The bladder and bladder control
Sudden urgency, leaking when you cough, frequency and passing urine at night are common, affect women and men, and are not an inevitable part of ageing.
How does the bladder work?
The bladder has two jobs: holding and emptying. While it fills, the bladder muscle stays relaxed and the valves stay shut. When the time and place are right, the valves open and the muscle contracts. A bladder control problem means one of these two jobs is not going as it should.
Types of leaking
- Stress incontinence: urine leaks when you cough, laugh or lift. The usual cause is weakness of or damage to the pelvic floor muscles and the urethral sphincter.
- Urge incontinence: a sudden, intense need to go, with leaking at the same moment or soon after. The usual cause is an overactive bladder muscle.
- Overflow incontinence: the bladder does not empty fully and urine leaks often. Something is often blocking the way out.
- Mixed: stress and urge incontinence together.
Pregnancy and vaginal birth, obesity, family history and older age make leaking more likely. Even so, leaking is not an inevitable part of ageing.
Passing urine at night
Waking once is no problem for many people. If you wake two or more times and feel tired during the day, the cause is worth finding. It can be something simple such as an evening drink, or it can come from another condition. The article “Why do I wake at night to pass urine?” explains this in more detail.
How is it assessed?
The doctor asks about your symptoms and, depending on the case, does a pelvic or rectal examination. A bladder diary helps a great deal: for a few days you note what you drink and how often you go. If needed, urodynamic tests show how much the bladder holds, how well it empties and whether it contracts when it should not.
What are the options?
Treatment starts with the simplest step:
- Changed habits: cutting down on caffeine and alcohol, adjusting how much you drink, and losing weight if you are overweight
- Pelvic floor muscle training: the usual programme is at least 8 contractions at least 3 times a day, for at least 3 months. A specialist should check that you are contracting the muscle correctly.
- Bladder training: for urge incontinence, you learn to lengthen the time between feeling the need and going. This usually takes at least 6 weeks.
- Medicine: may be suggested if these steps are not enough.
- Surgery: the method depends on the type of leaking, and it is considered when other approaches have not worked.
When to come sooner
If these symptoms come with pain, blood in the urine or fever, do not delay. If you cannot pass urine at all, go to the emergency department at once.
Frequently asked questions
If I drink less, will I leak less?
Not necessarily. Drinking too little can make things worse, just as drinking too much can. Ask your doctor what amount suits you.
Are pelvic floor exercises only for women?
No. Research shows they can benefit everyone with urinary incontinence.
Will I definitely need surgery?
Usually not as a first step. Methods without medicine or surgery are tried first, and medicine or surgery may come after that.
To begin: a clear conversation.
Go to the booking page or talk to the support team. Have your test results, scans and list of medicines ready.