Urinary incontinence affects millions of women worldwide, and a significant number of men, too. Many people dislike the word ‘incontinence’ as it implies a total lack of control over urination, and prefer terms such as urinary leakage, bladder weakness, sensitive bladder, overactive bladder, or oops moments. Whether or not you experience slight dampening or complete loss of bladder control, there are products and devices available to help control and even cure your symptoms.
How common is urinary incontinence?
World-wide, as many as 200 million women are believed to experience significant urinary incontinence, and the number is much higher when slight damping or occasional accidents are taken into account. Most surveys show that between 20% and 45% of women experience significant urinary leakage at least twice a month. The number affected increases with age, and among women over 60, more than one in three report daily urinary leakage.
The number of men who experience urinary incontinence is approximately half that in women. Urinary leakage affects at least 1 in 10 men overall, rising to as many as one in three older men, of whom 2% to 11% reporting daily urinary incontinence.
Despite the size of the problem, over a third of people who experience urinary leakage have not seen their GP through embarrassment or a mistaken belief that nothing can be done. On average, women wait an average of 6.5 years from the first time they experience symptoms until they seek help and are diagnosed with a bladder control problem. Yet, around 70% of bladder control problems can be cured, and most other situations are dramatically improved by medical advice and treatment.
If you are experiencing bladder leakage, do see your doctor to find out the best treatment options for you.
Urinary leakage products
Modern incontinence pads are slim and easy to use, and will help tide you over until your symptoms improve with treatment. A wide range of effective and discreet products is available to mop up leaks. View the full range at Boots.com.
Pretty Clever Pants, designed by Carol Smillie, are attractive waterproof and leakproof cotton underwear that look and feel like normal knickers. They have a secret water proof layer that you can’t see or feel, with some featuring attractive lace side panels. Available from Amazon.co.uk and from Boots.com for international shipping.
If you prefer to use your own underwear, a range of incontinence pads are also available for men or women, which absorb leaked fluid to form a gel, preventing leaks and trapping odours. Having these shipped straight to your door from Amazon.co.uk or Amazon.com avoids the embarrassment of buying them in a shop, and usually works out cheaper with special offers and subscription deals.
Types of urinary incontinence
Urinary incontinence is an umbrella term for any involuntary urinary leakage, of which there are several different types, of which the most common are:
Stress urinary incontinence – involuntary leakage when increased pressure ‘stresses’ the valve mechanism that normally keeps the bladder closed. This causes urine to leak on effort or exertion, such as when jumping, sneezing or coughing. Smoking, and taking some drugs, such as ACE inhibitors (used to treat high blood pressure) can cause cough and make stress incontinence worse.
Urgency urinary incontinence – involuntary leakage accompanied by a sudden, compelling desire to pass urine which is difficult to ignore. This urgency may be associated with over active bladder (OAB) syndrome in which there is also increased urinary frequency and a need to pass urine at night so you are often rushing to the bathroom.
Mixed urinary incontinence – involuntary leakage that is associated with both urgency and physical effort such as exertion or coughing.
Urinary incontinence can also occur as a result of neurological conditions, diabetes, congestive heart failure and other medical conditions.
If recurrent urinary tract infections is a problem, click here for more information.
Causes of female stress urinary incontinence
The bladder is essentially a fluid storage bag that’s kept closed by a ring of muscles (sphincter). The bladder is supported within the pelvis by a sling of pelvic floor muscles. When the bladder is not well supported, it doesn’t take much increased pressure within the bladder to overcome the sphincter holding it shut. A sudden increase in intra-abdominal pressure during lifting, coughing, laughing, sneezing or running then causes urine to leak out.
Being overweight: One potential trigger which his often overlooked is being overweight, which puts additional strain on the muscles that control bladder opening. Losing weight, and performing pelvic floor exercises, as described below, will almost always solve the problem.
Physical exercise: Physical activity can lead to stress incontinence, so that between 28% and 52% of female athletes experience urinary leakage during exercise.
