause of urge incontinence is not known. This is called idiopathic urge incontinence. It seems that the bladder muscle gives wrong messages to the brain, and the bladder may feel fuller than it actually is. Sometimes urge incontinence can occur because of problems with the nervous system (the brain, spinal cord and other nerves in the body). Illnesses or diseases affecting the nervous system are called neurological disorders. Some people with certain neurological disorders may experience urge incontinence. Examples are Parkinson’s disease, multiple sclerosis (MS), spinal cord injury and after stroke.

Mixed incontinence. Women with genuine stress incontinence and overactive bladder are said to have mixed incontinence. For these patients, it is helpful to identify the most bothersome symptom and treat accordingly.

Overflow incontinence. This is when there is an obstruction to the outflow of urine. The obstruction prevents the normal emptying of the bladder. A pool of urine constantly remains in the bladder that cannot empty properly. This is called chronic urinary retention. Consequently, pressure builds up behind the obstruction. The normal bladder emptying mechanism becomes faulty and urine may leak past the blockage from time to time. Treatment depends on the cause.

Bedwetting (nocturnal enuresis) occurs in many children, but some adults are affected.

Functional incontinence is the name given to urinary incontinence where there is nothing obviously wrong with the nervous system controlling the bladder or the lower urinary tract (bladder/urethra) itself. An example would be incontinence because you were unable to reach the toilet, due to poor mobility.

Other types of incontinence exist. They include incontinence of urine when there is a congenital abnormality (birth defect) of the urinary tract; and problems that can occur after injury, accident or during operations.

Assessment and Treatment

An initial diagnosis of urinary incontinence can be made on the basis of a history alone, helped by physical examination and a few simple laboratory tests. Initial treatment may be based on these findings. If complex conditions are present or if initial treatments are unsuccessful, definitive specialized studies are required. Urinary incontinence can often be improved, and can be cured in many cases. Urinary incontinence is treated differently according to the type and cause.

Assessment

It is important to know which type of incontinence you have. Tell your doctor if you leak urine on a regular basis. He or she will be able to assess your symptoms, examine you, and may do some simple tests to try to clarify the cause. You may also be asked to keep a diary for at least three days to assess how often you go to the toilet, how much urine you pass each time, and how often you leak urine. Sometimes a referral to a specialist is needed to clarify the type of incontinence. The sort of tests that may be done by your GP or specialist to clarify the cause include the following:

Urinalysis. This is a simple dipstick test to check for infection, glucose (sugar), blood or protein in urine. A urinary tract infection (UTI) can cause incontinence, particularly in ol der people. Diabetes causes sugar in the urine and may cause increased thirst and an increased desire to urinate. Diabetes also puts you at more risk of UTI.
Residual urine. This test finds out if any urine is left in your bladder, and how much urine is l eft, after you have gone to the toilet. The amount of urine is usually measured using an ultrasound scan which can look at your bladder and measure the amount of urine in it. Sometimes, another method is used: a doctor or nurse may pass a thin catheter (a thin soft tube) into the bladder via the urethra. Urine then drains out to be measured.
Vaginal and anal examination. A doctor or nurse may insert a gloved finger into the vagina to assess the strength and tone of the pelvic floor muscles, and if there is any problem with bladder or urethra or if these are signs of pelvic organ prolapse during the vaginal examination.
Urodynamics. These are tests of urine flow that are sometimes done in a hospital unit if the cause of the problem is not clear. Urodynamics may also be carried out where surgery is considered to treat the problem (see below).
Bladder Diary – The 24-hour bladder diary can provide an accurate record of urinary output, average voided volume, frequency of voiding, and frequency and nature of incontinent episodes, as well as type and volume of fluid intake. You may be asked to catch and measure you urine output in a measuring cup during any “normal” 24-hour period you choose.

Treatment

Treatment depends on the type of incontinence, whether it is a Stress or Urge Incontinence (the commonest two types) or whether it is Mixed Incontinence. Conditions such as Bedwetting (Nocturnal Enuresis) will need to be addressed if relevant. For example: pelvic floor exercises may cure or improve stress incontinence ; bladder training may help urge incontinence; an alarm system may cure enuresis; medications are sometimes used to help stop urge and stress incontinence, and also to stop enuresis. Other types of incontinence are less common and treatments vary, depending on the cause. However, regardless of the type of incontinence, lifestyle changes may also significantly help some types of incontinence. These can include:

Managment of Fluid Intake

Changing How Much You Drink. If you drink large volumes, it follows that you will pass more urine. If you suffer with incontinence, you should not restrict your fluid intake too much, as you risk dehydration. Restricting fluids can also irritate the bladder and so make urge incontinence worse. However, if you drink excessively, moderation may improve your symptoms. 6-8 glasses of water per day is recommended by the NHS, but there is no scientific evidence we should drink that much. In practical terms, it is best to drink when we need to, to quench our thirst. Note that about one fifth of our daily water intake comes from food. that other drinks contain water.

Changing What You Drink may help. Drinks containing caffeine (for example, tea, coffee, hot chocolate and cola) make urge incontinence worse. This is because caffeine is a natural diuretic. Diuretics are chemicals that make you need to pass urine. You might consider switching to decaffeinated alternatives. Also, Changing When You Drink. You should try to maintain a normal life as much as possible with regard to drinking an d visiting the toilet. However, drinking late at night may mean your sleep is disturbed by the desire to get up and go to the toilet. If you have kept a bladder diary, the diary enables your doctor to make helpful suggestions regarding the type and amount of fluid intake.

Weight Loss.

It has been shown that losing a modest amount of weight can improve urinary incontinence in overweight and obese women. Even just 5-10% weight loss can help symptoms. If you are overweight and incontinent then you should first try to lose weight in conjunction with any other treatments.

Toilet habit.

This is also dealt with in bladder training but in general it is best to visit the toilet only when you need to, rather than “just in case”. Depending on how much (and what) you are drinking, and your level of activity (how much you are sweating), it is normal to pass urine every 3 -4 hours on average.

Avoiding Constipation.

Try to maintain a healthy balanced diet that contains plenty of fruit, vegetables and soluble fibre. Sever e chronic (long-term) constipation can stop the bladder emptying properly and cause overflow urinary incontinence (as well as faecal incontinence). Dehydration can also cause constipation.

Physiotherapist and Continence Advisor

Your GP may advise on treatment or refer you to a continence advisor for advice on bladder training and pelvic floor exercises. Sometimes physiotherapists can help with pelvic floor exercises. In some situations, you and your doctor may decide to wait and see how things go before trying treatment. This is because some mild cases get better on their own, over time without treatment. Sometimes a specialist (usually urogynaecologist) needs to be involved in more difficult cases. Surgery can be used to treat incontinence, especially stress incontinence. If your incontinence persists and is not helped by treatment, your local continence advisor can give practical advice on how to manage. They may be able to supply incontinence pants, pads and other products. These days there are many different aids, gadgets and appliances that can greatly help when living with incontinence.