Health Insights · Urology
Urinary incontinence: causes and effective treatments
Around one in three women and one in ten men experience urinary incontinence, and most wait years before mentioning it. It is not an inevitable consequence of childbirth, ageing or prostate surgery. Most people improve substantially with treatment, and the first-line treatment is free.
Seek prompt assessment if you have
- blood in the urine
- inability to pass urine with a painfully full bladder
- incontinence with back pain, leg weakness or numbness around the groin — this is an emergency
- fever with loin pain, or recurrent urine infections
- a sudden change in bladder control, or a lump felt in the vagina
- incontinence with bowel leakage
New incontinence with saddle numbness, leg weakness or back pain may indicate cauda equina syndrome and needs emergency assessment within hours. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Which type
- Stress incontinence — leaking on coughing, sneezing, laughing, lifting or exercise. Caused by a weakened pelvic floor or sphincter. Commonest after childbirth and after prostate surgery.
- Urge incontinence — a sudden desperate need to go, with leakage before reaching the toilet, often with frequency and getting up at night. Caused by an overactive bladder muscle.
- Mixed — both, which is very common.
- Overflow — dribbling from a bladder that does not empty, most often in men with prostate enlargement.
- Knowing which you have matters, because the treatments are different and doing the wrong one does not help.
Most people do pelvic floor exercises wrongly
Up to half of people given verbal instructions alone contract the wrong muscles — bracing the abdomen, squeezing the buttocks or, worst, bearing down, which makes things worse. The correct action is a lift-and-squeeze inwards, as if stopping wind and stopping the flow of urine, without holding your breath or tightening your stomach, thighs or bottom. Do not practise by stopping the flow mid-stream — that is a test, not an exercise, and doing it repeatedly can interfere with normal bladder emptying.
Pelvic floor training done properly
- Find the muscles. Sitting or lying, squeeze as though stopping wind and stopping urine at the same time, and lift inwards and upwards.
- Do long holds — hold for as long as you can up to 10 seconds, rest for the same, repeat up to 10 times.
- Do short squeezes — quick, strong contractions, up to 10 times.
- Three sets a day, every day, for at least three months before judging it. Improvement usually starts at six to eight weeks.
- Add the knack — squeeze before you cough, sneeze or lift. This alone reduces leaking considerably.
A supervised programme with a pelvic health physiotherapist is substantially more effective than doing them alone, and is recommended as first-line treatment for at least three months before anything else is considered.
Bladder retraining for urgency
- Do not rush to the toilet when urgency strikes. Stop still, sit down if you can, and contract the pelvic floor quickly several times — this suppresses the bladder contraction. Wait for the urge to pass, then walk calmly.
- Gradually extend the interval between visits, by 15 minutes at a time over weeks.
- Stop going 'just in case' — it trains the bladder to hold less.
- Keep a three-day bladder diary; it is the single most useful thing to bring to an appointment.
Other measures and treatments
Helps
- Reducing caffeine, fizzy drinks and alcohol
- Drinking normally — restricting fluid concentrates urine and worsens urgency
- Treating constipation, which presses on the bladder
- Losing excess weight, which reduces stress incontinence measurably
- Stopping smoking — chronic cough drives stress leakage
Treatments available
- Vaginal oestrogen after the menopause, which helps considerably
- Medication for overactive bladder
- Botulinum toxin into the bladder for resistant urgency
- Surgical options for stress incontinence
- Containment products, which are a support rather than a solution
Why come to us. Incontinence is under-treated mostly because it is under-reported, and because pelvic floor exercises are handed out on a leaflet without anyone checking you are doing them correctly. We offer discreet assessment for women and men, urine testing and bladder scanning with ultrasound on site, referral to pelvic health physiotherapy, and urology and women's health input under one roof. Unhurried appointments, 7 days a week, and a female clinician available on request.
Private assessment for urinary incontinence in London
Bladder leakage is common and often improves markedly with the right treatment, so it is worth addressing rather than living with. A private GP in East London can identify the type of incontinence, arrange tests, and start treatment, and our private urology clinic in London and pelvic-floor physiotherapy team can help with tailored care. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Urinary incontinence in London: common questions
Can urinary incontinence be treated?
Yes — most people improve significantly with pelvic-floor training, bladder retraining, lifestyle changes and, where needed, medication or procedures.
What are the main types?
Stress incontinence (leaking on coughing or exercise) and urge incontinence (a sudden need to go) are the commonest; treatment differs.
Does physiotherapy help?
Yes — pelvic-floor physiotherapy is highly effective, especially for stress incontinence, and we offer it on site.
Do I need a referral?
No — you can start with a private GP or book urology or physiotherapy directly.
Discreet assessment, and physiotherapy that works
Ultrasound on site, female clinician available. 7 days a week.