Bladder leakage: types and NHS help

What are the types of bladder leakage?

Urinary incontinence means passing urine by accident. The NHS lists four types: stress, urge, overflow and total incontinence. In stress incontinence, leaks happen when pressure on the bladder rises, for example when coughing or laughing. Urge incontinence involves leaking after a sudden, intense need to pee. NHS inform says stress and urge incontinence are the two most common types. Mixed incontinence is a combination of stress and urge symptoms, and NICE uses this term in its guidance for women. Overflow incontinence happens when the bladder does not empty fully, so urine builds up. In total incontinence, the bladder cannot store urine at all.

What causes it?

The NHS describes different causes for each type. In stress incontinence, pressure inside the bladder rises above what the urethra, the tube that carries urine out of the body, can hold closed. Weakened or damaged pelvic floor muscles and urethral sphincter muscles are the usual underlying problem. Urge incontinence is usually linked to overactive detrusor muscles, which control the bladder. The NHS lists triggers for urge symptoms including alcohol, caffeine, constipation, bladder or urinary tract infections, bladder tumours and neurological conditions. Overflow incontinence usually follows a blockage in the bladder. It can also happen when the detrusor muscle does not contract fully, so the bladder never empties completely. Possible causes of total incontinence include a problem present from birth, a spinal injury, or a fistula, which is a small tunnel-like connection between the bladder and a nearby area.

Risk factors and seeing a GP

The NHS lists pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age as factors that raise the risk, without necessarily causing it directly. It also says incontinence is not an inevitable part of ageing. The NHS says a GP usually diagnoses urinary incontinence after a consultation. The GP may suggest a diary in which a person notes how much fluid they drink and how often they pass urine. NICE guidance for women also advises bladder diaries in the initial assessment of women with urinary incontinence or overactive bladder.

What can be done about it?

The NHS says treatments that do not involve medicines or surgery are usually tried first. These include lifestyle changes, pelvic floor muscle training and bladder training. Medicines or surgery are considered afterwards, depending on the cause and type of incontinence. The NHS advises cutting back on caffeine and alcohol. It also says that treating constipation matters, because straining to poo weakens the pelvic floor muscles and makes urinary incontinence worse. Pelvic floor muscle training is a programme of exercises to strengthen the muscles that support the bladder. NHS inform says that pads are not a treatment for urinary incontinence, but they may be helpful while waiting for an assessment or for a treatment to start working. The NHS says pads and pants are widely sold, and that it may be possible to get incontinence products on the NHS, depending on the local integrated care board.

What about surgery?

NHS inform says that if other treatments have been unsuitable or unsuccessful, a doctor may discuss surgery, and the choice depends on the cause and type of incontinence. For stress incontinence, it describes urethral bulking agents as a less invasive surgical option. For urge incontinence, the NHS lists sacral nerve stimulation. The NHS also says that at the moment it may not be possible to have vaginal mesh surgery for urinary incontinence on the NHS.

What does NICE say about women with incontinence?

NICE has guidance called urinary incontinence and pelvic organ prolapse in women: management. At the first assessment, it asks clinicians to categorise the incontinence as stress, mixed, or urgency or overactive bladder. For mixed incontinence, it says treatment should be directed towards the predominant symptom. NICE says duloxetine, a medicine, should not be used as a first-line treatment for women whose main problem is stress incontinence. NICE advises against offering absorbent containment products, hand-held urinals or toileting aids to treat incontinence. It says such products are considered for long-term management only after treatment options have been explored. NICE also says devices placed inside the vagina or urethra should not be used for routine management.

When should someone get urgent help?

New bladder leaking or difficulty passing urine, together with low back or leg pain or numbness around the bottom or genitals, can be signs of cauda equina syndrome. An NHS Scotland patient leaflet says anyone with a combination of these symptoms should go to the local emergency department (A&E) immediately. An NHS Scotland guideline says all suspected cases should be managed as an emergency. Blood in the urine is a different matter. The NHS lists blood in the pee, which may look bright pink, red or dark brown, among the reasons to ask for an urgent GP appointment or get help from NHS 111. It says this on its pages about urinary tract infections and kidney infection. For leaks without these signs, the NHS describes a GP as the person who usually makes the diagnosis.