Bladder control problems (urinary incontinence) Mate tōngāmimi

Types of urinary incontinence include:

• stress incontinence — this is leaking wee when you cough, sneeze, laugh or exercise
• urge incontinence — this is when you have a sudden, strong urge to wee, followed by accidentally leaking wee
• overflow incontinence — this is a constant dribbling of wee
• total incontinence — this is when your bladder cannot store wee at all.

You may have more than one type. For example, you might have both stress and urge incontinence.

Stress incontinence

Stress incontinence is caused by damage to your pelvic floor muscles, ligaments and tissues. Pelvic floor muscles run from your pubic bone to your tailbone and support your pelvic organs. The damage can be due to:

• childbirth, particularly a vaginal birth
• pregnancy
• obesity.

Urge incontinence

Urge incontinence is caused by overactive bladder muscles, which may be due to:

• a neurological (brain and nerve) condition such as a stroke or multiple sclerosis
• a urinary tract infection or painful bladder problem
• overactive bladder
• ageing.

Overflow incontinence

Overflow incontinence happens when your bladder does not empty completely. This can be due an obstruction affecting the flow of wee, such as:

• an enlarged prostate gland
• constipation.

Continuous incontinence

Continuous (total) incontinence can be caused by:

• bladder problems you were born with
• spinal cord injury.

Treatment for urinary incontinence without using surgery includes:

• lifestyle changes
• pelvic floor muscle training
• bladder retraining
• medicines.

Lifestyle changes

• Avoid or reduce your caffeine intake — it increases the amount of wee your body makes. Limit drinks containing caffeine to 2 or 3 cups a day. Caffeine is in coffee, tea, energy drinks and cola drinks.
• Space your drinks throughout the day.
• Avoid drinking too much before bedtime.
• Stay a healthy body weight.

Pelvic floor muscle training

Pelvic floor exercises can help you retrain and strengthen weak or damaged pelvic floor muscles.

Bladder retraining

Bladder retraining aims to:

• improve your bladder control
• teach your bladder muscles to increase the amount of wee your bladder can hold
• reduce the number of times you have to have a wee.

Bladder retraining does not happen quickly. But over time, you should be able to control your bladder.

You may do bladder training and pelvic floor muscle training at the same time.

It is often useful to complete a bladder diary. A bladder diary records:

• when and how much you drink
• when and how much wee you pass.

If you are drinking enough, you can expect to go to the toilet 6 to 8 times a day.

Bladder retraining involves setting times when you want to wee. You then gradually increase the intervals between weeing. This results in reducing the number of times you wee in a day.

Steps to control your bladder

• Avoid too much caffeine as it can increase the amount of wee your body makes.
• Limit caffeinated drinks to 2 to 3 cups per day. Caffeine is in coffee, tea, energy drinks and cola.
• Space your drinks throughout the day.
• Avoid drinking too much before bedtime
• Avoid going to the toilet 'just in case'.

Steps to control your urgency

When you feel a sudden strong urge to wee, try to delay going straight away. Try to hold on for one minute at first. Then gradually increase this by a few minutes according to your ability. Over time, your bladder should learn to hold more wee. This will be a gradual process. The following techniques may help:

• try to stay calm and still and wait until the urgency feeling lessens (it may take a few minutes) — slow, deep breaths may help keep you calm
• do pelvic floor exercises
• mental distractions may help, for example, counting backwards or in multiples, reading or talking
• physical distractions may also help, for example, sitting straight and clenching your fists or crossing your legs, pushing the ball of your foot hard onto the floor, sitting down on a firm chair or the edge of a seat.

When the urgency feeling goes away, either:

• continue what you were doing
• walk calmly and slowly to the toilet.

Practise these steps every time you feel a sudden urge to wee.

After 3 months, if these steps are not helping, speak to your healthcare provider.

Medicines

If your symptoms continue, medicines may help your bladder control problems. The medicines should reduce your urge to wee as well as how often you wee.

Medicines used for bladder control problems include:

• oxybutynin
• solifenacin
• vaginal oestrogen, for postmenopausal women
• doxazosin, tamsulosin and finasteride for an enlarged prostate gland.

If you have urge incontinence, your healthcare provider or pharmacist may check all of your current medicines. Some of them could make urinary incontinence worse and you may be able to use alternatives.

If non-surgical treatments do not help, your healthcare provider may refer you to see a specialist.

If you have urge incontinence, you may be offered Botox injections to the bladder.

There are several types of surgery that might help treat bladder control problems.