Bladder incontinence

Last updated 28 March 2017 — Last reviewed 15 January 2014

Bladder incontinence, also called bladder weakness, is common. Different types of incontinence, what is normal, the causes, symptoms and how incontinence is diagnosed are discussed.

What is incontinence?

Woman needing the toiletIncontinence 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:

  • a need to pass urine often
  • an urgent desire to pass urine
  • a need to pass urine frequently during the night
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

female pelvic floorAs 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
  • Diabetes

Diagnosis

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
Medical history

Your doctor may ask you questions about:

  • how often you leak urine
  • when the leakage of urine occurs
  • whether there is any burning sensation
  • whether the bladder feels empty after urinating
  • how often you urinate during the day
  • how often you urinate during the night
  • your daily fluid intake
  • respiratory conditions that cause you to cough often
  • how often you lift heavy weights
  • any surgery that might have contributed to the symptoms
  • medications you are taking
Physical examination

The physical examination will assess:

  • the strength of your pelvic floor muscle
  • whether there is any bulging of the bladder into the vagina (prolapse)
  • whether there is any other form of prolapse
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.
Fibre

To avoid constipation and the strain on the pelvic floor muscles, try to eat some fibre each day:

  • 2 serves of fruit
  • 5 serves of vegetables
  • 5 serves of cereals/breads
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.
Coughing
  • If you smoke the chronic coughing associated with smoking can weaken your pelvic floor – for help to quit call the Quitline on 13 7848 or visit quit.org.au
  • Visit your doctor if you have ongoing respiratory problems that cause you to cough
Hormone replacement therapy
  • In some women incontinence becomes worse after menopause due to a reduction in the hormone oestrogen 
  • Sometimes the use of oestrogen therapies, either vaginally or as hormone replacement therapy (HRT), may help – speak to your doctor for more information
Toilet habits
  • Go only when you have the urge to go
  • Avoid the habit of going to the toilet 'just in case'
  • Sit down properly with your feet firmly supported to fully relax your pelvic floor and sphincter muscles
  • Don't strain
  • Don't stop the flow of urine midstream as an exercise, as this can send incorrect messages to your bladder and stop it from emptying completely
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.

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