Urinary Incontinence: Types, Causes and What Helps

Urinary incontinence means leaking urine when you do not mean to. The two most common types are stress incontinence, when you cough or laugh, and urge incontinence, with sudden strong urges to go. It is very common, above all after childbirth and the menopause. It nearly always gets better with pelvic floor exercises and a few habit changes. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280).

What are the types of urinary incontinence?

• Stress: urine leaks when pressure on the bladder rises, as when you cough, laugh, sneeze, jump or lift. The cause is a weak pelvic floor or bladder outlet.
• Urge: you get a sudden, strong need to pee and leak before you reach the toilet. It is often due to an overactive bladder.
• Mixed: both of the above.
• Overflow: the bladder does not empty fully, so it dribbles often. It is more common in men with a large prostate.
• Total or functional: the bladder cannot store urine, or the person cannot reach the toilet in time because of mobility or memory problems.

What causes urinary incontinence?

• Pregnancy and vaginal birth.
• The menopause, as oestrogen levels fall.
• Being overweight.
• Long-term constipation, or a long-term cough, for example from smoking.
• A large prostate, or prostate surgery, in men.
• Urine infections, which can cause sudden leaks.
• Some medicines, such as water tablets (diuretics) or sedatives.
• Nerve conditions, such as stroke, multiple sclerosis or Parkinson's.
• Family history and older age.

What can I do at home?

• Pelvic floor exercises (Kegels): squeeze the muscles you would use to stop peeing or hold in wind. Hold for a few seconds, then relax. Do them every day. You notice results after a few months of steady practice.
• Bladder training: slowly stretch the time between feeling the urge and going, so your bladder holds more.
• Less caffeine and alcohol: coffee, tea, cola and alcohol irritate the bladder.
• Do not drink less in the day: strong urine irritates more. Spread your drinks out and only cut back late in the evening.
• Weight and constipation: losing extra weight and avoiding constipation take pressure off the bladder.
• Bladder diary: for a few days, write down what you drink, when you pee and when you leak. This helps your doctor a lot.

What treatments are there?

• Pelvic floor physio with a trained physiotherapist, who checks you do the exercises right.
• Medicines for an overactive bladder, if habit changes are not enough. Your doctor picks one to suit your age and health.
• Vaginal oestrogen for some women after the menopause.
• Pessaries and other devices.
• Surgery, such as a sling for stress incontinence, when other things have not worked.

Why do I get up at night to pee? (nocturia)

Getting up once a night can be normal. Getting up twice or more is called nocturia (nicturia in Spanish). Common causes:

• drinking a lot in the evening, or coffee or alcohol with dinner;
• a urine infection;
• a large prostate in men;
• pregnancy;
• diabetes, heart failure, kidney disease or swollen ankles;
• water tablets taken late in the day;
• sleep apnoea.

If you get up often, it is worth a check, and sometimes a blood and urine test.

What about incontinence in men?

In men it is often linked to the prostate. A large prostate can cause a weak flow, dribbling at the end, a frequent need to go and nocturia. Leaks are also common after prostate surgery. They usually improve with pelvic floor exercises.

Could it be a urine infection?

Yes. If leaks start suddenly with stinging, a constant urge or cloudy urine, it may be cystitis. Read what white blood cells in urine mean.

What do I ask for in Spain?

In Spanish, incontinence is incontinencia urinaria, pelvic floor is suelo pélvico and a pelvic floor physio is a fisioterapeuta de suelo pélvico. Pads are sold in pharmacies and supermarkets as compresas or absorbentes para incontinencia.

When to see a doctor

• Any leaking that bothers you. It is common and can be treated.
• You see blood in your urine.
• Peeing hurts or stings, or you have a fever.
• It is hard to start peeing, or your bladder never feels empty.
• You get up twice or more every night.

When to go to A&E or call 112

• You cannot pee, and your lower tummy is swollen and painful.
• Leaks start suddenly with back pain, weak legs, or numbness between the legs or around the bottom.
• High fever with shivers and pain in your side.
• Sudden weakness on one side, a drooping face or trouble speaking: call 112.

Frequently asked questions about urinary incontinence

Getting a medical assessment

If you leak urine or get up a lot at night, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about urine infections and the menopause. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.