Urinary incontinence

Urinary incontinence (UI) is the involuntary leakage of urine caused by a disturbance in the normal storage and holding of urine. Continence (the ability to hold urine) depends on the coordinated function of the bladder, urethra, sphincters, pelvic floor muscles and nervous system. Incontinence occurs when the closing mechanism is weakened, the bladder contracts involuntarily or bladder emptying is impaired.

Urinary incontinence is a common problem in both sexes, but it occurs more often in women than in men, mainly due to pregnancy, childbirth and changes in the pelvic floor. It becomes more common with age, but it is not an inevitable part of ageing.

Stress incontinence – urine leaks when coughing, sneezing, laughing, during physical effort or when lifting loads. In women it is often linked to a weakened pelvic floor, while in men it may occur mainly after prostate surgery.

Urge incontinence – a sudden, strong urge to urinate followed by involuntary leakage of urine. It is often associated with an overactive bladder.

Mixed incontinence – combines the features of stress and urge incontinence.

Overflow incontinence – occurs when the bladder does not empty completely and becomes overfilled. The cause may be an obstruction to urine outflow or a reduced ability of the bladder to contract.

Functional incontinence – leakage occurs mainly because reduced mobility or other functional limitations prevent the person from reaching the toilet in time

Incontinence can be mild, moderate or severe. In some patients it occurs only occasionally and in small amounts, while in others leakage is more frequent and requires protective aids.

Often more important than the amount of urine is how much it affects a person's life. Leakage can gradually lead to limiting sports and social activities, travel, intimacy and everyday life. Incontinence is therefore not just a physical problem; it can also cause psychological distress and limit social activities. Because of its significant impact on quality of life, it is important that incontinence is not seen as a normal part of ageing or childbirth, but as a medical condition that can be properly diagnosed and treated.

Diagnosis is based on determining the type of incontinence, its cause, the severity of symptoms and their impact on quality of life, and is tailored to each patient. The basic diagnostic steps include a detailed medical history, usually complemented by a questionnaire assessing symptoms and quality of life, a clinical examination and urine analysis; women are also referred to a gynaecologist. Patients then keep a 3-day bladder diary to assess their voiding pattern, fluid intake and leakage episodes. If stress incontinence is suspected, we also perform a cough test. If needed, we carry out an ultrasound measurement of post-void residual urine, uroflowmetry and urinary tract ultrasound or a pad test. More complex or unclear cases may require further tests such as urodynamics, cystoscopy or extended imaging.

The aim of diagnosis is not only to confirm that urine leaks, but above all to understand why, because treatment differs depending on the type of incontinence.

Urinary incontinence is common in women, and more than half of all women experience it at least once in their lives. It can occur at different stages of life; most often it is stress urinary incontinence. With age, mixed or urge urinary incontinence becomes increasingly common, usually as part of the overactive bladder (OAB) syndrome, and most often the cause is multifactorial.

Treatment starts with pelvic floor exercises (Kegel exercises), bladder training and lifestyle changes (weight loss, treating a chronic cough). Stress urinary incontinence is managed by urogynaecologists, who also offer surgery if conservative treatment fails. If conservative treatment of urge urinary incontinence fails, the urologist prescribes medication (anticholinergics or β3 agonists); other options include botulinum toxin A injections into the bladder, tibial nerve stimulation or sacral neuromodulation.

Treatment of male urinary incontinence depends on its cause, type and severity. We start with measures tailored to the individual, in which pelvic floor muscle training, changes in daily habits and treatment of associated lower urinary tract disorders play an important role. For urge incontinence, medication (anticholinergics or β3 agonists) can be used alongside behavioural measures and bladder training, and for persistent problems also modern methods such as botulinum toxin and neuromodulation. For stress urinary incontinence, especially after prostate surgery, surgery is possible if the problem persists. Depending on the degree of incontinence, a male sling or an artificial urinary sphincter (AMS 700) may be considered.

Various discreet medical aids are also available to help manage leakage and make everyday life easier: absorbent pads and pants, condom catheters with a urine bag, penile clamps and, for bladder emptying disorders, intermittent or indwelling catheterisation.

Kegel exercises, or pelvic floor muscle training, are an important part of conservative treatment, especially for stress urinary incontinence. It is important to do the exercises regularly and correctly. Bladder control usually improves gradually over a few weeks to months.

How to do the exercises? – when you start, first identify the pelvic floor muscles correctly – it feels like holding in urine and wind, but do not do the exercises while urinating.

• squeeze the muscles and lift them upwards,
• hold for about 5–10 seconds,
• then relax them completely,
• repeat 8–12 times, 3 times a day,
• gradually increase the length of each squeeze and add a few quick squeezes.