Pregnancy and childbirth: The pelvic floor muscles are stretched during pregnancy and childbirth, so that two out of three women experience stress incontinence during pregnancy. One study found that 12 months after delivery, more than one in two (54%) still have stress incontinence and more than one in three (37%) still experienced some degree of urinary urgency. The pelvic floor exercises described below can solve this problem in almost all cases.
Menopause: Urinary leakage can become a problem in later life, when muscles that were previously stretched during childbirth naturally become thinner and weaker as oestrogen levels fall after the menopause. This can cause the bladder to bulge into the front of the vagina, causing a pouching known as a cystocoele. Weakness can also occur as a result of a prolapse or a hysterectomy.
Constipation: The pelvic floor muscles can also weaken if you are constipated and strain on the toilet.
Causes of urge urinary incontinence
Urge urinary incontinence, or overactive bladder, is due to involuntary contraction of muscles in the bladder wall. Urgency can result from irritation if there is a urinary tract infection. Overactive bladder can also occur from damage to the nerves or muscles involved in controlling urination.
Causes of male urinary incontinence
For men, one of the most common causes of urinary leakage is having an enlarged prostate (benign prostatic hyperplasia, or BPH for short).
Men can also experience stress urinary incontinence on exertion, due to weakened bladder support muscles, or poor functioning of the sphincter muscles that normally keep the urethra closed. This can follow prostate surgery, injuries to the urethral area, or taking drugs such as alpha blockers (prescribed to treat high blood pressure or prostate symptoms) which relax the bladder outlet.
Men can also experience urge urinary incontinence due to overactive bladder muscles.
How urinary incontinence is diagnosed
Your doctor will ask questions to determine the type of urinary incontinence you have, and to identify any contributing factors such as medication side effects, diabetes, or urinary infection. For women, an internal examination (ask for a female doctor if you prefer) is needed to assess the size of the womb and ovaries, and how well your bladder is supported. For men, a rectal examination is important to assess the size of the prostate gland. Don’t be put off by the need for these examinations – although no one likes having them done, they do not take long, should not hurt, and provide invaluable information to help assess the cause of the problem and the best treatments.
A urine sample will check for signs of infection, protein, glucose or hidden blood, and you may have a blood test to assess how well your kidneys are working.
You may be asked to keep a bladder diary for at least 3 days to record the amount and types of fluid you drink, how much urine you void during the day and night, how many times you experience urgency or leakage, how many pads and clothing changes you need, and so on.
The ‘normal’ number of times to pass urine is four to eight times a day, including one void at night. If you pass water more often than this at night, then you may have an underlying conditions such a high blood pressure or, for men, an enlarged prostate gland. Click here to find out more about having to get up to pass water at night (nocturia).
In some cases, further investigation is needed to measure your urinary flow, bladder pressure, and to see whether your bladder muscle is irritable.
Pelvic floor exercises
If you have pure stress incontinence, your doctor will usually refer you for a program of supervised pelvic floor muscle training exercises (PFMT) overseen by a continence adviser, a nurse specialist or a physiotherapist.
Often known as Kegel exercises, after the doctor who first described them (as far back as 1948), these exercises are designed to strengthen the pubococcygeal muscles supporting the bladder, vagina and rectum.
There are two types of muscle fibre involved:
- slow twitch fibres – which need multiple repeated contractions to retrain them
- fast twitch fibres – which need maximum “squeeze” effort to retrain them.
Pelvic floor muscle training programs will teach you how to do pelvic floor muscle exercises correctly, and can produce a dramatic improvement in symptoms. Research shows that performing at least 8 contractions, 3 times a day, for at least 3 months, is needed for effectiveness – and ideally more.
Jane Wake – INNOVO spokesperson, female fitness professional and pelvic floor expert advises the following:
STEP 1 How to find your pelvic floor
Sit tall on a chair and lean slight forward.
Make sure your buttocks are pulled out from underneath you and you can feel your ‘sitting bones’ on the chair.
Visualise your pelvic floor like a hammock underneath you that goes from your tailbone (coccyx) at the back to your pubic bone at the front.
Take 3 deep breaths and close your eyes relaxing as much as you can.
