Urinary incontinence, the loss of bladder control, can prevent you from enjoying an active life and time out with your friends and family. Knowing how to recognise its signs, manage symptoms and what treatments are available can help you feel more in control of your bladder and health. Mr Roland Morley, Consultant Urological Surgeon at New Victoria Hospital, answers 5 questions during Continence Awareness Week. 

What is urinary incontinence

Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect 3 million people.

If you feel the need to pee all the time, it doesn’t necessarily mean that you have a bladder condition. How often you urinate depends on a lot of factors such as fluid intake, type of drinks consumed and how much you sweat. However, in some cases, the urge to urinate can be a sign of diabetes or infections of the urinary tract.

What you need to notice is any change in your regular habits. For example, if you need to go to the loo more often or the urge to pee becomes pressing.

Stress and urge incontinence

Most people with urinary incontinence have either stress incontinence or urge incontinence. 

Stress incontinence

Stress incontinence is when you leak urine when your bladder is put under sudden extra physical pressure. It's not related to feeling stressed. 
Other activities that may cause urine to leak include: 

• sneezing  
• laughing  
• heavy lifting  
• exercise 

The amount of urine passed is usually small, but stress incontinence can sometimes cause you to pass larger amounts, particularly if your bladder is very full.

 Weak or damaged pelvic floor muscles can cause stress incontinence

Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or if your urethral sphincter, the ring of muscle that keeps the urethra closed, is damaged. Problems with these muscles may be caused by:

• damage during childbirth – particularly if your baby was born vaginally, rather than by caesarean section
• increased pressure on your tummy – for example, because you are pregnant or suffer with obesity
• damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy), or removal of the prostate gland 
• neurological conditions that affect the brain and spinal cord, such as Parkinson's disease or multiple sclerosis
• certain connective tissue disorders such as Ehlers-Danlos syndrome
• certain medicines

Urge incontinence

Urge incontinence, or urgency incontinence, is when you feel a sudden and very intense need to pass urine, and you're unable to delay going to the toilet. There are often only a few seconds between the need to urinate and the release of urine.
This type of incontinence often occurs as part of a group of symptoms called overactive bladder syndrome, when the bladder muscle is more active than usual.
As well as sometimes causing urge incontinence, overactive bladder syndrome can mean you need to pass urine very frequently, including several times during the night.

Lifestyle factors may often cause urge incontinence

Lifestyle can play a big role in urgency incontinence.

The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of your bladder. 
Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. 
The reason your detrusor muscles contract too often may not be clear, but possible causes include: 

• drinking too much alcohol or caffeine
• not drinking enough fluids 
• constipation
• conditions affecting the lower urinary tract (urethra and bladder), such as urinary tract infections (UTIs) or tumours in the bladder 
• neurological conditions
• certain medicines

Urinary incontinence: 5 Questions answered 

Dr Roland Morley, Consultant Urological Surgeon, answers 5 of the most common questions around urinary incontinence.

1. Are women more likely to suffer from incontinence?

Incontinence is twice as common in women than in men. Women are more likely to have UTIs because their urethra is shorter. Pregnancy, childbirth and menopause are also risk factors. In men, incontinence is mostly related to an enlarged prostate.

2. Do pelvic floor exercises really help to prevent incontinence?

Your pelvic floor muscles surround the bladder and urethra (the tube that carries urine from your bladder out of your body) and control the flow of urine as you pee. Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
Pelvic floor or Kegel exercises are useful to strengthen muscles in your pelvis, train your urethra to close tightly and have more support for your bladder. These exercises are both helpful in preventing incontinence in later life and managing symptoms.

3. How can I improve my quality of life if I suffer from urinary incontinence?

Small lifestyle changes can help improve your symptoms and achieve a better quality of life. Certain drinks can trigger symptoms; smoking and obesity are also risk factors.

