Bladder or urinary incontinence is common.
Different types of incontinence, what is normal, the causes and symptoms of incontinence, and how incontinence is diagnosed, are discussed.
What is incontinence?
What is normal?
Types and symptoms
Causes of incontinence
Diagnosis
Prevention & management
Treatments
Interstitial cystitis/painful bladder syndrome
Incontinence is the accidental or involuntary leakage of urine, faeces or wind. It is a common condition; one in three women who have had a baby, and up to 10% of women who haven't had a baby, have bladder incontinence. There are always ways that incontinence can be improved. Mild symptoms unfortunately tend to worsen over time, so seek help as soon as possible. Know that it's never too late, and you are never too old to improve.
Related resource
Bladder & bowel health - fact sheet
According to the Continence Foundation of Australia, a normal bladder:
Women can have both urinary and bowel incontinence. Below are different types of bladder incontinence.
| Types of incontinence | Signs and symptoms |
|---|---|
| Urge incontinence (urinary) | The bladder muscle contracts with little warning and you may feel:
|
| Stress incontinence (urinary) | Urine leaks when you exert yourself, such as when you sneeze, cough, laugh or jump, due to mobility in the bladder neck because of a weak pelvic floor. |
| Mixed incontinence | You experience both urge and stress symptoms. |
| Overflow incontinence | Occurs when the bladder fails to empty properly, becomes over-full and then tends to leak – it may be caused by poor contraction in the bladder muscle or by certain neurological or medical conditions, such as diabetes. |
The pelvic floor muscles – the 'sling' of muscles that supports the bladder, bowel and uterus – can stretch and weaken, leading to continence issues.
The following may also contribute to incontinence:
Many women are embarrassed to talk to their doctor about bladder incontinence, or are unsure what incontinence is. If you are worried about leakage, try to tell your doctor what's happening, no matter how trivial you think it is.
The causes of bladder incontinence can be diagnosed by a number of different methods:
| Diagnostic approach | What to expect |
|---|---|
| Medical history | Your doctor may ask you questions about:
|
| Physical examination | The physical examination will assess:
|
| Urodynamics | A test of bladder function, which fills the bladder and determines what causes it to leak and how well it empties. |
You can help to prevent and manage bladder incontinence with a number of simple dietary and lifestyle actions.
| Water | Drink 6-8 cups or glasses of fluid per day. This does not have to be only water, and includes all of your drinks. Reducing your fluid intake does not reduce incontinence. Concentrated urine due to lack of fluids can lead to urinary burning and make you more likely to develop a urinary tract infection. Once you have had your 6-8 cups or glasses of fluid, reducing your fluids after your evening meal will help you to stop getting up overnight. |
| Caffeine and alcohol | Eliminate caffeinated drinks (remember chai, green tea and energy drinks may be caffeinated). Fizzy drinks and drinks with added colouring and sweeteners, as well as alcohol, can worsen symptoms and cause increasing frequency. |
| Fibre | To avoid constipation, which can worsen bladder leakage, try to eat plenty of fibre. Each day, eat:
|
| Physical activity | Aim for 30 minutes of moderate physical activity most days of the week. This maintains general muscle function and mobility. Avoid fitness activities that cause bladder leakage – they won't make it better. See Pelvic Floor First for a fitness program that is safe for your pelvic floor. |
| Pelvic floor exercises | Do pelvic floor exercises regularly so that you can use the muscles to help prevent leakage. Podcast: Pelvic floor exercises You may need to see a pelvic floor physiotherapist if your technique is incorrect, and to teach you bladder retraining techniques. |
| Lifting | Avoid heavy lifting, as this can weaken your pelvic floor; take particular care lifting children, and weights at the gym. Learn to 'brace' your pelvic floor muscles prior to any lifting. |
| Coughing |
|
| Menopause hormone therapy (MHT) |
|
| Toilet habits |
|
| Bladder training | You can be guided through bladder training by a continence nurse or pelvic floor physiotherapist at a public hospital, continence clinic or private clinic. |
| Medication | Your doctor might prescribe medication to treat your bladder incontinence once it has been fully assessed. |
| Surgery | Some types of bladder incontinence can be managed with surgery. If appropriate, your doctor will refer you to a specialist gynaecologist or urologist. |
| Continence products | Continence pads and accessories can help you feel more comfortable and secure, and help maintain your quality of life while you are seeking treatment. Continence panty liners are just as small as other liners, but are specifically designed to absorb urine, so do a better job. You can discuss these products with your doctor, continence nurse, pelvic floor physiotherapist or pharmacist. |
Medications that can calm down an overactive bladder:
Persistent bladder pain affects quality of life considerably. Why it occurs is not exactly known, and there may be more than one cause. The diagnosis is made when no other causes of bladder pain can be found. It often coexists with other chronic pain syndromes such as fibromyalgia and irritable bowel syndrome.
This condition is not to be confused with overactive bladder syndrome, which presents with urinary urgency, but typically not with bladder pain.
The possible symptoms include:
A urine test will most likely show no evidence of bladder infection. Cystoscopy (an examination of the inside of the bladder) is usually performed to exclude other causes of bladder pain.
If you have these symptoms and have been investigated with no other causes found, such as a urinary tract infection, ask your doctor for referral to a gynaecologist, urogynaecologist or urologist for further management.
The aim of treatment is to provide symptom relief. There is a wide range of therapies used. Education and psychological support are necessary because of the impact of the symptoms on mood and wellbeing.
There are a number of ways you can help to manage the symptoms:
A pelvic floor physiotherapist can help with bladder retraining, which can reduce urgency and also relax the pelvic floor, which is often overactive.
Many medications have been used, taken both orally or administered into the bladder. The latest therapy that seems to benefit some women is the injection of Botox into the bladder wall under anaesthesia.
Maintaining pelvic floor fitness - video
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2018.