On your 4th breath, as you breath out and relax try to connect to your pelvic floor by first drawing up through your back passage as if trying to stop wind, then pull up through your front passage as if trying to stop urine.
Imagine then pulling these two points together and up inside you. Think of pulling up through the vagina.
STEP 2 Pelvic floor exercises
Once you’ve found your pelvic floor, do the following…
Volume switch full power
Contract your pelvic floor as described above, keep turning up the feeling in your pelvic floor, as if it’s a volume switch that you can turn up and up and get stronger and stronger. Allow the muscle to relax back down – it is really important so do this slowly, feeling the muscles completely let go. Repeat turning it back on and up – as high as you can go, then relax back down. Repeat this for as many as you can – your aim is to be able to do 10 contractions.
Volume switch half power
Contract your pelvic floor as described above, except this time turn the volume up half way, so not all of your effort. Now take some deep breaths and try to maintain the hold for 2 – 3 breaths. Release and let it go and repeat as many as you can, up to 10 times.
The 5 floor lift
Imagine your pelvic floor is a lift going up 5 floors. Contracting your pelvic floor as described above, lift up to 1st floor – 20% of your effort, hold, then lift up to 2nd – 40% of your effort, hold, then keep lifting and holding on each floor, going as high as you can (you may not get to 5th floor – that’s fine!) lower back down aiming to halt at each floor on the way down until you go back to ground level – i.e. relaxed. (This is really hard so don’t worry if it just falls to zero! But the more you do it, the more you will be able to control this feeling – so keep trying!) Release and let it go and repeat as many as you can, up to 10 times.
Quick squeezes or ‘flick switch’
Contract your pelvic floor as described above but this time pull up quickly – think of it like a flick switch. Very importantly, allow the muscle to relax after you have flicked it on, so flick off! But give yourself a second or two longer to relax before you flick it on again. Repeat this as many as you can, up to 10 times.
STEP 3 How to fit pelvic floor exercises into your day
Unlike any other form of exercise this really is easy to fit in. That’s because you can do them any time anywhere, you don’t need a class, gym, personal trainer – you just need you!
It doesn’t matter then when you do your exercises – you just have to do them ideally 3 times a day, and if your pelvic floor is weak, it’s important to spread these out throughout the day – i.e. once in the morning, noon and night, so that your pelvic floor rests and recovers in-between.
Here’s a schedule you can follow but remember – it’s about fitting it into your life, not the other way around, so use this as a guide, then get your diary out and see where/when it can work best for you, and use an alarm on your phone or the INNOVO app to remind you.
7 A.M – In the shower, while cleaning teeth, waiting for the kettle to boil
- Flick switch x 10 (total 30 seconds)
8.A.M – On the train/bus, reading the morning paper/ a magazine
- Volume switch – full power x 10
- Volume switch – half power x 10
- 5 floor lift x 10 (6 mins total)
11 AM – Standing at the photocopier, or waiting for coffee in coffee shop
- Flick switch (total 30 seconds) or if you have longer also do…
- Volume switch – half power x 10 (1-2 mins)
1 PM – While having lunch
- Volume switch – full power x 10
- Volume switch – half power x 10
- 5 floor lift x 10 (6 mins total)
3 – 6PM – Waiting at the school gate, waiting for a train/bus, on a train/bus, sat in a waiting room…
- Flick switch x 10
- Volume switch – full power x 10
- Volume switch – half power x 10
- 5 floor lift x 10 (7 mins total)
6 – 10PM – Eating dinner, sat in front of TV, sat at a bar, in the cinema, reading a book…
- Flick switch x 10
- Volume switch – full power x 10
- Volume switch – half power x 10
- 5 floor lift x 10 (7 mins total)
Quality, rather than quantity is the key when it comes to pelvic floor exercises. It’s better to do them well, twice a day, than to do them badly ten times a day.
These simple measures can produce a dramatic improvement, and are even more effective if performed against a resistance device.
You should also pull in your pelvic floor muscles before coughing, sneezing or lifting and avoid standing for long periods of time.
