Urinary incontinence

What is urinary incontinence?

Urinary incontinence is any involuntary or unwanted loss of urine. It is considered a medical condition if it happens regularly. The risk of developing incontinence increases with age, but younger people may also develop it. Women are more likely to suffer from this condition than men.

Incontinence is common and causes distress and embarrassment. Many people go without treatment because they feel uncomfortable discussing incontinence with their doctor.

If incontinence is frequent or affects your quality of life, it is important to seek medical advice. In most cases, incontinence can be treated or cured with various treatment options. These include pelvic floor exercises, drug treatment, or surgery. Together with your doctor you can discuss which treatment is best for you.

Causes of urinary incontinence

Some of the most common causes of urinary incontinence are:

  • Hormone deficiencies
  • Weak pelvic floor muscles
  • Neurological lower urinary tract dysfunction
  • Urinary tract infections
  • Benign prostatic enlargement (BPE)

Common risk factors include:

  • Pelvic surgery
  • Prostate surgery
  • Childbirth
  • Menopause

Urinary incontinence becomes more common with increasing age. However, it should not be seen as a normal part of ageing.

Fig. 1a: The male lower urinary tract.
Fig. 1a: The male lower urinary tract.
Fig. 1b: The female lower urinary tract.
Fig. 1b: The female lower urinary tract.

Diagnosis

Urinary incontinence is a problem that needs to be diagnosed correctly so that you get the appropriate treatment. Discussing incontinence issues with a urologist may be uncomfortable, but it is important to do so. The urologist can help to improve your symptoms or even cure your condition. Your doctor needs to find out which type of incontinence you have and what causes it. This will help to find the best treatment.

This section lists the different tests your doctor may need to assess your situation. It offers general information about diagnosis and assessment of urinary incontinence. Keep in mind that situations can vary in different countries.

Medical history

Your doctor will take a medical history to understand what type of urinary incontinence you have. As part of the medical history your doctor will ask about any other conditions you may have, or medication you take. This can be related to the incontinence or have effect on your symptoms.

Your doctor may ask you:

  • If you take any medication
  • If you smoke
  • When and how much you drink
  • If you drink much coffee or alcohol
  • If you ever had surgery
  • To describe your bowel habits
  • If you have ever been pregnant
  • If you have entered menopause

Your doctor will also ask you about the impact of incontinence on your daily life, for example:

  • How often you go to the toilet
  • How often you have urine leakage
  • If you leak urine when you laugh, cough, or sneeze
  • If you wake up at night to urinate
  • If you need to hurry to reach the toilet in time when you feel the urge to urinate
  • If your bladder does not feel empty after urinating
  • The doctor may also ask you about your sex life and your treatment wishes.

Physical examination

The doctor may perform a physical examination of your abdomen to detect an enlarged bladder. He or she may ask you to cough with a full bladder, in order to see if you suffer from stress urinary incontinence (SUI). The doctor also needs to test how well the pelvic floor muscles work. For men, this is done through a digital examination of the rectum and the prostate (Fig. 1). Women will get a gynaecological examination.

Fig. 2: Digital rectal examination to feel the size, shape, and consistency of the prostate.
Fig. 2: Digital rectal examination to feel the size, shape, and consistency of the prostate.

Treatment

There are many different ways of coping with urinary incontinence. Seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist. It may be uncomfortable to discuss your condition with a doctor, but it is the most effective way to deal with your concerns.

There is no single solution to incontinence that works for everyone. Self-management measures can significantly improve your condition and lead to a better quality of life. These measures include lifestyle changes, bladder training and pelvic floor muscle exercises. Other treatment options, such as surgery and medication, should be considered if self-management is not effective.

Discuss with your doctor, consultant or specialist nurse which measures can help you can take control of the condition. It is common to try different options to figure out which one works best for you.

Treatment for urinary incontinence depends on the type of incontinence, how severe it is, and what may cause it. Often, self-management measures are combined with drug treatment. Together with your doctor you can decide which drug treatment is best for your situation.

The main types of medications used to manage incontinence are muscarinic receptor antagonists (MRAs), mirabegron, and oestrogen. Other drugs include desmopressin and duloxetine.

