Some topics people often avoid, whether out of embarrassment or uncertainty. We would like to open the conversation around topics that women may often avoid speaking about or keep to themselves.
Urinary Incontinence
Urinary incontinence is one of those issues. Bladder leakage is common, but it is not something women should feel embarrassed about or simply accept as part of getting older. It can affect women at different stages of life, including after pregnancy and childbirth, during menopause and later in life. Let’s break the silence around urinary incontinence. Understanding why it happens, recognising when to seek help and knowing that effective treatments are available can help women take back control—and live with greater confidence, comfort, and freedom.
Urinary Incontinence: What It Is, Why It Happens, and What You Can Do
Accidentally leaking urine can be embarrassing, frustrating, and disruptive. But urinary incontinence is common, treatable, and not something women simply have to accept as they get older. Leakage can range from an occasional small accident to frequent episodes that affect exercise, work, sleep, relationships, and everyday activities. Whatever the severity, it is a medical issue—not a personal failing—and talking to a healthcare professional is an important first step.
What exactly is urinary incontinence?
Urinary incontinence (UI) means losing urine unintentionally. There are several different types, and identifying which type you have is important because treatment is tailored to the underlying problem.
1. Stress urinary incontinence
This happens when urine leaks because pressure is placed on the bladder. You might notice leakage when you cough, sneeze, laugh, lift something heavy, exercise, or get up from a chair. Stress incontinence is particularly common in women during or after pregnancy and childbirth.
2. Urgency urinary incontinence
This occurs when you suddenly experience a strong, difficult-to-control urge to urinate and leak before reaching the toilet. It is often associated with overactive bladder, which may also cause frequent trips to the bathroom or waking during the night to urinate.
3. Mixed urinary incontinence
Some women experience both stress and urgency incontinence. This is known as mixed urinary incontinence. When this happens, treatment is usually tailored to the symptoms that are most troublesome.
4. Overflow and other types
Sometimes the bladder does not empty properly and becomes overly full, resulting in leakage. This may be associated with urinary obstruction, certain neurological conditions or problems affecting bladder emptying.
Incontinence can also occur when a person has difficulty reaching or using the toilet, or as a result of certain medicines or other medical conditions.
Why does urinary incontinence happen?
There is rarely one single explanation. A number of factors can contribute to bladder-control problems, including:
Pregnancy and childbirth, weakness or dysfunction of the pelvic floor muscles, menopause and hormonal changes, increasing age, radiotherapy, constipation, obesity, diabetes, neurological conditions such as multiple sclerosis or stroke, chronic coughing, smoking,
certain medicines and urinary tract infections.
One important message is that getting older does not mean you have to live with incontinence. Although bladder-control problems become more common with age, symptoms should still be assessed because potentially treatable causes may be present.
When should you see a healthcare professional?
If you are experiencing repeated urine leakage, speak to a doctor, nurse, pelvic-health physiotherapist or other appropriately trained healthcare professional.
An assessment may involve questions about your symptoms, medical history and medicines, together with a physical examination where appropriate. A bladder diary can also be extremely helpful in identifying patterns. Current guidance recommends that women being assessed for urinary incontinence or overactive bladder keep a bladder diary for at least three days.
Seek prompt medical advice if you experience blood in your urine, pain or burning when urinating, difficulty passing urine, an inability to empty your bladder, new or rapidly worsening urinary symptoms, pelvic pain or significant changes in urinary frequency.
These symptoms can sometimes point to an infection, urinary retention or another condition that requires further investigation.
What treatments can help?
The good news is that treatment does not automatically mean medication or surgery. Depending on the type and cause of incontinence, conservative treatments are often an important first step.
The pelvic floor muscles help support the bladder and urethra and play an important role in urinary control. Pelvic floor muscle training (PFMT), sometimes called Kegel exercises, can reduce leakage, particularly in women with stress or mixed urinary incontinence. European guidelines recommend supervised, intensive pelvic floor muscle training for at least three months as a first-line treatment for women with stress or mixed urinary incontinence.
