Urinary incontinence explained: types, causes and treatment

The main types

There are two common patterns. Stress incontinence is leaking when pressure rises inside the abdomen — during coughing, laughing, sneezing, lifting or exercise. It happens when the muscles and tissues that support the bladder and close the water pipe are weakened, often after childbirth or with age. Urge incontinence is a sudden, strong need to pass urine followed by leaking before you can reach a toilet, often with needing to go frequently and at night; it is linked to an overactive bladder muscle. Many people, especially women, have a mix of both, called mixed incontinence. Other patterns include overflow incontinence, where the bladder does not empty properly and dribbles, more common in men with an enlarged prostate.

Why it happens

The causes differ by type. Stress incontinence follows anything that weakens the pelvic floor or bladder outlet: pregnancy and vaginal birth, the menopause, being overweight, chronic coughing, constipation with repeated straining, and, in men, surgery on the prostate. Urge incontinence and overactive bladder arise when the bladder muscle contracts when it should be relaxed; this can be linked to age, bladder irritation, and conditions affecting the nerves. Some things make any incontinence worse, including caffeine, alcohol, certain medicines, urine infections, constipation and poorly controlled diabetes. Because the causes overlap and treatment differs by type, it helps to have the pattern properly assessed rather than assuming all leaks are the same.

Everyday self-help

Simple changes help a great deal. Pelvic-floor muscle exercises are the first-line treatment for stress incontinence and also help urge symptoms; done correctly and consistently for at least three months, they strengthen the muscles that hold urine in. Cutting down caffeine and alcohol, drinking sensibly rather than too little or too much, losing excess weight, stopping smoking and treating constipation all reduce leaks. For urge symptoms, bladder training — gradually stretching the time between toilet trips — helps the bladder hold more. Keeping a short bladder diary of drinks, trips and leaks helps you and your clinician see the pattern. These measures are safe, effective and worth persevering with before considering medicines or procedures.

Medical and specialist treatment

If self-help is not enough, there is much more that can be done. For urge incontinence and overactive bladder, medicines can calm the bladder muscle, and a specialist can offer further options such as bladder injections or nerve stimulation when needed. For stress incontinence, supervised pelvic-floor physiotherapy, vaginal support devices and, when appropriate, surgery can help. Vaginal oestrogen may ease symptoms linked to the menopause. Men with leaks from prostate problems are assessed and treated for the underlying cause. Continence products such as pads offer dignity and confidence while treatment takes effect. In the UK, GPs, practice nurses and specialist continence services provide this care, and a referral can be made if symptoms are complex or not improving.

When to seek help

Incontinence is not an inevitable part of ageing to be endured, and it is worth seeing a clinician even if it feels awkward — most people improve with the right help. Make an appointment if leaks affect your daily life, sleep, confidence or activity. See your clinician sooner if you have pain passing urine, blood in the urine, frequent urine infections, a sudden change in bladder habits, difficulty passing urine or a weak stream, or any new leakage alongside numbness in the saddle area, back pain or leg weakness — this last combination needs urgent assessment. A simple check for infection, a bladder diary and an examination often point quickly to the cause and the treatment most likely to help.