13 October 2016 07:00:40

Waterworks worries: what you need to know

There are two main kinds of incontinence, and it’s important to know the difference because the treatment options are very different. Some women suffer from a combination of both kinds.

None of us is exempt from the risk of incontinence. For men, it’s much less common – although men have problems all of their own to worry about. The most common urinary problem for men is BPE or Benign Prostatic Enlargement, which gets more common with age. With time the prostate gland at the base of the bladder naturally enlarges. This can lead to two main kinds of symptoms - storage symptoms (passing water more often, getting up at night to pee, having to rush to the loo) and voiding symptoms (poor stream, needing to wait once you get to the loo before the stream comes).

Symptoms of prostate enlargement are part of a cluster of symptoms called Lower Urinary Tract Symptoms, or LUTS – men, like women, can suffer from overactive bladder, along with urge incontinence (more on that below).

Many of the causes of male urinary symptoms can be treated with medication, either to damp down the nerve messages causing the need to pass water so frequently, or to shrink the prostate gland. Otherwise, prostate surgery can be an option.

Where women are concerned:

Incontinence means passing water when you don’t mean to – and at least 3.5 million women in the UK do it. Kate Winslet has publicly talked about her own experiences of incontinence – but all too many women suffer in silence because of embarrassment.

The two common types of incontinence

There are two main kinds of incontinence, and it’s important to know the difference because the treatment options are very different. Some women suffer from a combination of both kinds.

Your kidneys produce small amounts of urine all the time. This trickles down the ureters – the tubes that connect the kidneys and the bladder – and is stored in the bladder. When you pass water, it goes down a tube called your urethra. The opening to this tube is usually kept closed, largely because of your pelvic floor. This is a collection of muscles and supporting tissue that wrap around your urethra, and we’ll hear much more about them later.

Stress incontinence is the most common kind of incontinence. It’s usually down to weakness in your pelvic floor – often weakened by childbirth or hormone changes around the menopause. If the pressure inside your tummy increases - when you cough, sneeze, jump or even laugh – it can force the opening of the bladder open. You often lose only small amounts of urine, but it’s still very embarrassing.

The second most common kind of incontinence is urge incontinence. Here you have a sudden overwhelming urge to pass urine, followed quickly by an accident if you don’t get to the toilet in time. You’ll probably feel the need to pass urine very often, too, including at night. This kind of incontinence is sometimes known as bladder instability. There’s a complex set of nerve connections between the bladder and the brain. The bladder sends nerve messages to the brain to say it’s full. The brain controls opening the bladder neck and contraction of the muscles that squeeze urine out. If there’s a mismatch between these messages, the brain can instruct the bladder to empty at the wrong time.

These days, every woman who has a baby is given advice on pelvic floor exercises, to help strengthen the muscles in the pelvic floor and reduce the risk of incontinence. They mostly help with stress incontinence, but they can make a difference in urge incontinence too. Your GP or practice nurse can give you advice on how to do them.

If you have urge incontinence, you may benefit from bladder ‘retraining’. Many people with urge incontinence are terrified of an accident, so they visit the toilet very often just in case. This reduces the amount of urine your bladder can hold. Bladder retraining helps you gradually extend time between trips to the loo, building up your bladder capacity and reducing the urge to go.

There are over 360 NHS continence clinics where you can get help too. Continence advisors and specialist physiotherapists can help with bladder retraining and strengthening your pelvic floor. They can also advise on incontinence products.

After the menopause, hormone changes mean that the supporting structures in your vagina and around your pelvic floor get weaker and less springy. Hormone replacement therapy (HRT), including in the form of vaginal cream or pessaries, can reverse this. .

Lots of lifestyle changes will also help. Limiting your fluid intake too much can irritate your bladder, so you should drink enough to keep your urine a pale straw colour. Alcohol can make both kinds of incontinence worse. Cutting out caffeine (in tea and coffee) may help with urge incontinence. Losing weight will reduce the pressure on your pelvic floor and reduce the chance of accidents. Using the right kind of incontinence products is also really important -it is important to use products designed for incontinence or sensitive bladder. They’re much more effective for leakages than sanitary products, which are designed for a very different pattern of menstrual flow.

Exercise is also key– but some kinds can be a challenge if you have incontinence. Opt for low impact versions like yoga, Pilates, cycling or brisk walking. If you notice a sudden increase in accidents, especially with burning when you pass water, see your GP to exclude a urine infection. Please don’t put of speaking to your doctor – there’s lots of help available, but your GP can’t help if they don’t know!

With thanks to ‘My Weekly’ magazine where this article was originally published. 

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.