A pelvic-health physiotherapist or appropriately trained healthcare professional can assess whether you are contracting the correct muscles and help develop an individual programme.
For urgency incontinence and overactive bladder, bladder training can help women gradually increase the time between bathroom visits and learn strategies for managing sudden urges. It is commonly used as a first-line treatment for urgency symptoms and may be combined with pelvic floor muscle training, particularly when stress and urgency symptoms occur together.
Lifestyle changes can make a difference, although their effectiveness depends on the type and cause of incontinence. Useful steps may include maintaining a healthy weight, treating constipation, stopping smoking, reviewing high caffeine or alcohol intake and staying physically active.
Reviewing medicines that may contribute to urinary symptoms and managing fluid intake sensibly is important. Drinking too little can contribute to dehydration and may make some urinary symptoms worse. For women who are overweight, weight loss can improve urinary incontinence, with particularly good evidence for stress incontinence.
What about medication?
Medication may be considered when conservative treatment has not provided enough improvement, particularly for urgency incontinence and overactive bladder.
Depending on the individual situation, medicines may include antimuscarinic drugs or beta-3 agonists. These medications can have side effects, so the choice of treatment should be discussed with a healthcare professional.
Is surgery ever necessary?
Surgery may be considered when appropriate conservative treatments have not provided sufficient improvement, or when there is a specific anatomical problem that requires correction. For selected women with stress urinary incontinence, surgical options can include sling procedures. Shared decision-making between the surgeon and the patient is important when considering surgery and includes discussing the benefits, disadvantages and alternatives available. Surgery is not appropriate for everyone, and the decision should be based on an individual’s symptoms, diagnosis, preferences and overall health.
What about incontinence pads?
Absorbent pads and other continence products can be extremely useful. They can provide reassurance while you are being assessed or treated and may remain an important part of long-term management. However, pads manage the leakage rather than treating its underlying cause. Where effective treatment is possible, it is worth discussing the available options rather than relying solely on containment.
A simple first step: Keep a three-day bladder diary
Before your appointment, consider keeping a bladder diary for at least three days.
Record what and how much you drink, when you urinate, how strong the urge was,
when leakage occurs, what you were doing when the leakage happened, whether coughing, sneezing or exercise triggered the leakage, and how often you wake at night to urinate.
Taking this information to your healthcare professional can make the consultation more useful and help identify the pattern of your symptoms.
For women experiencing urinary leakage, bladder symptoms or pelvic floor problems, the urogynaecology service attached to AMFT provides specialist assessment aimed at identifying the underlying problem and developing an appropriate treatment plan.
Depending on the individual patient’s symptoms and clinical findings, the service may offer:
Medical treatment for urgency, overactive bladder and other urinary symptoms
Ultrasound and bladder scanning
Uroflowmetry to assess urinary flow and bladder emptying
Pessary fitting and management
Sling procedures for appropriately selected women with stress urinary incontinence
Advice and support regarding pelvic floor muscle training and bladder training
Further specialist investigation when the diagnosis is uncertain or symptoms are complex
Specialist assessment helps determine what is appropriate for each individual.
The bottom line
Urinary incontinence is common. It is treatable. And it is nothing to be ashamed of.
The first step is finding out what type of incontinence you have and whether an underlying condition is contributing to your symptoms. Pelvic floor muscle training, bladder training and appropriate lifestyle measures are important evidence-based treatments, while medication, continence devices and surgery may be appropriate for some women.
You do not have to simply live with urine leakage. If it is affecting your life, speak up and ask for an assessment. Don’t suffer in silence. Urinary leakage can affect far more than the bladder. It can influence confidence, exercise, sleep, work, intimacy and social life. Incontinence should not simply be dismissed as an unavoidable part of ageing. The goal is simple: to understand what is causing your symptoms, find the most appropriate treatment and help you regain confidence and quality of life.
Dr Quinton Blignaut
BPharm, MBChB, Dip Obst, FCOG, MMED, Cert Urogynae, BTh
Obstetrician and Urogynaecologist
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