Types of urinary incontinence and how to treat them

Having urinary incontinence can be distressing but there are effective ways of relieving these symptoms. While there are many things that you can do to help improve your symptoms on your own, some people do need medical help.

If you think you may have urinary incontinence, it’s helpful to know which type you have, as different types need different treatments. To help you understand more about urinary incontinence, and what you can do to help your condition, we spoke to King Edward VII’s Hospital consultant Urogynaecologist, Mr Anthony Kupelian.

What is urinary incontinence?

Having urinary incontinence means that you pass urine when you don’t want to and lose control of your bladder. It’s a very common condition, and the symptoms can range in severity from person to person.

Urinary incontinence can be mild, and some individuals may leak just a small amount of urine occasionally. In more severe cases, the leakage can be much greater, with leakage of large amounts of urine daily.

The good news is that there are lifestyle changes and medical treatments that can help you lead a normal life.

What causes urinary incontinence?

Factors that might make it more likely for you to develop urinary incontinence include:

• Pregnancy and vaginal birth
• Pelvic floor muscle weakness
• Obesity or being overweight
• The menopause in women
• Prostate problems in men
• Nervous system diseases such as multiple sclerosis
• Damage to the bladder due to injury or surgery

Urinary incontinence also becomes more common as we age.

What are the different types of urinary incontinence?

Different types of urinary incontinence can have different causes. Here we discuss the various types of urinary incontinence, and how they may develop:

Stress urinary incontinence

Stress urinary incontinence causes urine to leak from the bladder when it’s under physical stress, such as when you cough, sneeze, laugh or lift something heavy. Some exercises such as running or jumping can also cause stress incontinence.

Stress incontinence is not caused by emotional stress or being stressed at work. It means that in certain situations, when physical stress or pressure is placed on your bladder, you leak urine.

Stress incontinence develops when the valve that normally keeps urine from leaking out of the bladder stops working properly. This can happen when the muscles and supportive tissues of the valve, or the nerves that control the valve are damaged.

In women, pregnancy and vaginal birth can damage the muscles and nerves in the pelvis, along with supportive tissues called ligaments. This damage can affect how well the valve works, leading to stress incontinence.

In men, having surgery to remove the prostate can lead to stress incontinence. The prostate gland sits close to the bladder valve, and if it’s removed, the valve may stop working properly.

Constant straining or increased pressure on the bladder can also increase the risk of developing stress incontinence. This can be associated with:

• Obesity or being overweight
• Chronic coughing caused by smoking, asthma or other chest problems
• Chronic constipation and having to strain to go to the toilet

Urge urinary incontinence

Urgency to pass urine means that you experience a sudden desire to pass urine that you cannot ignore. This means that you may have to rush to the toilet suddenly and unexpectedly, and you may not get there in time.

This type of incontinence is caused by a problem with the nerves that carry signals from the bladder to the brain and back again. Normally, the bladder muscles should stay relaxed until you are in the toilet and ready to pass urine. Unfortunately, if the nerves that control the bladder malfunction, then you might suddenly feel like you have to rush to the toilet. The bladder muscle may start to contract before you get there and you may leak urine as a result.

Urinary urgency and the leakage that it can cause is also known as overactive bladder syndrome. People with overactive bladder syndrome may also need to visit the toilet very frequently in the daytime and overnight.

In those who are affected, the sudden urge to urinate might be more common in certain situations. For example, many people experience sudden urgency when getting home after being out and about. It’s common for urgency to develop when people are putting their key in the door after returning home and this problem is so common it’s been given a name: ‘latchkey’ urgency. In others, anxiety, stress, and even sexual arousal and orgasm can trigger urgency and incontinence.

Urinary urgency might sometimes be caused by other problems or lifestyle factors which are important to address. These problems include:

• Urinary tract infections (UTIs)
• Bladder stones
• Drinking too much caffeine

Mixed urinary incontinence

Some people experience a mix of both stress incontinence and urge incontinence. This is due to having a weak bladder valve but the control systems of the bladder may also not be working properly.

In some people, both types of incontinence may be just as troublesome, or it may be that one type of incontinence is worse than the other.

Functional urinary incontinence

Functional urinary incontinence means you are usually aware that you need to go to the toilet but you’re unable to get there in time. Any condition that can make it difficult to get around can cause functional incontinence.

Problems can range from temporary issues getting around caused by a broken bone that is in plaster to more significant disabilities, including neurological diseases. People may also experience functional incontinence if they are unable to undo their buttons or flies due to problems with their hands that might make this difficult. These problems can often be made worse in public places where toilets may not be equipped for people with disabilities.

Some people experience functional incontinence because they do not remember to go to the bathroom, even though their bladder is healthy. This can affect people with Alzheimer’s disease or other forms of dementia who are unaware that their bladder is filling up or that they need to go to the toilet.

Overflow urinary incontinence

Overflow incontinence is a different kind of incontinence. It develops when the bladder is not emptying properly, leading to the bladder becoming fuller and fuller. This is called retention of urine. Eventually, the bladder becomes so full that urine leaks out through the bladder valve, even if the valve is working properly. This is because the pressure in the bladder gets so high that the bladder valve can no longer keep the urine in.

