Urinary Incontinence
Assessment and treatment of involuntary urine leakage in men or women
What is urinary incontinence?
Continence depends on a bladder that stays relaxed while it fills and a sphincter that stays shut until you decide otherwise. Incontinence follows when either half fails. The two failures need opposite treatments, so separating them is the first task of the consultation.
Stress incontinence is a sphincter and support problem. In women it follows childbirth and the loss of pelvic floor support; in men it is almost always a consequence of prostate surgery. Urgency incontinence is a bladder problem, where the muscle contracts before you are ready for it. Many people have some of both, in a mixture that has to be weighed.
It is far commoner than consultation rates suggest. A great many people manage privately for years before mentioning it, and most of them turn out to have something treatable.
What you might notice
- Leaking urine on coughing or on the way to the toilet
- A sudden urge to pass urine that is hard to hold
- Getting up at night to pass urine
How it is diagnosed
A bladder diary kept over three days, recording what goes in and what comes out and when, tells a urologist more than any single test does.
Examination assesses the pelvic floor and, in women, the support of the front wall of the vagina, with a cough test to see what happens under pressure. A residual volume is measured by ultrasound after passing urine, and urine is cultured, since an infection mimics the urgent pattern exactly.
Urodynamic studies, which measure pressure inside the bladder as it fills, are used before surgery and wherever the picture is mixed. Operating on the wrong half of the problem tends to make the other half worse.
Recovery
Supervised pelvic floor training is the foundation and is judged over three months, with results that keep improving for as long as the exercises continue. Bladder retraining works to a similar timescale.
After a supporting tape, most people go home the same day or the next, occasionally with a catheter for a day. Desk work resumes in one to two weeks, heavy lifting and sport at six, and sex at six.
An implanted device is left alone until healing is complete at about six weeks, and there is a teaching session for working it. Control is generally immediate once it is switched on, and any residue afterwards is usually manageable with a light pad.
If it is left untreated
Incontinence is not dangerous in itself and no one is obliged to treat it. Where it is occasional and does not restrict your life, a pad and an annual review is an entirely reasonable plan.
What it does affect is behaviour. People restrict fluid, which concentrates the urine and makes the bladder more irritable, and they withdraw from exercise and from plans that involve being away from a toilet. Skin breaks down under continuous wetness, and falls rise in older people hurrying at night.
One pattern must not simply be watched. Incontinence alongside a bladder that is not emptying is overflow, and the back pressure it places on the kidneys is a genuine risk, so the residual volume is measured before anything else is decided.
Questions about urinary incontinence
Are pelvic floor exercises actually worth doing?
Yes, and they are the foundation of treatment for stress incontinence in women and after prostate surgery in men. The difference between exercises that work and exercises that do not is supervision: a specialist physiotherapist checks you are contracting the right muscle, since a large proportion of people push instead of lift when first asked. A programme is judged over three months and results keep improving while the exercises continue. They are also worth doing before prostate surgery, because starting early shortens the time to continence afterwards.
Is leaking after prostate surgery permanent?
Usually not. Most men improve substantially over the first three to six months as the sphincter recovers and the pelvic floor strengthens, and improvement can continue to twelve months, so surgery for it is not considered before then. If you are still using one or two pads a day at a year, a male sling is the usual option; if the loss is heavy, or a sling has already been tried, an artificial urinary sphincter is the more reliable answer. Both are day-case or single-night procedures with a defined recovery.
How do I know whether the problem is my bladder or my sphincter?
The pattern tells you most of it, and a three day bladder diary tells your urologist the rest. Loss on coughing, lifting or exercise, with no warning and no urge, points at the sphincter and its support. A sudden compelling urge with loss on the way to the toilet points at the bladder muscle contracting when it should be relaxed. Many people have a mixture, and the proportions matter because the treatments are opposite: an operation that supports the urethra can make an overactive bladder worse. Urodynamic studies settle it before surgery.
Other urology treatments
Treatment of kidney and urinary tract stones based on their size, location, symptoms and likelihood of passing naturally
Day CareManagement of benign prostate enlargement that causes urinary difficulty, frequency or incomplete bladder emptying
Day CareTalk to a care coordinator about urinary incontinence
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one