What is urinary incontinence?

Because of the stigma around incontinence, we’ve normalised it to the point where many of us treat it as a normal part of ageing or postpartum, but that only does a disservice to women.

Over one in three women in the UK will experience incontinence at some point in their lives, but although it’s a common issue, losing bladder control is an indication that something isn’t quite right – yes, even if you’re going through menopause or have just given birth.

What is urinary incontinence?

Urinary incontinence is the inability to retain urine, or involuntarily leaking urine. In layman's terms, it’s when you accidentally pee yourself! No shame in that, because we’ve all been there.

It can affect people of all ages and genders, and to varying degrees. Urinary incontinence can look like leaking a few drops when laughing at something your mate said, or completely emptying your bladder because you didn’t make it to the loo in time. It can be both temporary or more long-term, but it’s always treatable.

Different types of incontinence

Incontinence can be caused by several factors, and understanding what type of incontinence you’re dealing with is key to a correct diagnosis. Different types of urinary incontinence include:

• Stress incontinence

• Urge incontinence

• Mixed type incontinence (having both stress and urge incontinence)

• Overflow incontinence.

Causes of stress incontinence

Stress incontinence refers to involuntary leakage of urine triggered by activities such as coughing, laughing, sneezing, running, jumping on a trampoline. I don’t know how many of you are spending your days jumping on trampolines but frankly, it would be nice to have the option of doing so without wetting yourself!

These types of movements and activities generate pressure on the abdomen and pelvic floor, which in turn squeeze the bladder. Your pelvic floor usually suppresses the urethra (or more specifically, the urethral sphincter) so it can tighten and hold in your pee, but in stress incontinence, your urethra can’t quite cope with the pressure, so it accidentally expels some urine. And voila, you find yourself needing to change your knickers.

Despite the name, stress incontinence isn’t actually caused by psychological stress (although mental health and bladder health are definitely linked), but rather physical stress on the muscles around the bladder. Common causes for stress incontinence are:

• Vaginal childbirth, which can sometimes cause a dysfunction of the pelvic floor muscles. This depends largely on the complexity of your delivery, whether there were any tears, episiotomy, or prolonged pushing.

• Pregnancy can cause excessive amounts of weight on your bladder.

• Complications during surgery such as a hysterectomy.

• Neurological conditions like Parkinson's disease or multiple sclerosis, which affect your brain and spinal cord.

• Connective tissue disorders such as Ehlers-Danlos syndrome.
  

Causes of urge incontinence

Urge urinary incontinence is when you feel a sudden, intense urge to pee but are unable to get to the toilet in time, causing leakage.

Urge incontinence is usually caused by a problem with the detrusor muscles, muscles that surround your bladder. The detrusor muscles relax to allow your bladder to fill up with urine and contract when you go to the loo to expel the urine.

In urge incontinence, the detrusor muscles contract too much and too often. In fact, urge incontinence is sometimes also known as having an ‘overactive bladder’.

It’s not fully understood why your detrusor muscles contract too often, but possible causes include:

• Constipation

• Urinary tract infections (UTIs) or interstitial cystitis (chronic inflammation of the bladder)

• Some neurological conditions

• Medications such as angiotensin converting enzyme (ACE) inhibitors, diuretics, some antidepressants, hormone replacement therapy (HRT) and sedatives.

• Drinking too much alcohol or caffeine, or not drinking enough water. Both of these factors can irritate the bladder and cause symptoms of overactivity.

Causes of overflow incontinence

Overflow incontinence sometimes referred to as chronic urinary retention, is when you’re unable to fully empty your bladder in one go, causing frequent leaks.

Overflow incontinence is often caused by a blockage affecting your bladder (such as bladder stones) or by the detrusor muscles not fully contracting. In both cases your bladder doesn’t completely empty when you urinate, causing some urine to hang around and leak.

Is incontinence an inevitable part of ageing?

Urinary incontinence is often dismissed as a byproduct of getting older, but it’s not a normal sign of ageing! Yes, age and menopause can be a risk factors for incontinence but that does not mean you should have to put up with it – nor that everyone over the age of 50 is incontinent.

As we age, our pelvic floor muscles tend to weaken (like all muscles), meaning they can’t support our bladder and urethra as they once could. On top of that, through menopause women stop producing the hormone oestrogen, which plays a key role in supporting soft tissue.

A drop in oestrogen levels can cause the bladder and pelvic floor tissues to become weaker and thinner, making you more prone to leaks. Remember: just because incontinence is a common symptom, it doesn’t mean you have to accept it as a part of menopause.

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Poor bladder health shouldn’t be a “normal” part of ageing or childbirth — that’s why we created the Bladder Care Handbook: our guide to life’s trickly moments. Download your free copy for expert tips on how to look after your bladder.