What is Incontinence?

Many women report symptoms of both urge and stress incontinence. Incontinence is leakage of urine when you do not mean it to happen. It is caused by loss of bladder control and it can occur at any time.

This common and distressing condition affects about one million people in Australia. It affects men and women of all ages but it is most common in women and older people.

Incontinence can often be cured and even where this is not possible, there is much that can be done to improve it - no matter what your age. Many people, however, are too embarrassed to ask for help.

If you have a problem with incontinence, seek advice from your doctor as soon as possible. Modern treatments are very successful and, for many people, simple exercises and bladder training programs can help considerably. But if the problem is left untreated, it may be more difficult to treat successfully later on.

Types of Incontinence

The most common types of incontinence are:

• Urge Incontinence: The bladder muscle contracts without warning and, if the bladder is partly full, this forces urine to leak out. When it happens, the person often feels that they have "got to go", but it can be difficult to reach the toilet in time.

• Stress Incontinence: This can be likened to a 'leaky tap'. It is caused by weakness in the urethral valve (the valve that controls urine flow) and/or weakness in the muscles that surround and support this valve, including the pelvic floor muscles. Urine leaks when the person exerts herself; for instance, when sneezing, coughing, laughing or jumping.

• Overflow Incontinence: Occurs when the bladder fails to empty properly, becomes over-full, and then tends to dribble or leak. It may be caused by poor contraction in the bladder muscle, or by certain neurological or medical conditions. It can be worsened by chronic constipation.

• Continuous Incontinence: May be due to a fistula (a hole or abnormal passage between the bladder and vagina). The woman experiences continuous leakage of urine.

• Frequency: Is the need to pass urine very often, day and night. It can be associated with various types of incontinence, but it can also happen without incontinence.

Causes of Incontinence and Urinary Problems

As women age, their pelvic floor muscles - the 'sling' of muscles that support the bladder, bowel and uterus - stretch and weaken. A number of factors may contribute to this weakening, including the long-term effect of pregnancy and childbirth, being overweight, chronic constipation, chronic cough, frequent lifting of heavy objects, and changes in hormone levels after menopause - specifically, a lack of oestrogen.

Inflammation of the bladder - known as 'cystitis' - can cause pain when you pass urine. Cystitis may be caused by an infection, or by other problems, and it needs medical treatment. You can help to prevent it by drinking plenty of water and including cranberry juice regularly in your diet.

Loss of oestrogen after menopause can cause cystitis-like symptoms, especially night time frequency.

'Cystocoele' is a stretching and weakening of the wall between the bladder and vagina. It can cause symptoms like frequency or incomplete bladder emptying, and the woman may feel she has a lump in her vagina.

Some women find they go to the toilet very frequently simply to try to avoid the chance of leakage.

Prevention

Try the following to reduce your risk of incontinence:

• Drink six to eight glasses of water each day, to help maintain bladder capacity 

• Reduce your intake of coffee and other drinks containing caffeine, because these act as diuretics - that is, they increase the amount of urine the body makes 

• Exercise regularly 

• Avoid smoking, excess body weight, chronic cough and chronic constipation

• Do pelvic floor exercises (see below)

Treatment 

Pelvic Floor Exercises

Like other muscles in the body, the pelvic floor muscles - the 'sling' of muscles that support the bladder, bowel and uterus -can be strengthened by exercise. 

Pelvic floor exercises should be done regularly. Ideally, all women should do them throughout adulthood to maintain strong muscles and reduce the risk of incontinence.

Pelvic floor exercises are particularly good for stress incontinence. When combined with a bladder training program (see below), they help to increase the bladder's capacity.

Women with strong pelvic floor muscles may also have an improved sexual response. You can do the exercises anywhere - while waiting in the car at traffic lights, in a queue at the bank or supermarket, watching television, sitting at a table, cooking dinner etc.

How to do Pelvic Floor Exercises 

• Tighten and draw in the pelvic floor muscles around the urethra, vagina and rectum. Lift up as if stopping your urine flow in midstream. Do not push down - you need to tighten and draw up the muscles.

• Count to five and then relax completely before repeating the exercise. 

• Continue until you can do this eight or ten times.

• This comprises one set. 

• Gradually increase the amount until you are able to do four to five sets daily. 

• Concentrate on working only the pelvic floor muscles - not the thighs or buttocks.

Remember: Tighten and draw up muscles - don't push down.

 How to do Pelvic Floor Exercises (5.42 MB)

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Bladder Retraining 

Bladder retraining improves the bladder’s capacity and enables it to hold more urine. It is useful for women who have frequency or urge incontinence.

How to do Bladder Retraining  

• Drink six to eight glasses of water daily 

• Delay urination by five minutes, then gradually, over weeks, increase this time by 10 to 15 minutes or more. To help delay urination, try: 
  - Pelvic floor exercises 
  - Perineal pressure (e.g. sitting firmly on the arm of a chair)
  - Distract yourself with mind games, relaxation or anything else that works for you

• It is also helpful to keep a diary - discuss this with your continence adviser  

• Avoid bladder irritants like coffee and alcohol  

Hormone Therapy

In some women, incontinence becomes worse after menopause because of the lack of the hormone, oestrogen. 

These women may be helped by oestrogen treatment - either hormone therapy, or a cream, tablet or pessary applied to the vaginal and urinary area. 

The woman should also do pelvic floor exercises and bladder retraining exercises. 

If these do not improve the problem sufficiently, you may need to be referred to a specialist doctor who specialises in women's urinary or reproductive problems. 

The specialist may be a urogynaecologist, gynaecologist or urologist.

Incontinence Aids

If you have problems with continence, incontinence pads and accessories can help you to live a normal life.

Discuss these with your doctor, pelvic floor physiotherapist and pharmacist. A wide range of aids, to suit varying degrees of incontinence, are available from your pharmacy.

Where to Seek Advice

The Jean Hailes Medical Centre for Women - phone (03) 9562 7555

Further Resources

Bladder and bowel health

 Incontinence (96.42 KB)

Incontinence: The Hidden Epidemic (Women’s Weekly Series)
By Kerrie Lee

Women’s Waterworks: Curing Incontinence
By Dr Pauline Chiarelli

Continence Foundation of Australia

Content updated February 22, 2006