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Incontinentia urinae
On coughing or on urgency — this one question separates two forms that are treated in opposite ways. And drinking less makes it worse, not better.
Also known as: urinary incontinence · involuntary urine loss · bladder weakness
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Involuntary loss of urine is common, well treatable and nonetheless the subject spoken about least. On average years pass before anyone raises it — usually with the thought that it is part of growing older. It is not. Decisive is the distinction between two forms, because they are treated in opposite ways. In the stress form urine is lost on coughing, sneezing, laughing or lifting, in small amounts and without a preceding urge; here the closure is too weak. In the urge form a sudden, barely postponable need arrives, often followed by larger amounts; here the bladder muscle announces itself too early. Both together are common. Before anything else happens, a look at the circumstances is worthwhile: a urine infection, constipation, blood sugar that is too high, water tablets, sedatives and, after the menopause, a dry lining are all correctable and explain a surprisingly large share. The most effective lever of all is properly guided pelvic floor training over at least three months. Drinking less does not help — it makes it worse.
The most effective lever of all — and the one most people fail at, because the exercise is done wrongly or given up too early. Guidance from a specialist doubles the chance of success.
Time, amount, urgency, what was drunk, and when something was lost. Only this sheet shows which of the two forms predominates — and that decides the treatment.
Concentrated urine irritates the bladder further and strengthens exactly the urgency. What to reduce is caffeine, alcohol and the amount late in the evening — not the daily total.
Urine infection, constipation, high blood sugar, water tablets, sedatives and sleeping pills. Going through this list once solves more cases than expected.
In the urge form it helps to put off going to the toilet deliberately by a few minutes and to lengthen the intervals over weeks. Going just in case makes the problem worse.
A low-dose local application often clearly improves urgency, burning and recurring infections. It is rarely offered unprompted — asking for it is worthwhile.
Constant dribbling in a man can be an overfull bladder overflowing — the opposite of a weak bladder. An ultrasound of the residual urine tells the two apart in two minutes.
About one woman in three and one man in ten are affected in their lifetime. On average six to seven years pass before anyone brings it up. Pelvic floor training needs three months to show an effect — and helps two in three with the stress type.
In stress incontinence there is hardly an effective drug — pelvic floor training is what works, over three to six months with daily practice; it helps about two thirds. In urge incontinence, anticholinergics damp the bladder muscle but cause a dry mouth and are questioned in older people because of the effect on thinking; mirabegron works differently and is preferable there. Botulinum toxin into the bladder wall lasts six to nine months.
Small amounts, with no urge beforehand. That is the stress form — pelvic floor training works best here.
A sudden urge on coming home, washing hands or hearing running water. That is the urge form, and it is learned — which is why it can be unlearned.
Constant dribbling can be an overfull bladder overflowing. That is the opposite of a weak bladder and needs a different treatment.
The lining of urethra and vagina grows thinner and less tight. A local treatment works well here and is often not even mentioned.
Three things that press permanently on the pelvic floor. Treating them improves the incontinence along the way, without tackling it directly.
A urine infection is the commonest passing cause and is spotted in five minutes. Blood in the urine belongs clarified independently.
Sugar that is too high drives the amount of urine and over the years damages the nerves of the bladder. The two together turn a small weakness into a large problem.
Important above all when the bladder does not empty fully. A rising value means the back pressure has reached the kidneys.
A sufficient amount of urine across the day dilutes what would otherwise crystallise or irritate. Spread evenly it works better than in two large portions.
With reduced kidney function it rises and becomes dangerous for the heart rhythm; under water tablets it falls. In both directions it belongs measured and not guessed.
Cutting out calcium is the wrong route with stones: it binds oxalate already in the bowel. Calcium with the meal instead of between meals is the lever, not avoidance.
Much salt drives calcium into the urine and so raises stone formation; it also lifts the blood pressure that strains the kidneys. Most of it sits in bread, cheese and ready meals.
Traditionally used; the studies are small and open-label. What works measurably is pelvic floor training over at least 3 months — with stress incontinence the measure with the best numbers of all.
Less caffeine measurably reduces urgency and leakage. Anyone drinking less out of worry about leaking makes it worse — concentrated urine irritates the bladder further.
After the menopause the tissue of urethra and vagina thins — one of the reasons the trouble increases then.
Drinking less gives concentrated urine that irritates more. 1.5–2 litres over the day, little in the two hours before sleep, is the usual approach.
In controlled trials losing 5–10 % of body weight halved the number of episodes — comparable with pelvic floor training.
Pelvic floor training is the first-line treatment in stress incontinence, before any procedure.