Leaking urine when you cough, sneeze, laugh or lift something, or not quite reaching the toilet in time, is far more common than most people think. It affects women after childbirth and around menopause, men after prostate problems or prostate surgery, and older adults of both sexes. Many people quietly put up with it for years, wearing pads and planning their day around toilets. Bladder leakage is a medical condition, it can be assessed simply, and in most people it can be improved.
What is urinary incontinence?
Urinary incontinence means any involuntary leakage of urine. It can be a few drops now and then or enough to soak through clothing. Doctors describe several types, because the cause and the treatment differ for each:
- Stress incontinence: leakage when pressure on the bladder rises, such as coughing, sneezing, laughing, jumping or lifting. It is usually due to weak pelvic floor muscles or a weak urethral sphincter. It is common in women after childbirth and in men after prostate surgery.
- Urge incontinence (overactive bladder): a sudden, strong need to pass urine, with leakage before you reach the toilet. It often comes with frequent urination by day and waking at night to pass urine.
- Mixed incontinence: a combination of stress and urge symptoms, which is common in women.
- Overflow incontinence: dribbling because the bladder does not empty fully. In men this is often linked to an enlarged prostate or a narrowing of the urethra. It can also happen with diabetes or nerve problems.
Common causes
- Pregnancy, childbirth and menopause
- Enlarged prostate, or previous prostate surgery or radiotherapy
- Urine infections, which can cause sudden, temporary leakage
- Diabetes, stroke, spinal problems and other conditions affecting the nerves
- Constipation, being overweight and a long-standing cough
- Some medicines, such as water tablets (diuretics)
- Too much tea, coffee, cola or alcohol, which irritate the bladder
When to see a urologist
Any leakage that bothers you is worth discussing. Please see a doctor sooner if you notice:
- blood in your urine
- pain or burning when passing urine, or fever
- a weak stream, straining, or a feeling that the bladder has not emptied
- leakage that started suddenly, or together with leg weakness or numbness
- repeated urine infections
What happens at the consultation
The consultation is private and straightforward. Your urologist will ask when the leakage happens, how often, and what makes it worse, and will review your medicines and medical history. You may be asked to keep a simple bladder diary for three days, noting what you drink, when you pass urine and when you leak. This one sheet of paper often says more than any test.
Basic tests usually include a urine test to rule out infection, a blood sugar check, and an ultrasound to measure how much urine stays in the bladder after you pass urine. Some people need a uroflowmetry test, which measures the strength of the urine stream, or urodynamic studies, which show how the bladder fills and empties. A few need a cystoscopy, a camera look inside the bladder.
Treatment options
Most people start with simple measures, and many improve without surgery.
- Pelvic floor exercises: regular, correctly done exercises strengthen the muscles that hold urine in. They help most with stress incontinence, in both women and men after prostate surgery. A physiotherapist can teach you to do them properly.
- Bladder training: gradually stretching the time between toilet visits to retrain an overactive bladder.
- Lifestyle changes: cutting down on caffeine and fizzy drinks, spreading fluids through the day rather than avoiding water, treating constipation, losing weight and stopping smoking.
- Medicines: for overactive bladder, medicines can calm sudden urges. For men with an enlarged prostate, medicines can improve flow and emptying.
- Treating the underlying cause: such as a urine infection, an enlarged prostate or a urethral stricture.
- Procedures: when simpler steps are not enough, options include Botox injections into the bladder for overactive bladder, sling procedures for stress incontinence in women and in selected men, and an artificial urinary sphincter for some men after prostate surgery. Your urologist will explain the benefits and risks of each option for you.
Small habits that help
- Drink around 1.5 to 2 litres of fluid a day, unless your doctor advises otherwise. Too little makes urine concentrated and irritating.
- Reduce tea, coffee and fizzy drinks, especially in the evening.
- Avoid going to the toilet “just in case” too often.
- Keep your bowels regular.
- Practise pelvic floor squeezes daily, for example while waiting at a signal or brushing your teeth.
Read more: Diabetes and your bladder and Enlarged prostate (BPH) treatment in Koramangala.
Consult a urologist in Koramangala
Dr Bivek Kumar (MCh Urology, FRSM) is a Consultant Urologist and Andrologist at Superhealth Hospital, Koramangala, beside Nexus Mall. He sees women and men with bladder leakage, overactive bladder and prostate problems in a confidential setting, and consults in English, Hindi, Kannada and Bengali.
OPD: Monday to Saturday, 9 am to 6 pm
Appointments: +91 90329 59964
This article is for general awareness only and is not a substitute for medical advice. Please consult your doctor about your own health.