Urinary incontinence is, in simple terms, ‘involuntary loss of urine’, and it affects a large amount of people. In fact, incontinence is a significant issue for approximately three million women in the UK.

A normal bladder gradually expands as it fills with urine, which is produced by the kidneys. The bladder wall is made of muscle, and usually sits in a relaxed state. The tube which empties the bladder, called the urethra, is held closed by the muscles in the pelvis, known as the pelvic floor muscles.

A typical person will feel the need to pass urine when their bladder fills to around 200ml, although a healthy bladder can, in theory, hold up to around 500ml of urine. The feeling of needing to pass urine occurs thanks to complex signals in the brain and spinal cord, which cause the bladder muscle to contract and the muscles surrounding the urethra to relax.

We can choose when we want to pass urine because an element of this signalling process is under voluntary control. However, a number of things can occur resulting in these normal actions being overpowered, leading to urinary incontinence.

The two principle types of incontinence are referred to as ‘stress incontinence’ and ‘urge incontinence’. These can occur simultaneously, in which case the condition is known as ‘mixed urinary incontinence’.

Other types of incontinence include overflow incontinence, otherwise known as chronic urinary retention, and total incontinence.

Stress incontinence

Stress incontinence occurs when the pressure in the abdomen suddenly increases and the bladder and pelvic floor muscles are unable to prevent the loss of urine, which can cause anything from small leaks to losses of large amounts of urine.

If you have weakened pelvic floor muscles, stress incontinence can occur when you cough, sneeze, laugh, or exercise. It isn’t related to feeling stressed, but occurs when the pressure inside your bladder becomes stronger than the strength the urethra needs to exert to stay closed.

Your urethra may not be able to stay closed if your pelvic floor muscles are weak or damaged, or if the muscle that keeps the urethra closed, the urethral sphincter, is damaged.

This could be due to damage sustained during childbirth, increased pressure on your stomach (perhaps due to pregnancy), damage to the bladder or nearby area during surgery, neurological conditions such as Parkinson’s disease or MS, or certain connective tissue disorders, such as Ehlers-Danlos syndrome. Certain medications can also cause stress incontinence.

Urge incontinence

Urge incontinence, or urgency incontinence, is when you feel a sudden and intense need to urinate and you are absolutely unable to delay going to the toilet. It often occurs as one of a group of symptoms collectively known as overactive bladder syndrome, which is where the bladder muscle is more active than usual.

Different environmental and psychological states can influence the process of the signals sent to the bladder from the brain and the spine. For example, environmental factors which may trigger the bladder include getting home, going out into the cold, and the sound of running water.

Your need to pass urine could also be triggered by a sudden change in position, or while having sex, particularly upon reaching orgasm.

Urge incontinence is typically caused by a problem with the detrusor muscles in the walls of the bladder. These are the muscles that, when relaxed, allow the bladder to fill with urine, and contract when you need to urinate. Sometimes these muscles contract too often, creating the urgent need to go to the toilet that is typical of urge incontinence.

The reasons your detrusor muscles contract too often may not always be clear but causes include consuming too much alcohol or caffeine, poor fluid intake, constipation, conditions affecting the lower urinary tract such as UTIs, neurological conditions and, again, certain medications.

Overflow incontinence

Otherwise known as chronic urinary retention, overflow incontinence occurs when your bladder cannot empty itself completely when you pass urine, causing it to swell above its normal size.

If you have the condition, you may find yourself passing small trickles of urine very often. It may also feel like your bladder is never fully empty, and you cannot empty it even when you try.

Overflow incontinence is often caused by a blockage or obstruction of your bladder. Even if your bladder is filling up as usual, if it’s obstructed it will be impossible to empty it fully. However, pressure from the urine that is still in your bladder will block up behind the obstruction, causing frequent leaks.

In a woman, the bladder can become obstructed as a result of bladder stones, or constipation.

Overflow incontinence can also be caused by the detrusor muscles not contracting fully, meaning that the bladder doesn’t completely empty when you go to the toilet and becomes stretched as a result.

