You may think that if you have leakage of urine then you just have to put up with the problem, and perhaps spend a fortune on pads. This is not generally true.
Decide What Type of Incontinence You Have
First, decide what type of incontinence you have. It is helpful to work out whether you have stress incontinence or urgency incontinence, or both, because they have different treatments. There are some simple questions to ask yourself in our types of urinary incontinence section.
What You Can Do for Stress Incontinence
If you have stress incontinence, there is a lot you can do to help yourself:
Check whether you are taking an alpha-blocker for raised blood pressure (hypertension). Alpha-blockers can cause stress incontinence, and your doctor could probably prescribe a different type of blood pressure medication instead.
Lose weight. Being overweight puts stress on your pelvic floor muscles and losing weight can reduce leakage by 60%.
Squeeze before you sneeze. Just before you cough or sneeze, or before any activity that causes you to leak urine, tighten your pelvic floor muscles and hold them tight during that activity to prevent leakage.
Strengthen your pelvic floor muscles with pelvic floor exercises or vaginal cones. Pelvic floor exercises are especially useful for stress incontinence and can reduce episodes of leakage by 50%. You may have to do them for a few months before you notice any improvement, so patience is essential. Ideally, these should be taught by a continence adviser, a nurse or physical therapist who specializes in the field of incontinence. It is important that you learn to do them correctly. One advantage is that they are invisible, so you can do them at any time: at bus stops, in the supermarket queue or while talking on the phone! Once you have learned to tighten your pelvic floor muscles, you can squeeze them and hold when you sneeze, lift or jump. This will protect them from more damage.
Learning pelvic floor exercises
- Stand, sit or lie with your knees slightly apart (sitting is easiest). Now imagine that you are trying to stop yourself passing wind from the back passage; to do this, you must tighten the muscles around the back passage. Squeeze and lift those muscles as if you really do have wind: you should be able to feel the muscles move and the skin round the back passage tightening. Your stomach, legs and buttocks should not move at all
Checking you are contracting the pelvic floor correctly
- If you are unsure you are exercising the right muscles, put one or two fingers in the vagina and try the exercise to check. You should feel a gentle squeeze if you are exercising the pelvic floor. A common mistake is to just clench your buttocks and hold your breath; if you cannot hold a conversation at the same time, you are doing the exercises wrongly. Counting aloud while you do the exercises will stop you holding your breath. Do not tighten the tummy, thigh or buttock muscles or cross your legs. Only use your pelvic floor muscles
- Using a mirror, check that the area between the vagina and back passage moves up and inwards when you contract the muscles
- Place your fingertips on the skin between your vagina and back passage. You should feel the inside lift up from your fingertips when you contract your muscles.
- Ask your sexual partner if he can feel the muscles squeezing during sexual intercourse.
Doing pelvic floor muscle exercises
- Stand, sit or lie with your knees slightly apart. Slowly tighten and pull up the pelvic floor muscles as hard as possible and hold for at least 5 seconds if you can, then relax (slow pull-up). Repeat at least five times. Now pull the muscles up quickly and tightly, then relax immediately (fast pull-up). Repeat at least five times. Do five slow and five fast exercises at least ten times every day.
Using vaginal cones
Vaginal cones are an easier way of toning up the pelvic floor, though they are not as effective as the exercises. The cones can be bought as a set consisting of several different weights with directions for using them. You insert a cone into your vagina and hold it there by contracting the pelvic muscles while you stand or walk. The cones have a rounded shape and are comfortable to use. The only problem is that it can be difficult to hold the cone in – a continence adviser or specialist can show you how to contract the correct muscles, which is similar to doing the pelvic floor muscle exercises. You should start with the cone that you can hold for 1 minute. By using it twice a day, you will find that you can gradually hold it in for longer and longer. When you can hold it for 15 minutes, progress to the next weight of cone. The aim is to use the heaviest cone in the set for 15 minutes twice a day.
Support your bladder neck to keep the bladder closed. You may find that simply inserting a large-size (super) tampon before sport or vigorous activity is all you need. (Remember to remove it afterwards.) There are some specially designed vaginal devices that do a similar job. Some women find them uncomfortable and they are not effective for everyone. If you use one, it is really important to follow the manufacturer’s instructions about removing and washing it regularly. Before buying one, get advice from a continence adviser.
What You Can Do for an Overactive Bladder
Check you don’t have an infection. Does it sting when you pass urine? If so, you probably have cystitis. See your doctor – the urge incontinence will disappear or improve when the infection is treated.
Retrain your bladder. The bladder can be retrained to hold larger amounts of urine, so that the muscle does not start to contract until you are ready. Bladder retraining (see box below) is tedious but does work, particularly for urge incontinence. There are certain things you can try to lessen urgency so that you will have more time to get to the bathroom.
