Urinary incontinence: types, causes and when to get help

The NHS describes urinary incontinence as the unintentional passing of urine, a common problem thought to affect millions of people. Which type you have depends on when and how the leakage occurs.

The NHS lists pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age among the factors that raise the chances, while stressing that incontinence is not an inevitable part of ageing.

Other factors a clinician considers include urinary tract infection, constipation pressing on the bladder, medicines such as diuretics, prostate enlargement in men, previous pelvic or prostate surgery, menopause-related changes in the lining of the urethra, neurological conditions and limited mobility. The NHS UTI page notes that, in older frail people and those with a catheter, leaking urine that is worse than usual can be a sign of a urinary tract infection.

Most incontinence is long-standing and managed through routine appointments. A few presentations are different.

• Call 999 or go to A&E if you have back pain together with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, or changes in bladder or bowel control such as difficulty peeing or peeing or pooing yourself; the NHS back pain page lists these as emergency symptoms.

• Sudden new inability to pass urine, with a swollen lower tummy and pain, needs emergency assessment because a blocked bladder is painful and can damage the kidneys.

• Ask for an urgent GP appointment or NHS 111 help if a urinary tract infection is suspected and you are over 65, a man, pregnant, have diabetes, have a catheter or weakened immune system, have blood in the urine, back or lower tummy pain, or a very high or low temperature, per the NHS UTI page.

• Seek prompt review for new incontinence after a stroke, a fall, spinal surgery or a new medicine.

• Blood in the urine, severe pain on passing urine or persistent leakage with weight loss should be investigated rather than assumed to be ordinary incontinence.

According to the NHS, urinary incontinence can usually be diagnosed after a consultation with a GP, who will ask about your symptoms and may do a pelvic examination if you have a vagina, or a rectal examination if you have a penis. The GP may suggest you keep a diary noting how much fluid you drink and how often you have to urinate, and you may be referred to a specialist for more tests.

Typical questions include when leakage happens, how much, whether you feel the urge first, how often you pass urine day and night, whether you strain or have a weak stream, and what medicines and drinks you take. A urine test checks for infection or blood. Specialist tests such as bladder scans, urodynamics or cystoscopy are reserved for complex or treatment-resistant cases.

The NHS says a GP may initially suggest lifestyle changes such as losing weight and cutting down on caffeine and alcohol, pelvic floor exercises that strengthen the muscles by squeezing them, and bladder training, in which you learn ways to wait longer between needing to urinate and passing urine. Absorbent pads and handheld urinals can also help, and medicine may be recommended if you are still unable to manage your symptoms.

Surgery may be considered, depending on the type. The NHS says surgery for stress incontinence, such as a sling procedure, reduces pressure on the bladder or strengthens the muscles that control urination, while surgery for urge incontinence includes enlarging the bladder or implanting a device that stimulates the nerve controlling the detrusor muscles. Overflow incontinence is treated by addressing the blockage or helping the bladder empty.

The NHS suggests keeping to a healthy weight, cutting down on alcohol and drinks containing caffeine such as tea, coffee and cola, which can make the kidneys produce more urine and irritate the bladder, and doing pelvic floor exercises, which everyone may benefit from. If you pass urine frequently at night, it suggests drinking less in the hours before bed, while still drinking enough during the day. The NHS gives 14 units a week as the recommended weekly alcohol limit.

Being pregnant and giving birth can weaken the muscles that control urine flow, and the NHS says strengthening the pelvic floor in pregnancy may help prevent incontinence. Planning toilet access, wearing easy-to-remove clothing and using protective products can restore confidence while treatment takes effect.