You can try to: 

• reduce your intake of caffeine, which is found in tea, coffee and cola, as caffeine can increase the amount of urine your body makes 
• alter how much fluid you drink each day, as drinking too much or too little can make incontinence worse 
• lose weight if you are overweight or obese – use the healthy weight calculator to find out if you're a healthy weight for your height

4. When do I need to see a Urologist?  

If incontinence symptoms are persistent or frequent, you should contact your GP or book an appointment with a urologist to undergo some examinations and receive adequate treatment.
A bladder diary can help you keep track of habits and symptoms and be useful when meeting your Consultant.

You may be examined to assess the health of your urinary system.Further tests may be necessary if the cause of your urinary incontinence is not clear. 

Cystoscopy

Cystoscopy involves using a thin tube with a camera attached to it (endoscope) to look inside your bladder and urinary tract. A cystoscopy can identify abnormalities that may be causing incontinence.

5. When is surgery needed to treat incontinence?

Conservative treatments, which do not involve medicines or surgery, are tried first. 
If non-surgical treatments for urinary incontinence are unsuccessful or unsuitable, surgery or other procedures may be recommended.

Before making a decision, discuss the risks and benefits with your specialist, as well as any possible alternative treatments. 
If you plan to have a pregnancy, this will affect your options. The physical strain of pregnancy and childbirth can sometimes cause surgical treatments to fail. You may wish to wait until after you have had children before you choose surgery.

Your Consultant Urologist will advise on the most appropriate surgical procedure to treat incontinence

Some of the surgical treatments for urinary incontinence available at New Victoria Hospital include

Colposuspension

Colposuspension involves lifting the neck of your bladder and stitching it in this lifted position. If you have a vagina, a colposuspension can help prevent involuntary leaks from stress incontinence.

Sling surgery

With sling surgery, a sling is placed around the neck of the bladder to support it and prevent urine leaking. In many cases, an autologous sling is used. It is made from part of the layer of tissue that covers the abdominal muscles (rectus fascia). These slings are generally preferred because more is known about their long-term safety and effectiveness.

Vaginal mesh surgery (tape surgery)

At the moment, it is not possible to have vaginal mesh surgery for urinary incontinence unless there's no alternative, and the procedure cannot be delayed and after a detailed discussion between you and a doctor. Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body (urethra) to support it. The mesh stays in the body permanently. A few people have had serious complications after mesh surgery. Some, but not all, of these complications can also happen after other types of surgery. 

Urethral bulking agents

A urethral bulking agent is a substance that's injected into the walls of the urethra in people with stress incontinence who have a vagina. Several different bulking agents are available, and there's no evidence 1 is more beneficial than another.
This is less invasive than surgical treatments for stress incontinence in people with a vagina, as it does not usually require any cuts. The substance is usually injected through a cystoscope (a thin camera) inserted into the urethra. Urethral bulking agents are generally less effective than other procedures, and you may need the injection to be repeated.

Artificial urinary sphincter

The urinary sphincter is a ring of muscle that prevents urine from flowing from the bladder into your urethra. In some cases, it may be suggested that you have an artificial urinary sphincter fitted to relieve your incontinence. This treatment is used more often for people who have a penis rather than a vagina.
Surgery and procedures for urge incontinence

Botulinum toxin A injections

Botulinum toxin A can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome. This effect can last for several months, and the injections can be repeated if they help.

Sacral nerve stimulation

The sacral nerves are located at the base of your back. They carry signals from your brain to some of the muscles used when you go to the toilet, such as the detrusor muscle that surrounds the bladder. Sacral nerve stimulation, also known as sacral neuromodulation, may be recommended for your overactive bladder. A device is inserted near 1 of your sacral nerves, usually in 1 of your buttocks. An electrical current is sent from the device into the sacral nerve. 

Posterior tibial nerve stimulation

Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor. It's thought that stimulating the tibial nerve will affect these other nerves and help control the urge to pee. A very thin needle is inserted through the skin of your ankle, and a mild electric current is sent through it, causing a tingling feeling and your foot to move. 

There are many stress and urgency incontinence treatments available that can help you improve the quality of your life and enjoy your favourite activities.

Should you notice any changes in your bladder habits, experience symptoms or feel the need to ask more questions about incontinence, you can make an appointment with our GPs or call our Outpatient Department on 020 8949 9020 or fill in our online form to book a consultation with our Urology specialists.