Urinary incontinence: it doesn’t have to be a secret shame

Most women are too embarrassed to talk about urinary incontinence – even to a doctor. gogoloopie/Flickr

Urinary incontinence, or the uncontrolled leakage of urine, is a common problem among women: it affects almost one in two women at some time in their life. It’s understandably a condition most women are too embarrassed to talk about and, unfortunately, health professionals often assume that if a woman doesn’t raise the issue, then it’s not a problem.

As a consequence, urinary incontinence often goes untreated and substantially affects women’s well-being and quality of life. But it doesn’t have to be that way. Affected women should tell their doctor about their incontinence symptoms as a variety of treatments are available.

Urinary incontinence can occur in three different patterns. Stress-only incontinence is the uncontrolled loss of urine when coughing, sneezing, laughing, bending over or during exercise. The urge-only type is uncontrolled loss due to an overwhelming urge to pass urine so that the person cannot reach the toilet in time. And a woman who experiences both of these types of uncontrolled leakage of urine is said to have mixed urinary incontinence.

Different types of incontinence are more common in different age groups. The stress-only variety, for instance, is most common in women between the ages of 35 and 45. Risk factors include having had at least one child and also being obese.

The mixed pattern of urinary incontinence is generally seen in women aged 45 and over. Its risk factors are being either overweight or obese and having had a hysterectomy. Urge-only urinary incontinence is most common in elderly women and the main risk factor is simply ageing.

Stress-only incontinence can occur when coughing, sneezing, laughing, bending over or during exercise. Mait Juriado/Flickr

Other specific causes of incontinence include infection of the urinary tract, stones in the bladder, some neurological conditions and certain medications. In most cases, it is not caused by any of these conditions, but related to pregnancy, obesity or ageing as described above.

Incontinence can have a marked impact on a woman’s life. Not infrequently, women have to make major adjustments to their everyday lives to accommodate their symptoms. They do this by planning their activities around access to a toilet, wearing incontinence pads or avoiding activities they know will result in urinary leakage.

There are treatments for incontinence so it’s important that women with persistent symptoms discuss them with their doctor. Tests are often done to eliminate the possibility of a specific cause.

These are likely to include:

  • Urinalysis: this checks the pH (acidity or alkalinity) of your urine and whether there are any traces of glucose, protein or blood in it.
  • Urine micro and culture: this is to check if you have an infection of the urinary tract.
  • Your doctor may suggest a blood test to check your blood glucose level (to exclude diabetes) and your kidney function.

Sometimes a bladder diary is helpful. This involves keeping a diary over a few days of every time you need to urinate and how often and how much you drink. It’s important not to restrict fluid intake to avoid having to pass urine, as that may cause dehydration.

Urge-only incontinence is most common in elderly women and occurs simply from ageing. Borya/Flickr

Sometimes, more specialised tests are needed.

Treatment of urinary incontinence often involves doing pelvic floor exercises. Pelvic floor is the name for the muscles that hold the bladder, uterus and vagina and bowel in the correct positions.

Other measures include bladder retraining, often taught by a physiotherapist, weight loss (if needed), avoiding irritants such as drinks containing caffeine (they increase the urge to urinate), and measures to prevent urinary tract infections.

There are a variety of drug treatments available for the specific types of urinary incontinence, as well as a range of specialised surgical procedures, which can be performed, if needed, with good outcomes. In some women, a combination of pelvic floor exercises or bladder retraining and weight loss will be enough to significantly reduce incontinence.

Urinary incontinence can be socially embarrassing and prevent women from participating in a range of activities. Those experiencing symptoms should really seek help, so that their problem can be treated and not be a secret shame holding them back anymore.

Further information is available from the Continence Foundation and the Monash Women’s Health Research Program.