Identifying pelvic floor muscles for men
The easiest way to identify the male pelvic floor muscles is to start urinating, then concentrate on stopping the flow mid-stream. Practice this every time you visit the bathroom until you are able to accurately squeeze these muscles at will when sitting, walking or lying down. Once you can do this, start exercising them regularly.
- Start with ten quick squeezes, holding each one for the count of three. Repeat two or three times a day.
- Build up to 20 quick squeezes at a time, holding each for the count of three
- After around a month, add in five long, slow squeezes after your 20 quick squeezes. Squeeze in to a count of ten, then hold for a count of ten.
- When you are comfortable with these, build up to ten long, slow squeezes after each series of 20 quick squeezes.
Devices to strengthen your pelvic floor muscles
An estimated 40% of women find it difficult to voluntarily contract their pelvic floor muscles as they find it hard to distinguish between the muscles in their buttocks and the muscles inside the pelvis. You may be shown how to insert one or two fingers into your vagina so that you can practice squeezing these until you can recognise which muscles are involved. Incontinence advisors may also suggest a course of biofeedback, in which a probe is gently inserted into the vagina to measure muscle active. This shows when you are contracting the right muscles, and how the strength of contraction can increase.
A physiotherapist can also help strengthen your pelvic floor muscles using a tiny electric current – two electric pads are placed on the perineum to stimulate the muscles at regular intervals. Several devices are also available to help you perform pelvic floor exercises more easily in your own home, too.
Weighted cones for urinary incontinence
Weight cones help to boost the effectiveness of pelvic floor exercises. These vary in weight from 5g to 55g and are worn internally for 5-10 minutes a day to tighten and tone vaginal muscles which have to contract to hold the cone in place. They will not suit everyone, however, and you may find them easiest to use under the supervision of an incontinence advisor.
Pelvic toners for urinary incontinence
Pelvic toners are a progressive resistance vaginal trainer device which is inserted into the vagina to give you something to squeeze against. User trials suggest this can improve symptoms in 42% of women after one week, rising to 79% after one month.
INNOVO for urinary incontinence
INNOVO is a clinically-proven and non-invasive device that is suitable for use by both men and women. INNOVO uses a hand-held controller attached to a two-part garment that fits over your thighs. This sends targeted impulses directly to the pelvic floor muscles via a set of conductive pads attached to your upper thighs and buttocks.
INNOVO exercises your pelvic floor muscles to improve stress incontinence without you having to do anything – the technology is designed to optimally strengthen your pelvic floor with over 180 perfect contractions per session, to do your pelvic floor exercises for you.
When following the 12-week program, via an app, 93% of users found a significant improvement after 4 weeks use and 86% were dry or near dry after 12 weeks. Available from Amazon.co.uk.
Other electronic devices that work internally and which have clinical evidence to support their use include the Elvie Trainer. the Kegel Fit Pelvic Floor Exerciser, and the TensCare iTouch Sure pelvic floor exerciser.
vSculpt for urinary incontinence
vSculpt is a new, home-use device that uses a combination of red and infrared light-emitting diodes, thermal heat and therapeutic vibration to stimulate collagen production, strengthen pelvic floor muscles and reduce stress incontinence. The intra-vaginal wand delivers a combination of light energy with thermal heat and sonic vibration and helps women gain control and confidence with just 10 minutes use, every other day, for a course of six to eight weeks.
vSculpt pelvic floor toner has been clinically validated to improve stress incontinence, strengthen the muscles of the pelvic floor, reduce vaginal dryness, and regenerate vaginal tissues within 45 days. In an independent clinical study, participants reported that:
Nine out of ten users said their bladder leakage was reduced. |
Self-help for urinary incontinence
Reduce caffeine intake to improve symptoms of urgency and frequency.
Drink 6 to 8 glasses of water per day to maintain hydration. Cutting back on fluid intake isn’t the answer. While it may reduce urinary volume, it also increases its concentration so it is more irritating, and may actually trigger an episode of urinary leakage. Low fluid intake can also lead to constipation, headaches, loss of concentration and fatigue.
Avoid standing for long periods of time.
Lose at least some excess weight.
If you smoke, do your utmost to stop, as this will reduce coughing which may trigger leakage.