Most people who develop bladder emptying problems become aware that their bladder is very full and seek medical help before they run into problems. Sometimes, the first sign of this problem can be leakage, and retention of urine can develop very slowly without someone realising it. In general, overflow incontinence is much less common than other types of incontinence.

Retention of urine and overflow incontinence is more common in some situations. Enlargement of the prostate gland in men, or surgery in the pelvis in men and women, can sometimes be associated with retention of urine.

A spinal cord injury, multiple sclerosis and Parkinson’s disease can all cause overflow urinary incontinence. The problem might also be caused by certain medications, especially strong painkillers like morphine.

Total urinary incontinence

Total urinary incontinence means that you are unable to hold any urine in your bladder and you experience constant leakage. This type of incontinence is very uncommon but it might be caused by damage to the bladder after surgery.

For example, if women have surgery in their pelvis and the bladder is damaged, a hole can develop between the bladder and the vagina causing constant leakage. This is known as a fistula.

How might I be able to treat my condition at home?

Urinary incontinence is a distressing condition that can have a huge impact on everyday life. There are things that you can do to help yourself if you are experiencing urinary leakage. Treatment also depends on the type of urinary incontinence you have.

Drinking habits

Changing what you drink and how often, can help. Caffeinated drinks including tea, coffee, cola and energy drinks can often make urine urgency worse. This is because caffeine is a diuretic, making the body produce more urine. This makes the bladder fill faster and will worsen urgency symptoms.

Some research suggests that caffeine may even irritate the bladder directly. It’s always worth having a caffeine-free trial to see if it helps things. Try avoiding caffeine for a month to see if it helps.

If you are troubled by frequent toilet visits you should try not to drink too much. Just drink when you are thirsty. You should remember that there is no need to drink a certain amount each day. Most people need not drink more than one and a half litres of fluids a day as the rest of their fluid intake is provided through the food they eat. Your body will tell you if you need more fluids by making you feel thirsty. If you struggle with lots of toilet visits overnight, try cutting your fluid intake down in the evening and before bedtime. Your should definitely avoid caffeine in the evening.

Some people need to keep their fluid intake high because of a medical condition. You should always check with your doctor if this is the case. For example, people with a history of kidney stones might be advised to drink more.

Losing weight

Being overweight or obese can cause urinary incontinence or make incontinence worse. This is particularly the case for those people affected by stress or urge incontinence, or those with mixed incontinence.

Lots of research studies have shown that losing even a small amount of weight can really help. Following a healthy diet and exercising regularly is a lifestyle change you can make that will usually improve things.

Pelvic floor exercises

Your pelvic floor muscles are a group of muscles in the pelvis that holds all of the pelvic organs in place. They’re also some of the muscles that control the bladder valve. If these muscles become weak or are damaged, it can lead to stress urinary incontinence.

Strengthening these muscles with pelvic floor exercises is a very effective way of relieving the symptoms of stress incontinence. Pelvic floor exercises are something that you can do anywhere without any special equipment, although to get results, you must do the exercises every day and continue long term.

Pelvic floor exercises are also called Kegel exercises and the British Association of Urological Surgeons has detailed instructions on Kegel exercises for women and for men.

What medical treatments are available for urinary incontinence?

When lifestyle changes and doing pelvic floor exercises yourself do not help, advice from a specialist and medicine or surgery can be beneficial.

We know that if pelvic floor exercises are not working for you, help from a specialist women’s health physiotherapist can really improve your chances of success.

There are medicines available for urge incontinence including anticholinergic medication such as oxybutynin, and a new medication called mirabegron. Your doctor or consultant can advise which might be best for you.

If these medications do not work, you could consider other treatments. Injections of Botox into the bladder wall can help to calm the nerves in the bladder and reduce urgency. There is even the option of a bladder ‘pacemaker’ called a sacral neuromodulator.

There are various surgical options also available that help to treat stress incontinence. These usually involve surgery through the abdomen, vagina, or both, to help improve how well the bladder valve closes. Surgery might be conducted through tiny keyhole incisions in the abdomen, a larger incision through the abdomen, or a combined approach through the vagina and abdomen. Again, your doctor or consultant can advise which type of surgery may be beneficial in your individual case.

At King Edward VII’s Hospital, we are one of only a few hospitals in London who offer Bulkamid injections to help treat urinary incontinence.

Bulkamid is a soft gel that is injected into the urethra and helps to make the bladder valve close more tightly to prevent stress incontinence. It can be injected under a short general anaesthetic or even under a local anaesthetic. You can go home the same day with no restriction on your activity or working afterwards.

Mr Anthony Kupelian specialises in urogynaecology and offers Bulkamid along with other surgical and non-surgical treatments for urinary incontinence.

More information

• If you think you have urinary incontinence, speaking to your GP is a good first step for getting help with your symptoms. (Don’t have a GP?)
• King Edward VII’s Hospital is fully equipped with the latest in urinary incontinence diagnostics and treatments and can help you live a life free from the symptoms of urinary incontinence. Make an enquiry