Urine leaks
Investigating and treating stress and urge urinary incontinence in women and men: rehabilitation, medical treatment and surgery where needed.
It isn't normal, even if it's common
Many people live for years with urine leaks, buying pads and planning their life around where the nearest toilet is, without ever mentioning it. It's a very common problem and in most cases improves a great deal with treatment. It's worth bringing up at the clinic.
Types, because treatment differs
- Stress incontinence: leaks when coughing, laughing, sneezing, running or lifting something heavy. Linked to pelvic floor weakness after childbirth, menopause or prostate surgery.
- Urge incontinence (overactive bladder): a sudden, hard-to-control need to go, with leaks before reaching the toilet, and frequent urination by day and night.
- Mixed: a combination of the two, very common.
- Overflow incontinence: continuous dribbling from incomplete emptying, typical of prostate obstruction.
How it's investigated
With your medical history, a bladder diary — what you drink, when you urinate and when you leak, over a few days: it's very revealing —, a urine test, an examination and an ultrasound to assess emptying. In selected cases it's completed with urodynamic testing.
Treatment
It almost always starts without surgery: adjusting drinking and toilet habits, bladder training, and above all pelvic floor physiotherapy, which is the first-line treatment for stress incontinence and very useful for urge incontinence too. Medication is added for an overactive bladder and, in postmenopausal women, local treatment is considered with gynaecology. Surgery is reserved for cases that don't respond, with a carefully judged indication.
Frequently asked questions
Is urine leakage inevitable with age or after childbirth?
No. It is very common, which is not the same as normal, and in most cases it improves greatly with treatment. Many people live for years with pads without ever having mentioned it: it is worth raising in the consultation.
What is a bladder diary?
A record of what you drink, when you pass urine and when leaks happen, kept over a few days. It is highly revealing and guides the diagnosis more than many tests: it distinguishes stress incontinence from urge incontinence, which are treated differently.
Is surgery necessary?
Almost never as a first step. We start with retraining habits, bladder training and pelvic floor physiotherapy, the first line in stress incontinence, and drug treatment is added in overactive bladder. Surgery is reserved for what does not respond.
How is urinary incontinence cured?
It depends on the type. Stress incontinence improves considerably with properly prescribed pelvic floor physiotherapy and, if that is not enough, with surgery. Urge incontinence responds to retraining habits, bladder training and medication. The first step is to tell them apart, because the treatments are nothing alike.
What causes urinary incontinence?
Weakness or poor coordination of the pelvic floor after childbirth or surgery, hormonal changes at the menopause, an overactive bladder muscle, obstruction from the prostate in men, chronic constipation, excess weight and some medications. It is hardly ever just "old age".