Urinary incontinence

Urinary incontinence is when you accidentally urinate or wet yourself. This can range from leaking a small amount of wee to completely wetting yourself.

On this page:

• About urinary incontinence
• What causes urinary incontinence
• How is urinary incontinence diagnosed?
• How is urinary incontinence treated?
• More about surgery

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About urinary incontinence

There are different types of urinary incontinence. The most common are stress incontinence and urge incontinence.  

Stress incontinence is triggered by pressure on your abdomen (for example when you laugh, cough, sneeze or do something physical like playing sport or lifting things). 
 
Urge incontinence is triggered by an overactive bladder. It is characterised by strong ‘urges’ to go to the toilet and not making it in time. 

Urinary incontinence is very common and can affect up to one in two women (or 30-50 percent). It happens to women of all ages although it becomes more likely the older you are. 

Urinary incontinence can have a big impact on your quality of life. Many women find it so embarrassing that they don’t seek medical help but there are a range of treatments that can help. 

What causes urinary incontinence?

We don’t always know what causes incontinence in a particular woman. You are most likely to have urinary incontinence if you’ve had children and/or been through menopause.

During pregnancy, the extra weight and changes in hormones weaken your pelvic floor – the ‘hammock’ of muscles, ligaments and tissues that support your bladder. The pelvic floor is then weakened again during labour by pushing and then after menopause, when your body makes less of the female hormone oestrogen that helps keep the pelvic floor strong.

You are also more likely to have urinary incontinence if you:

• often have constipation and strain to empty your bowels or cannot empty them completely or easily
• have a long history of poor bladder habits (e.g. going to the toilet ‘just in case’, straining too hard) 
• have a prolapse where your bladder, uterus or bowel has ‘dropped down’ into your vagina and puts pressure on your bladder
• are over 65 years of age
• have had a condition affecting your brain’s ability to send messages to your bladder (like a stroke, Parkinson’s disease or multiple sclerosis)
• have bad eyesight, trouble moving around or using your hands
• have dementia.

How is urinary incontinence diagnosed?

Your local doctor or GP will most likely: 

• ask you questions about the history of your health
• examine your body
• ask you to cough, push down or tighten your pelvic muscles. 

They may ask you to keep a bladder diary to work out what type of urinary incontinence you have. This means recording things such as how much fluid you drink, how many times you go to the toilet and when you leak. They may send you for urodynamic testing to try to work out what is causing your incontinence. This involves putting small tubes into your bladder and back passage (rectum) and monitoring how your bladder responds when it is filled with water. 

How is urinary incontinence treated?

The kind of treatment you have will depend on:

• the type of urinary incontinence you have
• how severe it is
• your age, health and medical history.

Your doctor may refer you to a women’s health physiotherapist or a doctor who specialises in women’s pelvic floor problems (called a urogynaecologist). They may recommend one or more of these treatment options: 

• Lifestyle changes such as losing weight, quitting smoking, eating more fibre, drinking more water or lifting less. 
• Medication to help relax the bladder muscles, which play an important role in urge incontinence. 
• Physiotherapy to strengthen the pelvic floor, which supports your bladder. A physiotherapist can design a special pelvic exercise program for you. 
• Surgery to support or ‘hold up’ your bladder or urethra (the tube that links your bladder to the outside of your body). Surgery is usually only considered if medication or physiotherapy have not been successful. 
• The success of treatment can vary. While treatment may not ‘cure’ your incontinence, it can still help you live more comfortably with it.

More about surgery

You may consider surgery, or your doctor may recommend it, if you:

• have stress incontinence
• made lifestyle changes and/or tried physiotherapy without success
• need surgery for another pelvic condition (e.g. prolapse).

What surgical options are there and how do they work?

There are four main operations used to treat stress incontinence.

Mid-urethral sling procedure installs a U-shaped mesh tape under your urethra to give it support. This usually involves small cuts to your vagina and belly (key-hole surgery).  You will be given an injection of medicine to either numb the area being operated on (local anaesthetic), the whole pelvic region (regional or spinal anaesthetic) or to put you to sleep (general anaesthetic). This procedure is sometimes called a tension-free or trans-vaginal tape (TVT) operation. 

Colposuspension uses stitches to lift up the neck of the bladder and attach it to the pubic bone. This can involve small cuts to your belly (key-hole surgery) or a longer cut along your belly. You will be given a general anaesthetic for this procedure

Rectus fascial sling takes a small amount of the tough, thin tissue that covers your belly muscles and puts it under your urethra where it works as a supportive sling. 

Urethral bulking agents involves injecting substances into the neck of your bladder that make it tighter and stronger. You will be sedated or given an anaesthetic for this procedure. 

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