If you are menopausal, hormone replacement therapy (HRT) can help to strengthen your tissues and increase the chance of success with pelvic floor exercises or surgery. If HRT tablets or patches aren’t suitable for you, you may benefit from the oestrogen vaginal ring or oestrogen pessaries which supply oestrogen locally to stretched tissues with little being absorbed into the circulation. Oestrogen creams are also available, although many women find them too messy for regular use.
Medical and surgical treatments for stress urinary incontinence
A prescription medicine called duloxetine is available to treat moderate to severe stress incontinence, usually alongside pelvic floor exercises. NICE guidelines consider it a ‘second line’ treatment for use only if you prefer not to have surgery (which offers a more permanent solution).
If these medical approaches fail, you will be referred to a specialist (urogynaecologist, gynaecologist, or urologist) for assessment and advice on surgical options available.
Surgical treatments are designed to better support the bladder neck and urethra.
Urethral bulking: A bulking agent (eg collagen) is injected into the walls of the urinary tube (urethra) via a viewing device (cystoscope) inserted via the urethra. The injections thicken the urethral walls and help them stay closed against higher pressures. The effectiveness tends to reduce with time so that repeated injections may be needed.
Tape procedures: A piece of tape is inserted through an incision in the vagina and threaded behind the urethra. The ends are then fixed in place to hold the urethra in the correct position, usually without tension. Around two out of three women having a tape procedure do not experience any leaking afterwards, although you may find you need to visit the toilet more frequently or urgently than before. If leaking does occur, it is usually less severe than before.
NB Some types of vaginal mesh implant used to treat stress urinary incontinence are associated with a high level of side effects and complications such as post-operative pain. Do ensure you fully discuss the pros and cons with your surgeon before deciding whether or not to go ahead.
Sling procedures: A sling is placed around the neck of the bladder to provide support. The sling may be made of synthetic material or, often, is made from the layer of tissue that covers your abdominal muscles. The most commonly reported side effect is difficulty emptying the bladder fully.
Colposuspension: The bladder neck is lifted and stitched into its new lifted position either through a large incision in the abdomen or by laparoscopic (keyhole) surgery. Colposuspension is effective but can lead to difficulty emptying the bladder fully, recurrent urinary infections and discomfort during sex.
Medical and surgical treatments for urge urinary incontinence
Several medicines are available to reduce urgency and urge incontinence by relaxing bladder muscles. They take up to 4 weeks to work and can cause side effects such as dry mouth, constipation, blurred vision, dizziness, and difficulty urinating, which may limit their use. If they are effective and well tolerated, however, they can be continued long-term.
If night-time urination is troublesome, then a hormone called desmopressin can be prescribed to help reduce urinary production at night.
Surgical approaches are also available to treat urge urinary incontinence:
Botulinum A toxin can be injected into the sides of the bladder to relax the muscle and reduce urge incontinence and overactive bladder. The effects last several months but can make it difficult to empty the bladder naturally. You will be shown how to insert a thing, flexible catheter to drain urine. This treatment is
Sacral nerve stimulation: A device can be surgically implanted in a buttock, to electrically stimulate one of the sacral nerves. This helps to regulate signals sent to the brain to reduce urinary urgency. While sacral nerve stimulation can be uncomfortable, it can significantly improve urge incontinence.
Don’t let urinary incontinence affect your life
Not surprisingly, having to plan your day around frequent visits to the toilet, and a fear of embarrassing leaks, has a major impact on your day-to-day quality of life. This can lead to loss of confidence, anxiety, depression and social isolation. Your sex life may suffer, along with your quality of sleep. Having to rush to the toilet also increases the risk of falls and even bone fractures if you also have osteoporosis.
Don’t put up with urinary incontinence – seek advice from your doctor. There’s no need to be embarrassed – doctors deal with these sort of problems every day, and given how common they are it’s likely your doctor has even experience urinary leakage themself.
If your urinary symptoms are associated with urinary tract infections or prostate enlargement, pumpkin seed oil may help.
Image credit: pixabay; Innovo; open.stax/wikimedia
