How to manage urinary incontinence: From lifestyle changes to surgery

Urinary incontinence refers to the unintentional leakage of urine, which can range from occasional small leaks to a complete loss of bladder control.

This article provides essential information on the causes, lifestyle changes, medications, and surgical options related to urinary incontinence to help you make informed decisions about your health and wellbeing.

What can cause urinary incontinence?

There are numerous causes of urinary incontinence, and the underlying reasons may vary depending on the type of urinary incontinence (stress, urge, overflow, or mixed).

For women, pregnancy and childbirth are leading causes, as the strain on the pelvic floor that occurs during these events can weaken the muscles and tissues that support the bladder. The menopause is another factor, as declining oestrogen levels can reduce muscle strength and lead to a thinning of the tissues in the urethra and bladder.

For men, benign prostatic hyperplasia, prostate surgery, and treatments for prostate cancer can interfere with normal bladder function, leading to urinary incontinence.

Other causes include age-related changes, which lead to reduced bladder capacity and muscle tone, and certain neurological conditions such as Parkinson’s disease, which can disrupt signals between the brain and bladder. Additionally, temporary incontinence may also occur due to urinary tract infections (UTIs), constipation, or medications like diuretics.

What are effective lifestyle changes for urinary incontinence?

In many cases, simple lifestyle changes can help manage urinary incontinence and even improve symptoms.

Maintaining a healthy weight is essential, as excess weight can increase pressure on the bladder, leading to urinary incontinence. Adopting a balanced diet and regular exercise routine can aid weight management and strengthen the muscles that support the bladder.

Pelvic floor exercises, commonly known as Kegel exercises, can also be beneficial. These exercises involve tightening and relaxing the pelvic floor muscles to strengthen bladder control. Patients can consult a physiotherapist to learn the correct technique and develop an effective routine.

Furthermore, establishing a regular toilet schedule, also known as bladder training, can gradually increase the time between toilet visits, training the bladder to hold more urine and reducing the urgency associated with urge incontinence.

In severe situations, wearing absorbent pads can provide security and ease stress in social situations.

Are there medications that can also help?

Medications may be a suitable option for patients who don’t experience sufficient improvement with lifestyle changes alone. The type of medication prescribed will depend on the specific type of urinary incontinence.

For urge incontinence, medications known as antimuscarinics are prescribed to relax the bladder muscles and reduce the frequency and urgent need to urinate. Beta-3 agonists such as mirabegron are another option that increases the bladder's capacity to store urine by relaxing the bladder wall.

For women experiencing urinary incontinence due to the menopause, low-dose topical oestrogen treatments can help strengthen the tissues of the urethra and improve bladder tissue health and function, which helps to alleviate symptoms.

For men, alpha-blockers can help relax the muscles around the prostate and bladder neck, improving urine flow and reducing incontinence caused by prostate problems.

Is surgery ever necessary for urinary incontinence?

Surgery is generally considered a last resort after other treatments have been explored and when the condition significantly impacts quality of life. Surgical options vary depending on the type and severity of the urinary incontinence.

For stress incontinence, sling procedures are commonly performed. This involves placing a synthetic or natural mesh material around the urethra to improve closure and prevent leakage during physical activities.

If stress incontinence is severe, another option is colposuspension (bladder neck suspension). This procedure involves lifting and supporting the bladder neck to provide added support and help prevent urine leakage. Minimally invasive injections of bulking agents can also help by strengthening the urethra’s ability to hold urine.

For urge incontinence, treatments such as sacral nerve stimulation can regulate bladder function by delivering mild electrical impulses to the nerves controlling the bladder.

Lastly, for men with urinary incontinence caused by prostate surgery or injury, an artificial urinary sphincter can be implanted to help control urine flow.

If you are experiencing symptoms of urinary incontinence, it’s important to consult with a specialist who can help determine the most appropriate course of action based on your individual needs.