What is incontinence?
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 some form of incontinence.
What is normal bladder function?
According to the Continence Foundation of Australia a normal bladder:
- empties 4-8 times each day (every 3-4 hours)
- can hold up to 400-600ml of urine (the sensation of needing to empty occurs at 200-300ml)
- may wake you when it is full, but gives you enough time to find a toilet
- does not leak urine
Incontinence: types and symptoms
Women can have both urine and bowel 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.|
|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.|
Other symptoms might include:
- straining to get urine to flow
- a sensation of fullness or pressure in the vagina
- a bulge or swelling felt in the vagina
In severe cases the vagina and bladder may stick out of the vaginal entrance.
Causes of incontinence
As women age, the pelvic floor muscles – the 'sling' of muscles that supports the bladder, bowel and uterus – can stretch and weaken.
The following may contribute to this weakening:
- Recurring urinary infections
- Pregnancy and childbirth
- Being overweight
- Chronic constipation that causes you to strain
- Chronic coughing
- Chronic back pain
- Frequent lifting of heavy objects, including children and weights at the gym
- Reduction in the hormone oestrogen after menopause
- Some medications
Many women are embarrassed to talk to their doctor about bladder weakness or are unsure about 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. Bladder weakness can be diagnosed by a number of different methods:
|Diagnostic approach||What to expect|
Your doctor may ask you questions about:
The physical examination will assess:
|Urodynamics||A test of bladder function including asking you to fill and empty your bladder.|
|Bladder ultrasound||An ultrasound is used to measure any leftover urine in the bladder after passing urine.|
|Midstream urine test||You may need to provide a urine specimen to check for, and exclude, bladder infection.|
Preventing & managing
You can prevent and manage incontinence with a number of simple dietary and lifestyle actions.
|Water||Drink 6-8 glasses of water per day (more if the weather is hot or if you are exercising) because not drinking enough water makes stools hard, dry and difficult to pass, which increases the strain on the pelvic floor muscles.|
|Caffeine and alcohol||Cut down on caffeinated drinks, fizzy drinks and alcohol as they can worsen symptoms by making you need to urinate soon after eating or drinking.|
To avoid constipation and the strain on the pelvic floor muscles, try to eat some fibre each day:
|Physical activity||Be physically active as this stimulates movement of the bowel: aim for 30 minutes of moderate physical activity most days of the week.|
|Pelvic floor exercises||Do pelvic floor exercises regularly to strengthen your muscles.|
|Lifting||Avoid heavy lifting as this can weaken your pelvic floor; take particular care lifting weights at the gym.|
|Hormone replacement therapy||
|Continence products||Continence pads and accessories can help you feel more comfortable and help maintain your quality of life. You can discuss these products with your doctor, continence nurse, pelvic floor physiotherapist or pharmacist.|
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 January 2014.