Surgical treatment for women with SUI

Stress urinary incontinence (SUI) occurs when an increase in abdominal pressure through coughing, sneezing or physical activity is transmitted to the bladder and causes an involuntary leakage of urine due to a weakness in the muscular support around the bladder neck or urethra. Sometimes SUI does not get better with self-management or pelvic floor exercises prescribed by your doctor. In this case, your doctor may recommend surgery.

This section offers general information and situations can vary in different countries.
Surgical TreatmentDescription Recommended for
Standard
Midurethral slingA strap that is placed under the urethra* to provide support, most commonly a synthetic (polypropylene) meshMost patients
Burch colposuspensionAn operation to support the bladder neck, which connects the bladder to the urethra, to resist pressurePatients who cannot have a synthetic or midurethral sling
Autologous fascial slingA strap made from the patient’s own body tissue that is placed under the urethra to provide supportPatients who cannot use a synthetic or midurethral sling
Special situation
Bulking agentsSubstance that is injected into the wall of the urethra to improve closure. In general, a temporary effectPatients who are not eligible for surgery, only expect a short-term benefit, or want to postpone surgery
Artificial urinary sphincterAn inflatable cuff placed around the urethra connected to a hand-controlled pump that allows you to pass urinePatients with complex problems for whom other treatments have not worked

*The urethra is a tube that allows passage of urine from the bladder.

Surgical treatment for men with SUI

If you suffer from stress urinary incontinence (SUI), your doctor may recommend surgical treatment to improve or cure your condition. Common surgical options for SUI are:
  • Slings
  • Artificial Compression Devices (balloon insertion)
  • Artificial Urinary Sphincter (AUS)
  • Bulking agents
The aim of all procedures is to make you continent. How this is done varies. Together with your doctor you can decide which approach is best for you, based on:
  • Your age
  • The severity of your urinary incontinence
  • How bothersome your symptoms are
  • Your general state of health
This section offers general information and situations can vary in different countries.

Treatments for special situations

Problems in the urinary tract can make SUI difficult to treat. If you have such a problem, your doctor may recommend other treatment than those listed here.

Second-line treatment for urgency urinary incontinence

Sometimes self-management or the drugs your doctor prescribed do not improve your urgency urinary incontinence (UUI). In these cases, other treatment options are available. Together with your doctor you can decide which approach is best for you.

Common second-line treatment options for UUI are:

Bladder surgery

In case your symptoms have not improved with drug or other treatments, you may need surgery on your bladder. The goal of the procedure is to increase the capacity of the bladder. This will reduce the pressure in the bladder as it fills so that it can hold more urine.

The doctor makes an incision in your lower abdomen and uses a piece of your bowel to increase the size of the bladder. This procedure is called bladder augmentation or cystoplasty, and is rarely performed nowadays (Fig. 1). If this surgery is recommended, you will need to discuss its implications and side effects with your doctor because they can be significant.

Fig. 1: Bladder surgery to increase the size of the bladder.
Fig. 1: Bladder surgery to increase the size of the bladder.

Living with urinary incontinence

Urinary incontinence can be an embarrassing and isolating condition that affects your physical and psychological health. Although it is not life-threatening, it usually has a negative impact on your quality of life. Incontinence can affect your social life, your work, and your sex life. It causes physical and emotional discomfort, and can lead to low self-esteem.
Urinary incontinence can make you feel powerless. Having unwanted urine leakage in a public place can be upsetting and embarrassing. This could lead to fear of leaving the house, and a sense of isolation which prevents you and your loved ones from fully enjoying life.
There are many causes of incontinence. Some can be cured, and others can be managed. Social attitudes to urinary incontinence can make it difficult to talk about it, even to your closest friends. Looking for professional help can take your mind off your situation, and allow you to better cope with the condition.

This information was produced by the European Association of Urology.

  • Prof. Dr. Frank van der Aa, Leuven (BE)
  • Dr. Jean-Nicolas Cornu, Paris (FR)
  • Ms. Sharon Holroyd, Leeds (UK)
  • Prof. Dr. José Enrique Robles, Pamplona (ES)
  • Ms. Eva Wallace, Dublin (IR)

Updated March 2018 by:

  • Dr. Jan-Peter Jessen Essen (DE)
  • Dr. Ricardo Pereira e Silva, Lisbon (PT)