Let’s Talk About Incontinence

Urinary incontinence is something no one likes to talk about, yet it’s believed to affect up to six million people in the UK, probably more, because many people are reluctant to consult their GP. It’s more common in women and older people but can affect anyone at any age.

Your bladder ideally needs to be emptied around 6-7 times per day. You’ll start to feel the need to pee when it contains around 200ml of urine, and on average, you’ll pass around 220ml – 400ml of urine every 3-4 hours. When you pass water, the valve-like urethral sphincter muscle relaxes and your bladder muscles contract to push urine out.

If you routinely urinate more than eight times in a 24-hour period, or you wake up more than twice in the night to pee, you may have an overactive bladder, and this can lead to incontinence.

• Cystitis

Cystitis is one condition causing a strong urge to pee accompanied by a burning sensation. It’s usually due to a bacterial infection in your bladder and may recur frequently. Cystitis can also be caused by chronic inflammation of your bladder wall when it’s known as interstitial cystitis.

• UTIs

Equally miserable and potentially more dangerous are urinary tract bacterial or fungal infections. You’ll usually experience pelvic pain if you have a UTI, and your urine may appear cloudy. It’s important to consult a GP if you suspect you have a UTI.

• Stress Incontinence

This occurs when urine leaks out with exercise such as jumping, or when laughing, coughing or lifting heavy objects. It’s much more common in women than in men, and it’s connected with a weakening of the pelvic floor muscles (see video below) supporting the urethra and the sphincter muscles. So, anything putting pressure on these muscles can cause urine to leak out.

The muscles naturally become weaker with age, as well as during pregnancy and childbirth. They can be damaged during prostate surgery.

Stress incontinence is more common in people who are obese or smoke, and many people find drinking alcohol and coffee makes the condition worse, as can being constipated. Some medications can make you pee more often, and frequent urination is a side effect of diabetes.

The changing hormones at menopause, including a drop in oestrogen, can lead to a weakening of the pelvic floor muscles, and some women notice they have less control over their bladder at certain times of their menstrual period.

• Urge Incontinence

This is characterised by an overwhelming urge to pass water, even if there isn’t much urine in your bladder. It’s caused by frequent involuntary contractions of the bladder muscles at inappropriate times, in other words, your bladder is overactive.

The urge to urinate should occur gradually as your bladder fills with urine and expands. The change in size is detected by nerves which tell your brain it’s time to urinate. But if the bladder muscles contract involuntarily, the sense of urgency will be relayed to your brain, even if there’s no need to urinate. If the sphincter muscles relax too, then urine will leak out.

Stress and urge incontinence often occur together, but not always.

In any form, incontinence can cause both physical discomfort and emotional stress and embarrassment. It can be hugely inconvenient and may interfere with work and social life. In turn, this stress can make the condition worse.