Things that can cause your detrusor muscles to not contract fully include having damage to your nerves, for example as a result of surgery or a spinal cord injury, or if you’re taking certain medications.

Total incontinence

Urinary incontinence that is severe and continuous is known as total incontinence. The condition may cause you to pass large amounts of urine constantly, even during the night.

However, the condition can also cause you to pass large amounts of urine occasionally, but leak small amounts in between.

Total incontinence can be caused by a number of things, including a problem with your bladder form birth, or an injury to your spinal cord, which can disrupt the nerve signals between your brain and your bladder.

It can also be caused by a bladder fistula, which is a small, tunnel-like hole that can form between the bladder and a nearby area, such as the vagina in women.

Incontinence risk factors

Certain things can increase your risk of developing incontinence without directly causing the problem themselves.

These include:

  • Family history – there may be a genetic link to urinary incontinence
  • Increasing age – incontinence gets more common towards middle age and is very common in people over the age of 80
  • Having lower urinary tract symptoms (LUTS) – these are a range of symptoms that affect the bladder and urethra

Other bladder conditions

There are many conditions that can cause incontinence as a symptom, or may make you feel like you have incontinence even when you don’t.

In fact, bladder and urinary symptoms can be divided into four groups: storage symptoms, voiding (obstructive) symptoms, post micturition (urination) symptoms, and infective symptoms.

Storage symptoms include:

  • Urinary frequency
  • Waking up at night to urinate
  • Urinary urgency
  • Urinary incontinence

Voiding symptoms include:

  • Slow stream
  • Hesitancy
  • Straining

Post micturition symptoms include:

  • The feeling of incomplete emptying
  • Dribbling after urinating

Infective symptoms include:

  • Pain on urination
  • Strong smelling urine
  • Blood in urine

The most common troubling experience that women experience is urinary urgency.

Some symptoms, such as pain on urination, could be indicative of a urinary tract infection, and may require treatment with a course of antibiotics.

If you are experiencing any symptoms related to your bladder it is important to see your doctor to get a diagnosis, and to rule out anything serious.

Many bladder problems are easily treatable, and there are both non-surgical and surgical treatments available.

Urinary incontinence is twice as common in women as in men and becomes more common with age. The two most common types of urinary incontinence, which can occur simultaneously, are:

  • Stress incontinence, when the supporting pelvic floor muscles are too weak to contain the urine, which leaks when the bladder is under pressure, eg coughing or laughing
  • Urge incontinence, when you experience an extreme urge to pass urine

Don’t suffer urinary incontinence in silence. There are plenty of treatment options available and most do not involve surgery. If you have symptoms of incontinence, make an appointment to see your GP, who will carry out some simple tests and, if necessary, refer you to a specialist.

This has been written by The Femedic, an educational website that deals specifically with areas of women’s health considered taboo.

The Femedic is proud to partner with Wellbeing of Women to produce educational content and resources, and to raise awareness of women’s health issues.

Sue’s story

“It was just the odd leak at first, when I coughed or laughed. But it gradually got worse. I became very conscious of the fact I was leaking and would worry that people could smell urine on me. I began to get very anxious, so I made an appointment at the doctor, who suggested I do pelvic floor exercises. Well I tried, but the leaking became worse.  

“Eventually, the doctor referred me to the hospital and arranged for me to see a physiotherapist at the Continence and Urology Clinic. I couldn’t believe that I was suffering from incontinence – I was only 50! The hospital checked how much my bladder held and how much I was leaking. Because of the weakness of the muscles around my bladder, I was told an operation would be necessary. 

“When I was waiting for the operation, I attended physio, where they told me how to do pelvic floor exercises correctly. I did flow charts showing my fluid intake, how often I went to the toilet and how much urine I was passing. I was told I was drinking too much coffee, which can cause irritation to the bladder, and try drinking water, fruit juice and decaffinated coffee instead.

“Finally, I was given my operation date. The operation went really well and the difference was incredible – even more noticeable because I’d had a bad cold but no leakage at all.
I have felt great since the operation and I don’t need to go the toilet as often. It’s taken a few weeks for me to recover but, as far as I’m concerned, the operation has been 100% successful.”