Leaking urine, or urinary incontinence, is common, and it becomes more likely as you age and after childbirth. It may affect your comfort and confidence, along with your freedom to take part in everyday activities, such as exercise or laughing with friends.
Sadly, many women live with it for years before seeking help, often assuming it is a normal part of ageing or something they cannot change. Neither is true, as bladder symptoms can be investigated and improved.
The first step is understanding which type of incontinence you are experiencing, or if you have mixed incontinence. Stress incontinence and urge incontinence are quite distinct, though some women experience a mixed picture. This article explains how they differ and what tends to cause each one. It describes the treatments a specialist can recommend, and it also recommends the specialist who is best placed to help, as bladder symptoms in women often overlap with pelvic floor and gynaecological concerns.
How do stress and urge incontinence differ?
Stress incontinence occurs when the intra-abdominal pressure rises on the bladder, such as when you cough, sneeze, laugh, exercise or lift something heavy. Urge incontinence is a sudden and intense need to pass urine that is difficult to hold, and leaking can happen before you reach the toilet. It is often linked to an overactive bladder, where the bladder muscle contracts before the bladder is full. Many women have symptoms of both together, which is known as mixed incontinence.
What does stress incontinence feel like?
The tell-tale sign is a small leak at moments of physical effort. Coughing, sneezing, laughing, exercise, and lifting something with a bit more weight can all bring it on, as each raises the pressure inside your abdomen. This happens when the pelvic floor support and the muscles around the bladder outlet are weakened. Pregnancy and vaginal birth are common contributors, as is being overweight, and the likelihood tends to increase with age. Lower hormone levels after the menopause can also contribute to stress incontinence.
What does urge incontinence feel like?
Urgency is the defining symptom, a sudden need to pass urine that arrives without much warning. When a leak does happen, it can be larger than the small leaks typical of stress incontinence, particularly when urge incontinence is more severe. You may also find yourself going to the toilet more often than usual, and waking in the night to pass urine. Sometimes no clear cause is found at all. In other cases it can be linked to bladder irritation or a urinary infection, and some neurological conditions can also cause it. An overactive bladder can affect women of any age, and it is not simply a consequence of getting older.
Can you have both types at once?
Yes, and it is common to have both. Mixed incontinence means you have symptoms of both stress and urge incontinence at the same time. National guidance advises directing treatment towards whichever symptom troubles you most to begin with.
How are stress and urge incontinence treated?
The first steps in treatment are conservative, meaning non-surgical, and they help many women. For stress incontinence, supervised pelvic floor muscle training for at least three months is the recommended starting point. For urgency and mixed incontinence, bladder training for at least six weeks comes first, often alongside lifestyle measures such as reducing caffeine and reviewing how much you drink. Where your BMI is above 30, losing some weight may also be suggested, though BMI is only a rough guide, as it cannot distinguish muscle from fat.
If these steps do not settle the symptoms, medicines for an overactive bladder can be considered, and a specialist will discuss whether they suit you. For postmenopausal women with vaginal dryness, a topical vaginal oestrogen may be offered for overactive bladder symptoms. Surgery is usually considered later, once non-surgical options have been tried. Where a prolapse is contributing to symptoms such as incomplete bladder emptying, surgery to repair the prolapse may also be discussed. Before any operation, the benefits and risks are talked through in full, and the alternatives are explained.
Who should you see: a gynaecologist, a urologist or your GP?
Bladder symptoms in women can be assessed by more than one specialist, and the right choice depends on your symptoms. National guidance describes multidisciplinary teams that bring gynaecology and urology together with specialist continence services, as these conditions often overlap. A gynaecologist focuses on the female pelvic floor and reproductive organs, so this can suit women whose bladder symptoms sit alongside pelvic floor weakness or prolapse, including changes after childbirth, as these are assessed together.
On the NHS, care usually begins with your GP or a continence service, with referral to a specialist if the first steps do not help, or sooner where there are concerns such as blood in the urine or ongoing pain. In private practice, a woman can arrange a specialist assessment directly.
Mr Nicholas Morris is a Consultant Gynaecologist who assesses bladder symptoms in women, alongside related pelvic floor and prolapse concerns. He explains which type of incontinence is present and talks through the likely cause. He then sets out the options, including conservative care and, where appropriate, surgery.
When should you see someone about bladder leaks?
Bladder leaks are common, yet they are not something you simply have to accept. Arranging an assessment is worthwhile if leaks affect your daily life or your confidence. Seek advice promptly if you notice blood in your urine or have repeated urinary infections, as these need checking sooner. Ongoing pain in the bladder area should also be checked without delay.
Mr Morris offers consultations in person and online, usually available within 24 to 48 hours. Call 020 8371 1510 or email secretary@rapidaccessgynaecology.co.uk to book.
Frequently asked questions
Does incontinence go away on its own?
Milder symptoms can improve with pelvic floor exercises and lifestyle changes, though persistent leaking benefits from proper assessment.
Do I need surgery?
Usually not as a first step, as conservative treatments are recommended before surgery is considered.
Can a gynaecologist help with bladder problems?
Yes, particularly when bladder symptoms occur alongside pelvic floor weakness or prolapse, as these are examined and managed together.