- Use mental tricks to take your mind off the urge. For example, concentrate on the mental image of a tight knot in a balloon. Or distract yourself by thinking of as many words as you can beginning with the letter A, and then work your way through the alphabet. Some people find that curling their toes helps to suppress the urge.
- Some people find that sitting and taking some slow deep breaths until the urge lessens is also a helpful way to control urgency.
- Empty your bladder properly each time you pass urine. Do not hover over the toilet seat. Sit down and bend forward at the waist and take your time.
- Do pelvic floor muscle exercises. They will not cure the bladder contractions that cause the urge, but stronger pelvic floor muscles will minimize any leakages.
- Think about your fluid intake. It is natural to think that by cutting the amount you drink, you will have more control, and research backs up this idea. However, drinking too little, could worsen the problem by increasing your susceptibility to irritating bladder infections (cystitis) and encouraging the bladder to empty when it does not contain much urine. Aim to drink about 1.5 litres (3 pints) daily of all fluids (Trends in Urology, Gynaecology & Sexual Health 2009;14:10–16).
- Cut out or cut down on the amount of coffee and strong tea, because caffeine encourages overactivity of the bladder muscle. Avoid fizzy drinks, because these seem to worsen overactive bladder symptoms in some women (Trends in Urology, Gynaecology & Sexual Health 2009;14:10–16).
- Stop smoking as nicotine irritates the bladder. Smoking also causes coughing which can lead to stress incontinence.
- Eat plenty of fresh fruit, vegetables and fibre to avoid constipation, as hard stools can press on the bladder and the urethra.
- If you are overweight, lose weight. Studies have found that weight-loss programs for moderately obese women and weight-reduction surgery for morbidly obese women resulted in significant decreases in urinary incontinence (Journal of Urology 2009;182(suppl 6):S2–7).
- Carry pre-moistened wipes to clean the vulval area after leakage, to reduce any smell.
Bladder retraining drill. Bladder retraining is based on passing urine by the clock at regular intervals. If holding on is difficult, distract yourself by watching TV or making a phone call.
Days 1 and 2
Start by choosing an interval you feel fairly confident you can achieve, such as 1–2 hours.
Days 3 and 4
Increase the interval between urinating by 15 minutes.
Day 5 onwards
When you are comfortable with the extra 15 minutes, increase it again. As each interval becomes manageable, increase it again.
Seeing your doctor or continence adviser
You can ask your doctor for advice, or you can get help from a continence adviser or continence nurse specialist. These continence experts are specially trained nurses or physiotherapists. They are expert at working out what type of incontinence you have and the best way to deal with it. They can teach you how to do pelvic floor muscle exercises properly and tell you whether it is worth buying aids and devices such as vaginal cones.
Your doctor or continence adviser will also be able to check that you do not have a urinary infection or an unusual type of incontinence. For example, you might have a prolapsed womb or bladder. The doctor may wish to do a vaginal examination, inserting a speculum (like when you have a cervical smear) to check for prolapse of the womb or bladder.
If you discuss your problem with your doctor, it is quite likely that your doctor will put you in touch with a continence adviser. But you do not have to go through your doctor; you can arrange to see a continence adviser yourself. In the UK, your local Citizens Advice Bureau should be able to give you details, or you can find out more about your nearest continence advisory service from the Bladder & Bowel Foundation.
Things you can do before visiting your doctor or continence adviser. Make a urine chart (sometimes referred to as a bladder diary) for a few days before your appointment to record how your bladder is actually behaving. Get a jug (marked in millilitres or fluid ounces) that you can easily pass urine into and use it to measure how much urine you pass on each occasion. Note down the time and the volume on a chart. Make a record of the occasions when leakage occurs. Also, record on the chart how much you are drinking and when. You can print off a chart from the National Kidney and Urologic Diseases Information Clearinghouse website or the NAFC website.
Be prepared for questions: your doctor or continence adviser may ask you some of the following, so you might want to think about the answers in advance.
- When did you start having bladder trouble?
- If you have had the menopause, when did your periods stop?
- Do you have any pain or burning feeling when you pass urine?
- Do you often have a really strong urge to pass urine immediately?
- Do you leak when you cough or sneeze?
- How do you cope? Do you sometimes wear a sanitary pad because you are worried about leakage?
- How is the problem affecting your life? Do you avoid going out or doing certain activities because of bladder control problems? Are you always on the lookout for the nearest toilet?
- What medicines are you taking? Take a list with you, and include medicines you buy over the counter, as well as prescription medicines.
- Have you had any operations?
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Diane Newman
Last updated: October 2020